I'm Toni Pestro in Cincinnati, Ohio.   Not only am I a missing dot and a
lurker, but my earlier message to identify myself was lost in cyberspace.
 Oh, my.

I am an RN and an IBCLC who has happily worked with a group of pediatricians
in private practice for 12 years.  In this practice, I see all of our
breastfed infants for a visit during the first week or so of life.  Often I
have had a chance to meet with the family prenatally--especially if they are
new to the practice.  I believe that this has given me a non-problem oriented
approach to breastfeeding support.

However, about two years ago I was asked to add a new lactation hat.  That
was to help with the development of an outpatient based lactation clinic at a
suburban Cincinnati area hospital.  We offer telephone support (both to
families and professionals), inpatient consultations, outpatient
consultations and breastpump rentals.

Currently, my most frustrating area is dealing with those sleepy newborns.
 Just what is normal newborn behavior?  What is a newborn's  physiologic need
for calories and fluid?  Are we seeing normal newborns, if 90% of the babies
we see  have been exposed to maternal medications during labor?

I have really been enjoying Lactnet.  One of my favorite parts of the JHL has
always been the letters to the editor.  So, now I feel like I am in letter
heaven.

If anyone would have some thoughts/references/protocols regarding meeting the
newborn's physiologic needs during the first 24-48 hours, I would sure
appreciate them.

Toni Pestro, RN, BSN, IBCLC
wife, mother of three, Aunt Doula to my niece and nephew