Regarding pumping soon after delivery if the baby is not latching on,
I have noticed the following items. If mother and baby are separated
early pumping seems more important for a full supply later on.  If
the mother and baby are together with the baby nuzzling and licking
the breast and getting some skin-to-skin contact it doesn't seem to
be as critical. Involution in a mother who is not nursing (ie bottle
feeding) occurs pretty quickly after birth.  In fact, women are
offended if it doesn't happen quickly.  If the baby is not nursing
and mother is not pumping, some involution will take place as there
is no signal to the supply and demand system to supply. Also, if
there is no signal to supply, milk may come in slower setting up a
negative calorie cycle, baby doesn't eat enough, doesn't stool enough.
 gets a little jaundice, gets a little sleepy, doesn't feed well,
sleeps more, doesn't have enough calories to wake and feed vigorously,
 gets a little more jaundice, gets a little sleepier, doesn't feed
well etc.  If mom's supply has been stimulated when baby finally
latches on, breastfeeding seems to work better.  I am an advocate of
manual expression instead of the pump.  It is low cost, easily
accessible, portable and does a good job of stimulating production.
If a mother doesn't want to express manually, a pump is a good
alternative. In situations where it has taken the baby several days
to finally latch on and mothers have not been removing milk on a
regular basis, they sometimes have difficulty building and
maintaining an adequate supply for exclusive breastfeeding.

As a member of the global breastfeeding community, I support UNICEF
programs and initiatives protecting the health of young children
around the world. This includes the GOBI program which encourages
growth monitoring , oral rehydration, breastfeeding and immunizations
to protect the health of children  all over the world.  I think we
have a responsibility to the global community to serve as role models
and advocates for ALL of these identified areas and not just the one
we have a personal interest in.

Cathy Liles, IBCLC
College Station, TX