I am at Kaiser Hospital in San Francisco, which has had 24 hour rooming in almost since it was built -- for a while there was a "night" nursery, that mom's
could send their babies to, but we got rid of that in about 1979.  We were also
promoting breast feeding, even in those dark ages.

One of the first amazing unexpected side-effects -- babies had significantly
decreased incidences of jaundice.  No one could explain why!  Of course,
we understand now that it increased breast feeding, if infants were right there,
but also, importantly, it decreased the amount of D5W being given to babies
as "tide over" feeds.

We do try to get babies into mom's arms immediately after birth, but
as "friendly" as we are, individual nurses have not learned the importance of
certain things -- even I was guilty (until I took Karin aand Edith's course last
September),  of borrowing babies to do measurements and txs (in mom's room,
though) while mom went through mini-sleep phases, difficult epis. repairs, etc.
And I lash myself in retrospect, but also have moved on to encouraging even
those moms and dads to hold their babies, and offer them the breast.

I hear:  Oh, I'm too weak (tired, shakey).  Or the husband says she needs to rest.  And I agree with mom and dad (or others) that she is weak, tired, or shakey, then I put baby (from the perineum, barring pedi problems or severe
maternal problems) unwrapped into mom's arms.  I encourage dad or others
to help her hold and touch her baby, and suggest that holding the baby may be
the panacea for all those woes:  lends strength, re-energizes, gives a focal point
away from the shakes.  

I also remind them that the baby has been attached for nine months, give or take, and needs some time to adjust to separation, and now attach in a new way.  This seems to make sense to most families, regardless of age of mom or
cultural background.
 
With my co-workers I have been teaching by example and annecdote, and
refer to films, articles, etc.  We are fortunate to have many nurses who have
recently taken LC certification classes and have sat, or will be sitting for exams,
and we support each other, as we encourage our more reluctant co-workers to
drop their old ways.

But:  and isn't there always a but.  We also have to allow families to make their
own decisions.  And supportive as we are, and as high a start rate as we have,
1)  when babies are slow to latch, mom's want to supplement;  2)  when nipples
are sore, mom's want to take breaks rather than look for ways to correct the
soreness; 3) when baby wants to nurse all night long, mom requests a pacifier; and 4) mom's from some cultures have definitie ideas about how breast feeding
is accomplished, and spurn our teaching, even when breast feeding isn't working "their way".

And we know that after they leave the hospital, they are probably going to do 
what they want to do once they leave the hospital, anyway.

Someone has asked -- so why if this is the best, cheapest way to provide infant
nutrition, isn't it 100%.  We are battling tradition: mom's own family and cultural
expectations as well as our society's practices and politics.  We are fighting not
only governments, formula company's, old (uniformed) medical opinions, hospital
administrators, etc., but often our own couplet's baggage as well.  And it is difficult to teach were minds are unreceptive or ambivalent.

I was lucky.  I had my premie 24 years ago in San Francisco -- a time when
mom's here were already reclaiming the birthing process and breast-feeding as
a way of life, and even my NICU was instrumental in promoting our breast feeding. In my youth, I was happy to be involved in teaching via the ripple effect.  Now I am happy to be part of a much larger group of people, working on a global
scale.  

Yours, for a breast feeding world.

Chanita, still in San Francisco.