Well this is an interesting debate. I think we can all agree that, for the
most part, babies and moms should be left alone together to initiate
breastfeeding. But then again, with all the barriers and lack of support, we
LCs sometimes feel we have to give a little help. Here's a story from my
workday today:
Mom had essentially no prenatal bf information. Mom did not initiate
breastfeeding until 17 hrs of age (not unusual in my facility; mom sleeps at
nite and nurses feed the baby), at which time baby had just been
circumcised. Mom was eager to begin bf at this time and LC was eager to
facilitate this so formula would not be used again. The baby was positioned
with mom in football hold and some colostrum expressed. He licked but acted
quite sleepy. Mom and baby placed skin to skin upright between breasts and
instructed if baby roots to move into position like cross cradle. Came back
several times, mom was trying, still expressing a little bit onto lips.
Encouraged cuddling, no formula, skin to skin. Helped mom try positions a
few times but no latching occured. At about 21 hrs of age, baby still near
breast but not feeding. I suggested we spoonfeed a little colostrum which we
did, few drops. I then asked mom would she like to lie down next to baby I
would show her sidelying and see what he would do, as I have seen
non-latching babies bf in this positon when they won't in any other. (I am
wondering if I should ask mom to begin regular expression at this point, not
knowing if baby will nurse and knowing I will be off tomorrow for a
holiday). They move into sidelying and baby looks up a bit and latches
beautifully and feeds vigorously! Voila!

Moral of the story: I am not sure if I should have just left them alone or
did the intervening that I did (spoonfeed, encouraging different positions
every hour or so)???? When would the baby have initiated and would several
more hours have mattered? Would mom have used formula? (p.s. Dad was saying
the baby does not seem to want it, and she and I were trying to get Dad to
be comfortable with the watchful waiting approach). There are alot of
variables and I am just glad the baby did bf then, mom was quite happy about
it. She was very patient but yet persistent and did not give up.

Some other tidbits: I emphasize the 3 P's - positioning, patience, and
persistence when new babies don't latch. Persistence does not mean forcing
but just offering in a nice way. I also thought of an idea which I used for
this dyad: express a little colostrum onto babies fists and put hands near
mouth. Maybe the familiar hand to mouth action that baby does w/ the scent
of mom will facilitate a later latch. Not sure this had any effect today,
but it can't hurt????

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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