> Example: a woman who's had a
>medicated birth, with a sleepy baby who might nuzzle, mooch around, take a
>couple of sucks, & conk out. Is this a "normal" situation? Well, in pure
>terms, probably not - but in practice, there it is and we see it every day.

Yes, and that's pretty common here, too.

>So we make sure the baby's getting fed, we put mom & baby to bed, we share
>with her about lots of skin-to-skin & the importance of cuddling her babe,
>etc., etc.

Well, I wish that was more commonly done by midwives - it *is* happening in
the best places here,  but bedding in and sharing all this good info is not
routinely done anywhere. How common is all of this in the US?  However, we
do have universal rooming in and encouragement to feed ad lib. Women are no
longer told their babies should 'only' feed every x hours - of course this
bad practice does still exist, but it *is* dying out, and almost everywhere
has an official line in their policies that rules it out.

This seems to be enough to avoid major engorgement, even with the
conked-out babies.  Our main gripe (among bf supporters) is that hospital
midwives still do not know how to help mothers and babies learn to
recognise  effective positioning, and women get sore and told 'there's
nothing wrong' .

> But we also tell her to express her milk, because we *know*
>('cause we see it all the time!) that the pressure exerted by too much milk
>left in her breasts will decrease her supply tomorrow or the next day, and
>we know that that causes problems both for her and for her baby.

So, Cathy, when should mothers express? I mean on which day?

I am puzzled - the mother is not going to get truly engorged before day 3,
at the very, very soonest. And by then, her baby should be coming round
from this non-feeding zonked-out state, and can be trusted to deal with the
fulness (maybe with a little gentle 'softening' of the breasts by judicious
*hand-expressing*  if they are really water-melons) .

Are mothers actually *pumping* on day 2-3?  Why is it not better, if the
baby  still shows no signs at all of getting his act together, to hand
express the colostrum directly into a cup and give to the baby? We are
talking such small quantities, why risk some of it getting stuck in the
pump parts?  Or am I missing something here?

I too would like to see mothers taught to hand express. It's just as quick,
maybe even more efficient when it's done skilfully, it's cheap (well,
free!)  and it doesn't drag breastfeeding into the consumer arena.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html