From:  Pat Martens IBCLC, MSc ([log in to unmask]), Winnipeg, Canada
re:  Donna Cordoba's request re breast refusal

Breast refusal is one of the most frustrating situations in the early
days! There are a few suggestions that I have found worked well in such
situations:
1. never push a baby to the breast. This is most destructive to the
relearning process
2. look at the process in terms of "baby steps". Think of breastfeeding
at the breast as consisting of several stages - baby comes to the breast
in a content way, baby latches on to the breast, baby has an effective
suck. In order for the baby to come to breast in a content way, it is
essential that this position be introduced gradually. After baby is fed
by alternate means, cuddle baby skin to skin at the breast. Then the
next day or so, feed baby using alternate means, but in a sitting
position at the side of the mom and facing the breast as closely as
possible. That way, the baby associates a position near to what is
necessary to latch, but the baby will be fed in an alternate way. This
helps baby to associate the position with food. Once again, nuzzle baby
in that position after baby is fed and content.
3. Once baby is this far, then it is time to begin introducing the
breast.  But remove baby from the situation whenever there is balking.
4. As for finger feeding - I would probably not suggest this as the
first method. The mothers I have helped have found cup feeds to be
better at the transition stage to breast. Occasional finger feeds is a
good idea to stimulate a correct suck, and it does work well when you
try to feed the baby in a "breastfeeding position". It also works well
for that first few times of latching onto the breast if you attach the
SNS to the breast and bring baby there. But be careful of finger-feeding
- it sometimes makes a baby not open wide to suck. Cup feeding has the
advantage of bringing the tongue down, and I have a theory that the lack
of sucking makes baby more eager to latch onto the breast.
5. make sure the mother has lots of help around the house during this
time. It takes a lot of emotional energy to get baby back to the breast!
6. pumping with a good electric breast pump is very important, so that
the milk supply is sufficient when baby does relatch
7. expect several days of slight fussiness even after baby does latch.
The first day, I sometimes see only a few feeds going well. This seems
to increase gradually, until breastfeeding "takes off" - this is very
individual.
8. I expect the gassiness is due to lack of calories, and not passing
the meconium stool. Baby must be getting sufficient intake for baby's
age, whether expressed milk or ABM. Hopefully, if pumping is going well,
baby will be fed the breastmilk.
9. GOOD LUCK! This is a slow, patience-building process. In my own
experience, I have seen about 80% of the babies "return to
breastfeeding", but it varies from a day to a week of working at it.
Looking at the process as "baby steps" really helps, plus someone like
you being the cheering squad as well as the reassurance that the weight
gain and output is appropriate.

pat martens (outside is a roaring blizzard, with zero visibility! Can
you believe it's spring??)