>>You caught my interest on this topic because tonight I'm collecting
references to support my desire to intervene earlier as opposed to some
supportive health care practitioners who believe it is more supportive of
breastfeeding to wait and wait...  I look forward to reading more from
others<<


Natalie,
I was wondering, why you want to intervene earlier? What is "earlier" and how
do you plan to intervene?

I am a hospital-based RN & IBCLC, so this really interests me. I made rounds
yesterday and encountered a 16 hr old infant who was pretty sleepy, had some
wakeful times but had not latched on to nurse. In these cases I encourage
skin-to-skin, watch for signs of mouthing and have the mom massage & express
colostrum onto baby's lips. This mom told me that the pediatrician had used
some scare tactics on her, but she wasn't buying into it just yet. (Good for
her!) I observed a feeding attempt--this baby was finally getting his mouth
open wide, so I praised those efforts & explained that the next step was
mouth open wide & tongue protruding for latch. I encourage lots of patience
and observation, telling them that it often takes little baby steps to get to
good breastfeeding. We did discuss the possibility of expressing colostrum,
mixing with d5w & feeding baby by cup or syringe if baby continued to root
but didn't latch. But baby looked good & had no risk factors. This morning on
rounds, I noted that the baby had been breastfeeding, voiding and stooling
appropriately for an infant of 40 hrs of age. The mom thanked me for
supporting her & her decision to avoid formula supplementation unless
medically indicated. This made my day! It's great to see a couple get off to
a good start without a lot of intervention.

My primary method of determining when to intervene is by assessing the baby.
Of course this is done differently by different nurses, esp depending upon
their background. NICU & peds trained nurses don't always have a good
understanding of the normal newborn in the first few days. The log that we
give to the moms to take home has the minimum number of feeds, voids & stools
for each day during the first week. It also does NOT have times or length of
feedings on it. I don't care if the baby cluster feeds & then sleeps for 6
hours, as long as he has gotten enough food as measured by the output in the
diapers. I also don't want a parent to go home thinking that it is OK for a
baby to continue to eat, void & stool as he did in the first 24 hours of life
when they are often very sleeping & getting minimal volume. I also hope that
the nursing staff becomes more familiar with the nursing log so that they
don't begin to panic when baby is 12 hrs old & hasn't eaten yet.

I look forward to more of this discussion.

Laura Hart
Winter Park, FL


Do what you can, with what you have, where you are.
-- Theodore Roosevelt

             ***********************************************
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