Donna:
I will be very interested in the feedback you get on the monitoring of newborns.
Here in Puerto Rico  I have a lot of problems as a hospital LC as there are very
few UN-medicated deliveries.  In fact, I was thrilled to have two yesterday -
both breastfed wonderfully.  I was able to wrest them away from the Nursery to
breastfeed before they were bathed and they were lovely to watch...

However, my usual is medicated deliveries, c/s with epidurals.

What are the LactNetters suggestions to get these babies to the breast?
How to handle uncoordinated sucks?
When to intervene with fluids?
What fluids?
By what method?

I have been doing the following:
1. Skin to skin contact, unwrap babies, keep "the cafeteria open" and encourage
football hold as babies in that position seem to stay awake longer.
2. Moms are encouraged to have rooming-in ( very difficult sell, as MD's tell
them they need their rest).
3. No internal mouth contact by bottles, pacifiers OR my finger unless
attachment has been impossible for 24 hours, then I do a suck check.  In fact,
lately I haven't needed to do this as often.  Babies who make a noise when I try
to attach them to the breast (a sound similar to blowing on a balloon that is
too full) I find have the uncoordinated tongue with a "nipple confusion"-like
tongue movement.  This is so even in babies who have had NO bottles - some have
sucked their fist,  lower lip, tongue or finger 'in utero', others not.
4. I give glucose at the end of the shift during the 1st 24 hours if moms report
no attachment during the shift, and use cup feeding for those babies who showed
no problem with uncoordinated tongues and syringe-suck training for those who
do.  If I don't do this, bottles will be given by the next shift of nurses.

[I realize that ideally moms have started pumping so I could give the babies
their colostrum, but with the cost of pumps and the small amount of colostrum
that can be removed from these very medicated moms, glucose is usually the best
I can do.]

5. Then -  at 48 hours, often with little or no effective sucking, moms are
going home.  I try to teach cup-feeding, but with the large number of
deliveries, and now we have almost 80% of the moms wanting to breastfeed, what
to do?

I hope to institute a phone-call follow up of all moms - this is not yet
possible.  Moms are given a questionnaire and are asked to call if they answer
"no" to any of the questions.  LLL and our telephone number are provided.

I realize the ultimate goal is to reduce the medications of labor - but what to
do in the meantime?

Feedback appreciated!

Jeanette Panchula, BSW,LLL, IBCLC, RN  Puerto Rico
Beach time tomorrow!!!