It seems to me that we're so far from anything normal in our childbirth
practices that the patterns of breastfeeding, weight gain, engorgement,
lactogenesis, etc., are difficult to assess.

A speaker at a conference once recounted her experiences travelling in Africa
and observing breastfeeding.  She said that the babies are at the breast
almost constantly during the first day and the milk comes in around 24 hours.
 Anyone have any experience to back this up?  There are certainly many babies
I see who do not nurse at all in the first 24 hours, despite our best
efforts.  On the other hand, the babies who are frantically hungry and
wanting to nurse "all the time" until the milk is in are a real challenge to
parents and staff.  Part of it is cultural non-acceptance of this kind of
intense nursing, part of it the physical and psychological abilities of  mom
who may have had a C-section, be sleep-deprived, etc.

I am constantly baffled by the differences I see in mothers' colostrum
production - ranging from nothing at all to be expressed by any means tried
(of course, hard to reassure mom, as I always do, that "it's really in there,
just keep pumping and the milk will come",  no swallowing by baby despite
good attachment and suck - to babies who gulp at first feeding and moms who
can pump an ounce from day one!

In the discussion of when to initiate pumping, I think like most things there
are pluses and minuses and, also like most things, should be evaluated on an
individual basis.  Some moms can't deal with pumping the first day, and it
would probably be detrimental to push it.  Against this must be weighed what
I have observed - that some moms produce a copious supply despite terrible
beginnings, while with others it seems that if everything is not right from
day one, things never really take off properly.  For these latter moms, early
pumping would be beneficial, but we don't know in advance which ones they are
going to be.  Always an ongoing process of judgment, no hard and fast rules
that suit every case.  Miriam Levitt RN, IBCLC

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