Becky, I second adding circs to the red flag list. At the hospital I worked at
as an independent LC in Atlanta, we would get called by the nurses to come in
and handle the cases they couldn't. (The nursing staff there was very good and
could help most moms get bf off to a decent start.) Too often we would arrive
only to find out that the baby had just been circ'd and had effectively shut
down for the day.

We taught bf classes at this same hospital and made a point of warning the
prenatals that if the baby was circ'd then they could count on him sleeping for
quite a while and not be interested in bf or much of anything else. We tried to
steer clear of making any pronouncements as to WHETHER to circ, and instead just
tried to prepare them for typical behaviors is they DID have baby circ'd.

With some of these babies, if they slept so long that it went passed the
hospital protocol for blood sugar testing, then they would be force fed
(thankfully either by cup or fingerfeeding and not by bottle) whatever was
available. If by some wild chance the mother had been encouraged to pump and had
milk, they used that. Otherwise they would use formula, which in turn would make
the baby sleep soundly for hours and have little interest in bf or anything
else. And, mom gets used the idea that baby is supposed to sleep for four hours
at a time and so is shocked when the reality of infant feeding (a la breastmilk)
hits. Rather than questioning why baby slept so soundly with formula, they would
question their own ability to make enough milk. It all goes back to whether you
look at bf as the gold standard to which formula must be compared or the other
way around.

And the view from the soap box is lovely this time of day.....

Melissa Vickers, IBCLC
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