I find this to be a fairly common problem.  While I suspect is some
cases it relates to labor meds, I think in other cases some babies
just aren't immediately interested in eating.  After all, baby has
just been through a very traumatic experience: being squeezed
through an open that barely is large enough, then being bombarded
with bright lights (even if they are dimmed for the birth, it's
still more than baby has experienced before) and all kinds of
sounds.  I think if I had had a similar experience, I might want to
"tune the world out" for a while while I get my bearings.  I have
seen some babies that take no interest for as long as 12-24 hours.
Then if we haven't "messed them up" by trying to shove things
(including breasts)  into their mouths, they decide to eat and often
make up for the missed feedings by going on  a marathon nursing
spree.
I describe what's happening like this in taking with parents: "Baby
hasn't figured out yet that the free ride is over and (s)he now has
to "work" for food.  Up until now, nourishment came through the
belly button with no effort on baby's part.  Baby didn't agree to
this change in procedure.  As soon as (s)he has adjusted to life on
the outside, you can sometimes almost see the "light bulb" pop on
and baby says "Oh, I get it.  I'm supposed to do something about
this hungry feeling."  It might not be scientifically precise, but I
find that it helps most parents relax and watch for baby's cues.  I
suggest they keep offering every 2-3 hours until baby figures it
out, but not to get too upset if baby doesn't take them up on the
offer.
Of course it would be appropriate to assess the baby for any
abnormal reasons for the lack of interest, but barring any
indications that baby is having a problem, patience and persistance
are the key.  I find our nurses are for the most part getting more
relaxed about this, but some still keep pushing for a specific time
frame after which they have the go-ahead to intervene.  I keep
avoiding any specific times, emphasizing the importance of
evaluating each individual baby.
The more time that passes, the more likely I am to try some
interventions such as trying to get a few drops of mom's colostrum
to drip on baby's lips to see if we can spark an interest and in
some cases trying a tube at breast to provide some "instant
gratification".  When a nurse is getting panicked that baby hasn't
eaten, I encourage them to to an Accu-Check (non-lab blood sugar)
being sure to warm the heel first (I've seen that make as much as a
10 point difference).  The purpose isn't that I think baby has a
blood sugar problem (unless I see other symptoms), but that in the
vast majority of cases, the number is just fine and the nurse will
relaz and give baby more time.
One of my fellow LC's is from Australia and she reports that mom and
baby can stay as long as necessary until feeding is established.
Since we don't have that luxury (which should be a necessity), and
"not breastfeeding well" isn't a good enough reason for the powers
that be to give their blessing to a longer stay, we do want to try
to get as many feedings as possible in in that 24-48 hours so if
there are problems, we can work on them.
The major point is - each baby is unique and we have to avoid
expecting them all to fit our preconceived idea of how they should
behave.  Allowed to adjust at their own pace, nearly every baby
(unless there is some physical or physiological problem) WILL decide
to eat eventually.
Winnie Mading IBCLC

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