<<<<My question is when it does not work, I feel the best approach is hand 
expression, allowing infant to lick or mom's finger to baby mouth. If after 24 
hours if the baby is still not feeding, we start mom pumping with the symphony 
and finger feed.  I feel we should be spoon feeding but am meeting a lot of 
resistance.  Any ideas? comments??>>>>

Jane,
I feel your pain!  I think there are several reasons for the resistance.  First, 
nurses are concerned that they may be neglecting baby's needs by not giving 
them milk in larger (and measurable) volumes.  Nurses fear that infants will 
become: 1: hypoglycemic  2: dehydrated, and/or 3: lose too much weight.  
And in some cases these are valid concerns, so we need to emphasize 
recognition of sick infants VS sleepy infants.  I think this is the biggest 
obstacle, in my hospital anyway, and ongoing education and dialogue with the 
nurses and peds is the best way to overcome it.

Second, this is unfamiliar and may be something viewed as too much of an 
alternative to 'normal'.  Feed baby with a spoon?  Who ever heard of that?  I 
think this is also a factor when advocating hand expression.  I find that moms 
and nurses are just uncomfortable with this.  After suggesting hand expression 
to one mom, she said, "You mean you want me to milk myself...like a cow?"  
So in this case, I think just modeling this in our own practice with 
moms...making it more familiar and normal...is the best way to overcome it.

Finally, I think we're up against the same cultural values of breastmilk VS 
artificial milk.  Moms (and some nurses) don't believe that formula is 
harmful...many believe it is even necessary...so going to this much trouble to 
try to breastfeed simply isn't necessary.  When working with moms of 
nonlatching babies in the first few days postpartum, I can almost universally 
expect to hear the question, "Do you think I should just give him a bottle?"  So 
the best way to overcome this is to just keep on doin' what we do...

Julie Conaway, RN, IBCLC
Rolla, MO, USA

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