All this discussion reminds me of a recommendation I always give a
mom when we have had to "work" to try to get baby to take the
breast.

"Be sure you give baby at least as much happy time at the breast as
you do pressure time."

Ideally we would wait until baby is definitely ready to nurse, but
we know the reality is that if baby isn't "nursing well" by 24 to 48
hours, either baby will not be discharged and mom will, or mom will
be sent home with instructions to "supplement with an ounce after
every feed until your milk is in"!  Some peds are more relaxed about
it, but these alternatives are all too common.  Therefore, there are
situations where I find myself being a little more assertive than I
would really like to be. For example:
If baby is crying, I may keep baby at the breast BRIEFLY because
sometimes as baby "chomps down" between cries she will get a drop or
two of milk and go ahead and nurse.  I do NOT keep a baby at breast
more than maybe 10-20 seconds and not if baby is getting more upset.

We may try to help baby open the mouth a little wider if baby has a
relaxed jaw (not if he is clenching the jaw).
Because some of these attempts are preobably not pleasant for the
baby (and I am sure some of the staff on off shifts may be not
assertive, but aggressive) I remind moms to spend some time just
snuggling baby with her cheek to the breast without making any
attempts to latch on.  (Of course if baby begins to look for the
breast, go ahead and try to latch.)  This time should be at least as
much time as is spent trying to get baby latched-more is even
better.
Moms really seem to like this concept (and of course, the skin to
skin contact may be jsut what baby needs to stimulate the interest
in nursing).
Winnie Mading IBCLC - wishing we could always do things the "right"
way, but having to compromise at times.

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