Hi Sally,
IN answer to your question:
I see more non-latching than latching babies lately!! What I do is this: if
the baby fed in the delivery room, then it is ok if he does his
physiological sleep for 8-10 hours, after which I encourage the mother to
try to wake him, first by undressing him and doing lots of STS. If that
does not work, then we start hand expressing colostrum and spoon feeding in
tiny plastic spoons. I find that at least 5 spoons from each breast ( a
spoon being a puddle in the middle of the spoon) every 2 hours during the
day, and only when the baby wakes at night, supplies all that the baby
needs to maintain weight, while also maintaining milk supply. I find that
pumping with the electric pump at this stage is not effective. Those few
cc's of milk stick to the sides and flanges and very little gets to the
baby. The mother is discouraged by the seemingly small amount, and does not
continue. When she sees the milk in the spoon, it seems like much more. If
I can get larger amounts of colostrum, I have the mom hand-express into a
sterile test tube, and feed with a pipette, by gently dripping the milk into
the baby's mouth.
What often happens in either case is that the baby wakes up and starts
rooting, and then we try to latch. If no latch occurs, we continue spoon
feeding until day 3, or until the milk comes out in spurts, and, instead of
dripping into the spoon, shoots across the room. When the milk starts
spurting, we switch to pumping and bottle feeding ( don't get hysterical,
here!!) in a way that does not cause any suck dysfunction. If you use a
very slow flow nipple with a wide base, and rather than forcing the nipple
into the baby's mouth, you urge him to open wide, you can then put the teat
deep into his mouth making sure that the tongue is under the teat and moving
in the correct motion. Most babies that I have fed this way have little or
no problems going onto the breast after that.
Remember that all this time, if the baby is not latching, you have to look
for underlying reasons.
The most common reasons that I see are:
1. 35-38 weekers who are just sleepy and do not realize that they have left
the womb.
2. Babies who are orally defensive after deep suctioning and refuse to open
their mouth.
3. Babies who have had traumatic births especially VE births, or inductions.
4. Babies who are just not ready to eat yet.
5. Asymmetry
6. Oral cavity anomalies.
I urge the mothers to try to wake them or get colostrum into them in these
ways so that there is not dramatic weight loss which will cause all the
other sequella which are related to non-feeding in the first 3 days.
There you have in a nut shell most of what I do in my work in the hospital.
And this is a hospital where all babies are put to breast in the L&D and
there is full rooming-in, but 90 % epidural rates and 15% CS rates.
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
-----Original Message-----
From: sally myer [mailto:[log in to unmask]]
Sent: Thursday, July 10, 2003 9:03 AM
Subject: Non-latching newborns
For those of you who work with newborns, how long do you feed nonlatching,
normal newborns expressed colostrum only before you feel the need to begin
adding formula. According to Riordan and Auerbach's Breastfeeding and Human
Lactation it says Mother should begin expressing breastmilk and feeding it
to baby with cup or syringe if baby's not latching by 12-24 hours of age.
It also states that on average 37 cc (range of normal is 7-123 cc) is
yielded in the first 24 hours postpartum with approximately 7-14 cc ingested
per breastfeeding in the first 24 hours of age. I see mom's who are only
getting a cc or less of colostrum per pumping for the first day or two. Is
that enough to feed to baby as frequently as they show feeding cues (strive
for at least 8x per 24 hours but many are too sleepy to eat that many times
in the first 24-36 hours) until Lactogenesis II or does formula need to be
begun before this? Is there a point when these small quantities being pump
ed are inadequate, even when baby acts more or less satisfied with it.
These are fullterm, normal newborns who are at low risk for hypoglycemia.
Thank you. Sally Myer RN, BSN, ICCE, CLC (working toward IBCLC)
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