Barbara
I agree 100% w/ your post and thanks for taking the time to summarize so
succinctly, and provide references, the care and feeding of the near term
infant. In regards to rule #3 "keep something happening at the breast" I
have been guilty of advising mother to offer the breast first and then
supplement (ebm preferred of course). I generally advise the mother to not
tire and/or frustrate the baby, saying something like "let the baby
breastfeed to whatever extent he can but not trying and trying for 45 min."
It is important that the baby have the energy to take the ebm when he is not
doing NS at breast.  However, I really feel your suggestion below makes a
lot more sense and I think I will try it. :
"Using the breast as a pacifier AFTER feeding by alternative method helps
maintain the baby's orientation to the breast.  This is where you want
him/her to end up at the final stage of the
intervention. I like to give the breast when the baby is full (or at least
not too frantically hungry) so that the baby doesn't always associate the
breast with frustration and hunger."

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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