What to do in the case of a baby who isn't sobered up enough to surmount a
breast in the first half hour after birth is the subject of much
disagreement everywhere except here on Lactnet!  It is wonderful to read
about all the wise helpers who practice Watch and Wait..

I have not found any intervention to use in the first half hour, or even the
first couple of days (weeks!), that can make an uninterested baby nurse.  We
try not to disturb mother and baby until first attachment at the breast, or
before two hours post partum, which is when most places move women from the
birth room to the post partum ward.  But some professionals don't consider
weighing/measuring, bathing, and clothing the baby to be disturbing it.
(And many others disregard current knowledge about Pethidine's
ineffectiveness as analgesia in labour, as they mistakenly perceive the
sedation it causes, as pain relief, grrrr.)

Once the two hours are over, there is no agreement about how long to wait,
and many attempts may be made to attach the baby despite no interest on the
baby's part.
Even if left truly undisturbed, many pethidine-intoxicated babies will be
unable to organize their oral musculature enough to latch well at the
breast, and in my experience it does no good, and even does harm, to attempt
to place the breast in the baby's mouth.  I am personally comfortable with
not feeding a term, normal weight, healthy but drugged baby, for hours and
hours and hours.  Most of them where I work actually liven up after 12 hours
or so, and are ready to do what they ought to have done at birth.
Things that don't hurt the further course of BF are: continuing to keep
mother and baby in skin contact, ensuring that mother knows how to recognize
incipient signs of interest from the baby, teaching mother to express milk
and offering this to the baby directly, or by syringe or cup, and otherwise
RESPECTING the baby's right to decide what enters its mouth.  Most babies
willingly lap up drops of expressed milk, and even lick it off the breast,
while still not ready for that big, effective latch.

Things that often DO hurt the further course of BF are:
forcing the breast into baby's mouth (incorrect latch, pain, soreness for
mother, and aversion for baby)
separating them, particularly if mother is given the impression that it is
not important whether baby nurse at the breast or bottle first;
scaring the mother with stories of brain damage from hypoglycemia if baby
doesn't get fed within X number of hours;
scaring the mother with threats that BF will never succeed if baby doesn't
latch correctly within a set time limit after birth, when we all know of
babies who refused to latch for ages and went on to do fine;
feeding the baby anything at all by bottle.

The average length of time for self-attachment at the breast is over half an
hour, and pethidine lengthens the interval significantly.  Babies benefit
from caregivers knowing this, and allowing for it, making provisions for the
safe observation and care for the intoxicated baby until such time as baby
can get on with it.

To those who counter with how tired the mother is, and how she needs someone
else to watch the baby while she sleeps, I can only say that there are ways
to empower mothers to breastfeed their babies in the most trying of
circumstances and they will often thank you for it, too.  But there must be
enough staff so that when mother needs practical help to get situated in bed
at 2:30 AM, someone can help her, get her a glass of water, and change the
baby afterward if needed.  Almost no mother can resist being told her baby
prefers her to anyone else, and that by simply smelling like herself she is
meeting the baby's needs for comfort.

It helps, too, if you can communicate your own confidence that the simple
passing of time will alleviate this problem.

The work of Eva Nissen, and of Lennart Righard and Margaret Alade on
pethidine and establishment of breastfeeding is excellent.  I don't have
time to find the references just now, but some of Righard and Alade's stuff
has been published in The Lancet about 5 or 6 years ago.

Rachel Myr
Norway
where about 60-70% of labouring women seem to get pethidine still, and I am
in the middle of writing an article this very minute about why it is USELESS
and should be consigned to the rubbish heap of midwifery

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