BWC had some very insightful comments. I'd like to share some of my thoughts
on this if I may.
    Even nipples that don't LOOK sore or damaged can be painful in the first
days of nursing. The nipple skin gets "stretchier" as the prolactin levels
rise but a good latch is essential to avoid trauma or damage. Newborns in the
first 24-48 hours as a rule are very sleepy. Research (and experience) shows
that some times they will go for four or five hours without a "good" feeding
but will cluster feed several times before or after that. Bathing a 24 hour
old baby (immersion) is not advisable due to potential for cord infection but
a quick wipe with a cool cloth or unwapping baby, and putting skin to skin
with mom can help. I also like to "stroke" the cheek to try to elicit a
rooting reflex in a baby who appears to be sound asleep. Hand expression of
colostrum into a spoon can get 2-5 ccs into a baby who is drowsy (just don't
"pour" it in their mouth.) We can expect 4-5 pretty good feedings in the
first 24 hours (along with 2-3 sleepy ones) with 1-2 (minimum) stools and
wets. I'm willing to bet that the sleepiness and soreness are transient and
will improve with good latch and increased skin to skin contact. I've had
ladies say to me "ooh it feels like the nipples are bleeding" but the nipples
appear intact and colostrum can be expressed. Perhaps you can show this lady
how to do areolar expression, show her exactly where on the areola that
baby's mouth needs to be to efficiently express colostrum while feeding and
it will reassure her that there is something there. I always explain that
colostrum is like honey or syrup and baby's sucking pattern now will not be
the same in the next few days. Until I was in a hospital setting daily with
newborns and 1-2 day old babies, I did not know these things. I've learned a
lot in the last 10 years!
Food for thought (no pun intended)
Mary Kay Smith, RN, IBCLC
Romeoville IL

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