Kathy, If you are having mom hand express colostrum when baby isn't feeding,
can I assume that it is being fed to baby?  If so, is it a volume issue that
the health care providers you are working with are concerned about?  If the
baby's Dr. knows the baby will be given appropriate nutritional support then
I expect most of them will give you more freedom to support the breastfeeding
with the techniques you prefer  (they need to know it will work though and
mom is happy with it).

I work at a level 3 hospital and we have wonderful support from our
pediatricians because they know we will not hesitate to intervene and feed
the baby if we assess ineffective feeding.  In general we intervene at 12<24
hours postpartum if baby has not demonstrated effective breastfeeding despite
our assistance.  Earlier if the baby is at higher risk or mom desires it.  We
don't expect every 3 hours at first of course--- though we encourage it
strongly with high risk babies.  We do expect it from 24 hours onward ---- or
close to 48 hours for sure.

While we may have to augment colostrum with formula for some, the earlier
intervention really does work well for our LC program and the moms and
babies.  Mom gets a good milk supply established and we can assess baby's
response to treatment to know if the baby's Dr. needs to be concerned about
more than just sleepiness due to medications or if baby can eat enough to
manage when at home.  We see these moms for follow-up in 2<3 days and as
needed until they are breastfeeding exclusively.  Some are exclusively
breastfeeding at discharge and others take weeks of partial breastfeeding
until all milk can be obtained directly at breast normally.  The longer ones
are usually the premature baby or the one who finally gets sicker or
something like tracheal malacia is found and then we know why feeding wasn't
going well.

Protocol for intervention at 12<24 hours is on pg. 288 of the second edition
of Breastfeeding and Human Lactation by Riordan and Auerbach.

ILCA's "Evidence-Based Guidelines for Breastfeeding Management during the
First Fourteen Days" on page 12 supports intervention by 24 hours postpartum.

The fifth edition of Lawrence's book, Breastfeeding: A Guide for the Medical
Profession, on page 240 doesn't specify more than saying the following about
babies affected by labor medications: "The mother of an infant with a poor
suck may need some additional stimulus by electric pump to facilitate milk
production.  The infant may require extra assistance in latching on and
obtaining sufficient nourishment the first few days."

I really like the article in  Oct 1996 Contemporary Pediatrics, "Early
Assessment of the Breastfeeding Infant", by Dr. M. Neifert.  While this
article also doesn't give any certain time to start, she says it is best to
start intervention as soon as it is evident that baby isn't breastfeeding
effectively.

I recall someone wrote to start pumping at 6 hours pp if baby hadn't fed yet
but at the moment I can't recall or find it.  Anyone else remember?

You caught my interest on this topic because tonight I'm collecting
references to support my desire to intervene earlier as opposed to some
supportive health care practitioners who believe it is more supportive of
breastfeeding to wait and wait...  I look forward to reading more from others
on this one even if it is a topic that has been discussed.  And we will
continue to discuss it from many perspectives until we get more research on
which to base our protocols.  That is why we need each other and this list!

Natalie Shenk, BS, IBCLC
Findlay Ohio USA
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