Good afternoon, I will try to compose my thoughts succinctly on this. Also I know I have commented on the RN/IBCLC and the clock issue in the past, they do come up again and again, and it doesn't hurt to revisit these issues. First, it is so true that RN/IBCLC's or *any* IBCLC employed in a hospital setting is aculturated to the medical model, or even more significantly, *restricted* in her practice by the medical model, the nursery staff who may have more control over the feeding plans, and the MDs and DOs who really do have full control (sadly, often it's not the parents). This is a source of GREAT frustration to most hospital-based IBCLCs. Here are some recent examples: 34 wk twins, experienced mother who has bf 2 prior children, mother comes for every daytime feeding til 9pm. Doctor ordered bottles after each bf, because babies lost approx 1 oz after a day of bf. (I like gavage feeding small, early premies and allow ad lib bf - but I'm not in control). The doctor in question is our most bf-friendly. Baby with 16 glucose, confirmed 8 in lab, bottle fed all night per MD orders, no access to mother (yes IV fluids were done too). Another case - supplementation with water for physiologic jaundice (yes, this antiquated practice still persists). The IBCLC working with these dyads has to do some difficult side-stepping to support the mother and promote the bf, and offering options and suggestions to doctors, but keeping a good rapport going with said doctors. Gradually we do make changes. Some might see this as the IBCLC practicing in a non-evidence based or non-supportive way, but it's not the case. Now re the feed timing issue, most mothers ask us about the frequency of feeds. We discuss with her normal ranges. Again, remember, the babies in hospital are often born medicated, quite a few elective inductions, and with barriers in place in the hospital culture, like mandatory hearing screens and things that separate mother baby (albeit unnecessarily). I really believe many mothers are clueless (don't take this the wrong way), but they have NO experience with bf, esp. in Mississippi and other places with low rates and where bf in public is quite rare. They really want to have an idea when and how long babies feed. We often have mothers tell us the baby fed for 1-2 sucks or 1-2 minutes and went to sleep. They want to know if this was a feeding. I do give info on babies feeding patterns etc. We do ask the parents to wake the baby if he is not feeding at reasonable intervals and feeding effectively (teach all the signs); if the interval is more than 3 hrs or so in the first days (most moms in hospital 2 days including c/s). We recently had a f/u visit where the mother had not bf the baby, nor fed baby anything for 24 hrs. The baby vigorously drank 2.5 oz pumped from mother and mother pumped another 2.5 oz, would not latch. Also a 36 wk infant recently was not bf, just put her mouth on the nipple, and was not being given anything to eat. The baby was rooming in and treated as a well baby, mother post c/s and very groggy, was offering the breast and even a bottle, no intake. If you ever want to see my handout of what I teach mothers and what I give them in writing, feel free to email me at work [log in to unmask](many of you have gotten this in the past) and you will see what I say re timing, and everything else. And I welcome any feedback that you would give me. Laurie Wheeler MN RN IBCLC Hospital-based Mississippi USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome