Dear Lactneters, I work both in a hospital postpartum, and a hospital based outpatient setting. My question concerns how to handle the babies who have difficulty breast feeding in the first 24 hours. How vigorous and how equipment intensive are attempts to get babe successfully to breast before discharge. The majority of our patients seem to labor with the ?benefit? of epidurals which may or may not contain duramorph or fentanyl. This medical intervention seems to be the slippery slope which leads to so many more medical interventions. It's use is contraversial, with most of the L&D staff, OBs and anesthesiologists resisting any notion that epidurals could possibly interfer with breastfeeding. We often have babies who have not nursed in 12-18 hours going home. Our policy has been if the baby is not nursing well, to start mom with a manual pump, advise offering breast q2-3 hours and pumping when no latch acheived, if unable to latch in a 6-8 hour period to supplement with expressed colostrum. If no colostrum available and you are at the 12 hour mark, we suggest abm (I shudder to say this). OUr practice patterns vary and the supplement is either given by od syringe, by feeding tube at finger, by S&S or by a no-flow nipple on a bottle. We seldom use cup feeders; our population seems to balk the most at this device. Needless to say, by this mark we have a stressed family fearing that there is something wrong with mom's ability or with their baby. We have by this time had a great amount of lactation staff time involved and usually many pieces of bf equipment. I fear that we medicalize bf to such an extent in these instances that families will loose confidence and choose abms/bottles. I also fear that we are over-interventional in what is a normal pattern of infant behavior just so that we can see it being done correctly before d/ch. Our average stay is 24 hours for vag and 48-72 for c-sections. We have a very low compliance rate with seeking outpatient LC help; there is a charge for this help from our facility post d/ch. HELP!!!! What are your policies? When do you worry that a babe has not eaten, assuming normal birth weight & no other signs of illness? How do you manage to teach postpartum moms about breastfeeding in the first 24 hours post delivery? Does anyone have a post d/c f/u plan that patients will comply with? Thanks in advance Glenda Deahl ------------------ Glenda Deahl Editor Metronome Online Press, Inc. [log in to unmask] FAX (210) 497-7033 voice mail (210) 497-5791