Thoughts, please.  I am new to working with neonates.  My previous
experience was as LLL Leader, so I saw babies who were already at least
several days old (or older) with breastfeeding problems appropriate to
those ages.  Now, I am working as a staff nurse on a mother-baby unit
(soon to start L&D...yeah!).  I've run across a frustrating problem with
some newborns the last few months, only a couple of times, but need your
thoughts.
First baby to 28 y.o. mom.  Mom had a cesarean section for
non-reassuring fetal heart tomes, and failure to descend.  C-section
done under epidural (total duration of epidural, about 2 hours).  Baby
boy, 8# 8.9 ounces, with apgars of 7 & 9. Meconium, but none below the
cords.  No notation of deep suctioning.  I received mom for the night
shift, after she had been on post-partum about 6-8 hours.  Baby was on
glucose protocols, with the delivery room stick of 46, and 1-hour stick
of 37 (our lowest "acceptable" rate is 40).  Because baby had not nursed
by then, the nursery nurse gave baby about 1/2 ounce of sugar water
(D5).  When I got mom and baby that night, mom was very motivated to
breastfeed, as was dad to support the relationship.  Mom did have a
manual pump and had been told to pump q2 hours.  Mom's nipples were
"flattish," though not entirely flat.  She was not full, very soft.
Nipples would evert slightly upon stimulation (including pumping), but
not much.  Baby's sugars remained around 50 or higher the entire time I
had the couplet (3 more sticks, I'm sorry to admit, as required by the
unit protocol). Baby would wake slightly on occasion, but never cry
much.  When he did wake, he would immediately fall back to sleep when
put to breast.  I tried all my tricks to wake him and keep him awake.
Even for heel sticks, he only seemed slightly disturbed, and really
didn't notice the IM for hepatitis B.  He never latched on good at all
for the entire shift I had them (12 hours).
        By 10 hours post-partum, after baby had not had anything other than the
D5 much earlier, I tried a soy formula in a nursing
supplementer...useless, as baby would not latch on.  We let things go,
but the nursery nurses do get a bit antsy, so by 12 hours pp, baby was
given the soy formula by bottle ("orthodontic" nipple).  He did suck
what was poured in his mouth, but still wouldn't maintain a wakeful
state for any length of time.  I left with instuctions for the next
shift to:
1. have mom electric pump q 2 hours daytime, q 4 hours at night.
2. don't be too concerned about feeds, as his sugars were >50.
3. Let ped know that this baby does not root side to side.  I'm of the
opinion that breastfeeding is instinctual for a normal baby, and that a
desire not to nurse is something to check into.  I hope the ped did not
turn around and just order bottles, however.
4. Keep encouraging the breastfeeding.  I suggested the baby baby not be
offered any bottles, as long as he looked healthy, and continued to have
wet and soiled diapers.  Offer feeds at least q 2 hours, or sooner if
baby wakes.
Help, please.  I find these babies who just are too lazy to do anything
very baffling and frustrating, especially when mom (and dad, here)
really wants to get the relationship going.
Thanks,
Lee-Ann, RN, IBCLC