I, too, go by the rules of "feed the baby", "get the milk supply established"
and then work at getting the two together. I am only concerned with the time
element of 24 hours. Fifteen-twenty years ago, we did not feed any babies for
24 hours. I encourage early and frequent stimulation of the breast by the
baby, but do not really worry about good feeds if the baby is less than two
days old (esp if the mom had demerol/meperidine, sim to pethidine). Most of
my pediatricians back this. I encourage Kangaroo care, hand expression and
not allowing baby to suck on anything else (ie, fingers, pacifiers or bottle
nipples). If a baby must be supplemented it should be with cup feeding done
properly (ie baby-led). If baby has had some latch (or some formula, as our
nurses push it no matter what the peds say), I will not worry for 72 hours,
unless there is significant wt loss, minimal wet diapers, minimal meconium or
severe jaundice (and I tell my moms that ALL babies lose weight and get
yellow, so that they see it as normal, rather than pathological, when the
nursing staff "threaten" them with these conditions as a reason for formula).

With this approach, the moms do not get so worried, and know WHEN to worry
(ie, minimal wets/stools, excessive jaundice or excessive sleepiness). I
worry that getting moms to pump when there is a baby available for licking
and nuzzling sets them up for making breastfeeding seem like too much work. I
have moms  in my practice who are nursing longer than 5 years ago, so see
this as a good thing overall.

Kathy IBCLC RNC in NJ

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