Trisa,
Just as with everything else in breastfeeding there is the "ideally" and there
is the 'reality".

Ideally mom and baby should be together from birth with minimal separation.
Reality is that in many hospitals throughout the US this is not the case.  Moms
and nurses need to know that "all is not lost" if baby and mom aren't together
and bf within the first hour.  Yes, this makes things much easier for many
reasons - but when it doesn't work, moms need to be reassured that babies WILL
wake up and WILL nurse if allowed to follow their cycle.

This is one reason I think every LC should work in a hospital for one week every
5 years as part of the reaccredication process, just as all Hospital LC's should
be with a private-practice or follow-up LC for one week every 5 years - to learn
the consequences of what we do or don't do there.

In Puerto Rico, many moms are breastfeeding even under very difficult
circumstances.  I just met  4 who are trying to create a support group (one is
breastfeeding twins) and are breastfeeding even though they delivered in a
public hospital which didn't allow (until very recently) contact between mom and
baby except in the presence of a breastfeeding educator during her class.  (In
other words, one breastfeeding before discharge.)

Nurses, LC's, Doctors, etc. need to stress the need for Baby Friendly procedures
and encourage changes - but for the women who are delivering in the current
circumstances, we need to know:
        When to help a baby wake up (watch the baby's eyes and don't try to wake
him up when he's on "deep sleep." - he will go even deeper to sleep and you
could hang him from his heels - he won't wake up.
        When to be concerned if baby is not taking ANYTHING by mouth.  I usually
don't worry for 24 hours unless there are symptoms in baby or special
circumstances in pregnancy and delivery.
        What to use to wake baby up - skin contact, "open the cafeteria" (meaning
have baby's nose near the nipple and express some colostrum), lower the lights
and noises (I treat newborns - especially vaginal births - as if they had a bad
headache), sit him/her up and have Daddy and mom talk to him.  Try not to use
negative stressors such as tapping the feet - I find babies arouse then go into
a deeper sleep when these are done.
        Most of all, give parents the confidence that baby will wake up when
he/she needs to - then watch baby carefully yourself.

It is important that the NURSE be evaluating the breastfeeding - not accepting
mom's assessment "He isn't getting anything" can often mean baby latched on
fine, sucked for a while and went to sleep, then woke up when put in the
bassinette, which made mom think she wasn't feeding enough.  Or she may think
she has nothing in her breasts (there are days when I feel I'm the official
"milker" as I go from room to room expressing colostrum which calms mom, grandma
and dad down when they SEE something is there).

 If necessary, I have used any and all the methods of supplementing (except
bottles) the first 24-48 hours if baby giving signs of low blood sugar.  Keeping
the parents informed that you are assessing the baby makes them relax a bit and
lets them continue bonding with baby without the fear they need to be DOING
something.

Jeanette Panchula, BSW, LLLL, IBCLC,RN
Puerto Rico
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