Nikki,
 
I guess maybe I should have used a different phrase to describe what we see when a baby is nursing well. You see those nice pauses as part of a suckling rhythm - even on day one and two. Certainly I know babies can fool you with secretions. But the LATCH scoring system includes "Audible swallowing" as the A so I was using that as my marker!
 
 And I am still amazed (after years "working" as a LLLL with postpartum moms at home, waiting for the milk to come in) that we reliably see moms whose breasts are warm and heavy at 48 hours and beginning to drip milk soon after. Babies here go to the mom's arms immediately with a vaginal birth and we do mom/baby couplet care, so they are only separated if a mom wants to sneak in a nap or shower and asks us to keep an eye on the baby at the desk. C/S babies stay with mom in the OR for up to 45 minutes, then get "admitted" as mom goes to her recovery/postpartum room. (We're working at getting them to breast quicker, it's usually within two hours but we're still on a learning curve with recoveries - fortunately we don't do enough cesareans to all be experts!)
 
It's the babies who aren't nursing well - usually with a mom with abraded nipples! - who seem to wait a long time for that milk to come in. And then comes the engorgement etc when things haven't gone well. Grrr!
 
Dawn M. Kersula MA, RN, IBCLC
The Birthing Center at BMH
17 Belmont Avenue
Brattleboro, VT 05301
802-257-8278
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