You stated:

  On a further point I feel that one of the biggest impediments to
establishing breastfeeding is actually overenthusiastic caregiver support on
the first day.  Policies that recommend frequent nursing on day 1 (eg 3-4
hourly) set the mother up for failure and promote supplementation.  Once an
infant has been put to the breast immediately after birth, both mother and
child should be allowed to rest if they wish.  As long as the child is well
I have no anxieties about the infant not feeding for 8-12 hours.  I believe
that this "down-time" is physiological and that interfering with it is
interfering with a natural process.  I have left one infant 16 hours on the
first day, after which it woke and sucked effectively and consistently.

A second impediment is the false belief that infants should gain weight from
birth.  The mindset should be to encourage normal weight loss in the first
three days of life.  Parents should also be made aware that one wet diaper
on the first day is a common variant of normal and not a sign of dehydration.

    So what parameters would you suggest in terms of hours, or what other factors could
also be considered -- waiting until at least a certain weight loss?

 The point at which we must intervene with supplements, in our hospital,
is more than 10% weight loss (and unfortunately, we still have no
 protocols in  place for alternative methods of feeding in the hospital,  so
 this means  bottles when supplements do become necessary --talk about unclear on the concept.)

But  because our hospital also has the policy of feeding q 3 h, or 8 - 10
feeds in 24 hours, babies end up getting messed with much sooner.

That is a  feeding attempt must be documented at least every three
 hours, or an explanation as to why it hasn't -- numerous attempts, poor
 or no  latching; infant showing no feeding cues; mom having a tubal
 ligation, etc.etc.  This is in part for medico-legal reasons, to show that
 feeding is not being overlooked.   Many of our nurses, however, construe
 this to  mean that there must be a SUCCESSFUL FEED, and become those over-solicitous care-givers you mention.

How can we balance some of this out?

 Chanita, San Francisco