I have to share a wonderful story with all of you.

A full term baby girl was admitted to our hospital with fetal hydrops and
bilateral chylous pleural effusions.  She was on a ventilator for the first
month of life and had chest tubes draining chylous fluid for nearly 6
weeks.  On day 34 they initiated oral feedings with a special fat free
formula.  Breastmilk was not an option as she was not allowed to have
any long chain fat.  On day 40 they began to titrate her fat free formula
with a formula containing some medium chain fat (MCT oil).  Three days
later they began adding small amounts of breastmilk to her formula.  On
day 44 she had her first trial of full strength breastmilk by bottle.

I happened to be present during this monumental bottle feed and couldn't
help but notice how miserable the baby was, struggling to "latch-on" to
the rubber nipple.  She never did very well with bottles and needed to be
supplemented with half or more of each feeding by naso-gastric tube.
The speech therapist was working with her for "poor oral feeds" and
changed nipple types several times.

Since she was able to take straight breastmilk, it only made sense that
we let her start feeding the way nature intended her to feed.  So I
checked with her nurse and decided that the next feed would be at the
breast.  Mom confided in me that she was nervous because bottle
feeding wasn't going well. I reassured her that the baby would probably
do better at the breast (while secretly hoping that this would indeed be
true).  Sure enough, with minimal assistance in positioning, the baby
settled right down, latched on and breastfed for 5-10 minutes on each
breast.

That was 4 days ago.  Today Mom and baby are finally going home on
day 48.  They have been exclusively breastfeeding day and night for 3
days now.  Her feeding tube is gone and she's gaining weight.  We don't
see many successful "delayed onset" of breastfeeding situations.  But
here is a baby who waited over 6 weeks to begin breastfeeding and
when she finally did, it was as if she were just born!  Needless to say,
Mom is thrilled.

Rachelle Lessen, RD, IBCLC
Children's Hospital of Philadelphia