The norm in institutional childbirth where pharmacologic pain relief is
given to most mothers, is that babies are sleepier the first days.
There is a great blindness to the artifact effect of maternal analgesia
because nearly everyone has it.
In these circumstances we need to ensure that BF is not further undermined
by the measures taken to follow the babies up in the first days of life.
All intervention with an eye to getting nourishment into the baby needs to
be in line with good BF practice.  No artificial nipples, no artificial
feeds unless there is a documented need, like hypoglycemia as evidenced by a
blood test to measure it, AND a mother unable to provide any milk at all,
and no banked milk.

I've taken to recommending simply keeping mother and baby together as this
keeps blood sugars higher in babies and gives them more opportunity to wake
up near the breast, and has a positive effect on mother's milk production.
The truly obsessive may want to start pumping, but I am more and more
relaxed about that the first 24 hours.  Instead of harassing sleeping babies
and practically forcing bottles into them, let's use our energy to teach
mothers the skill of fingertip expression, and encourage them to do so right
into the baby's mouth, until such time as baby wakes up and starts looking
around for food.  This may not happen until 48 hours post partum and babies
do just fine.  They are in HOSPITALS where there are staff around ALL THE
TIME so if they do start looking sick, they can easily be treated.

I respectfully submit that if staff are concerned that 48 hours is too long
to wait, because mother and baby are going home by then, that this says
merely that there is something the matter with the care delivery system, and
not with the LC who wants to protect breastfeeding.  The baby can't say no
to maternal meds, and can't tell time.  Maybe we should send them straight
home after medicated births and have them come back at 48 hours for a crash
course in establishing lactation with an awake baby!  (I am only joking.)

Jennifer Davis asks whether LCs are more likely to advocate unmedicated
childbirth.  I don't know about that, but LCs are likely to notice the
significant deviations from a physiologic initiation of lactation in the
medicated mother-baby dyad, and be more appreciative of how much easier it
is if they are not drugged.  On the other hand, there are probably plenty of
LCs practicing where the only babies who aren't under the influence at
birth, are those born in the parking lot.

Rachel Myr
Kristiansand, Norway

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html