Sounds all too normal for a near-term baby.  Add to it the
less-than-ideal start with breastfeeding and it is almost
predictable.    I think your suggestions are on target.  Lots of
skin-to-skin, wake if needed to feed and refer to a LC who can
assess and help mom plan how to return breastfeeding to "normal".
These near-termers can certainly "swing both ways" with some acting
like term babies and others acting more like 34=36 weekers!  And
those that start out acting like termers can "hit the wall" after
the first few days and have some problems.  Moms of near term babies
need to know that this isn't a step backward, but baby is now
"acting his age".
At a neonatal conference a few weeks back I was thrilled to hear a
doctor talk at length about the near term baby.  Too many of the
Peds at the sponsoring hospital were not taking gestational age into
consideration and handling them like they were 40 weeks (unless
major concerns had arisen and not been seen as resolved in the short
hospital stay) - same guidelines given as for a term baby, no
follow-up until 2 weeks of age, etc.  I had even seen 36 week <5
pound babies sent home with the only instructions being "bring baby
to the office at 2 weeks and call if you have any concerns".  I
would always recommend at least a weight check in a few days and
when time would allow, I would try to contact the mom by phone
myself (they would get a routine follow-up call, but I'm not sure
the nurses making the phone calls would know baby's GA unless there
had been problems during the hospital stay).

Winnie

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