I spend a lot of time on this one and how early I intervene depends on the
circumstances.  24 hours is usually my time to do more than what you say,
i.e., breast massage and letting the baby lick the colostrum.  However if
mother is anxious or if the baby is small when I know the staff will be
concerned, I often begin pumping earlier and cup feeding the colostrum to the
baby.  Colostrum often helps wake the baby up.  I explain to the mother that
the problem with a sleepy baby is mostly the lack of stimulation to her
breasts, that the baby usually has plenty of reserve.  There is magic in
seeing the colostrum and "feeling like she is doing something."  This
practice has decreased bottles of ABM in some cases.
Judi Hall, RNC, IBCLC

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