Claudgrn asks what the policy is at other hospitals when a newborn doesn't
breastfeed.  We developed our policy last year in consultation with the peds
and midwives and came up with:  presume baby is full term, no risk factors.
We allow baby to go 8 hours, if no suckling do a full set of observations
and if all well leave another 4 hours.  At this time (12 hours now) if baby
won't suckle more obs, including blood sugar level; hand express mother and
give baby the EBM (finger feed/syringe milk in), even as little as 2 ml can
bring a BSL back up to normal.  Then the cycle can be repeated - personally
I will continue to express every 4 hours and give the baby the EBM after
that initial 12 hours - I think it helps the baby and is better management
of the lactation.
Which gets me on to my next point - I really don't like to see electric or
hand pumps used at all until the mother is producing reasonable quantities
(ie not before lactogenesis II).  I feel it is not sufficient stimulation
and the very small quantities that are produced, which may not even make it
to the bottom of the bottle, cause the mother to lose self confidence.
Also, hand expressing is a less invasive procedure and every little drop can
be caught and given to the baby.  What do others think?

Denise
Brisbane, Queensland, Australia

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