Can anyone provide any evidence-based recommendations for initiating
breastfeeding immediately after delivery?  I got frustrated for my 2nd C/S
patient when her baby was whisked off to the nursery to be monitored for
finger sticks in the 40s, while the mom and dad were crying and begging for
them to wait for us to just get them back into her room so she could start
breastfeeding instead.  At the point this happened, baby's F.S. was 48, and
we were within 5 minutes of physically leaving the OR to head back to her
room.

About an hour later, her OB found me and asked if I'd help her get the
patient into a wheelchair and down to visit the baby and get him nursing.
Her nurse said we couldn't do that (and no, of course not, two physicians
cannot possibly override the L/D nurse, especially when one's just a new
resident!) because the patient was still feeling the effects of the
epidural.  And then when we asked about a pump or hand-expression to get
colostrum for the baby, we were told that pumping would just waste the
colostrum by coating the flanges, and that hand expression just "wouldn't
work."  OKAY.  Mom was *very* upset and crying about not being able to nurse
or even hold/see her baby.

So when I was telling my anesthesia attending about all this and saying that
next time I'd just help mom try to nurse on the OR table (somewhat kidding
because I knew he'd find that a little scary at first), he was sympathetic
but then asked about what evidence exists recommending immediate nursing.
Anyone have any references or links I could check out and share???  Or any
information on why nursing infants should not receive *any* supplements
unless absolutely needed (particularly in those first few days)?  Another
resident asked me about this today and I don't think I gave him a
satisfactory answer.

At this point I'm not confident enough in either my anesthetic or
breastfeeding management to try to do both at the same time while mom is
draped, mostly numb and supine on a narrow table :) but if I'm ever up there
with one of my breastfeeding-experienced attendings, we may have to give it
a try.

(and my apologies if this post does not appear formatted correctly, haven't
figured out how to make them "look nice" yet)

Thanks,
Sarah Reece (gas-passer in training)

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