Rachel writes:

<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.>

Many of today's caregivers in their forties and older are totally unaware
that they themselves as newborns were probably dealing with the remains
of "twilight sleep" and gas anesthesia in their system, not suctioned at
birth except perhaps with a bulb syringe, or maybe minimally with a De
Lee.

<The truly obsessive may want to start pumping>

An additional artifact of institutional birth today seems to be the delay
in the postpartum fluid shift as a result of intrapartum IV fluids.

Resolution of excess intercellular fluids in the nipple-areolar area may
easily be made worse by application of vacuum. This often creates a
self-fulfilling prophecy that "no milk can be obtained by pump".

<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>

Yes! But first, HCP's have to learn how to do it effectively!

<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>

Many of these same caregivers (or their parents)were probably NPO for 12
hours, perhaps given 5% glucose water as much as they would take q. 4
hours for 3 feedings and then "allowed" to go to one breast, for 5
minutes, every 4 hours!

Of course, they probably stayed in the nursery all night and got maybe 1
ounce of formula at 2 and 6 a.m., because they were so mucousy that's all
they could take before they gagged or vomited.

The next day's total at one very engorged breast per feeding for 7
minutes, then 10 minutes the 3rd day, q. 4 hours didn't yield them much
more!

That was the artifact of the institutional births at the time, and we
thought it was "normal". It took a long time to re-educate a few of us to
try to create new understandings.

In the meantime, new perinatal norms have continued emerging, new
caregivers continue to arrive on the scene as others move on or retire,
and new artifacts creep in relatively unnoticed as a matter of course.

It's uphill work for the likes of us, but Rachel's solution (and the one
Gail Hertz describes) sounds like a wonderful compromise that will
endanger breastfeeding far less, and probably not harm the baby or mom
one tad.

I sure hope someone who can effect their institutional procedures in this
way will conduct some research to create an evidential base!

Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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