Jane--I would imagine that the baby, having been delivered by C-section, was
suctioned a bit after the delivery. Was it also exposed to drugs, esp
meperidine (Demerol) in labor?? Why are we worried about a baby who is 14
hours old?

I see a lot of babies who refuse to latch due to "oral insult"--often related
to deep suctioning, sometimes with ceasrean and more commonly with
meconium-staining in the amniotic fluid, which requires the docs to visualize
the vocal cords and suction deeply.

    I do explain all of this to the parents, that the baby has been subjected
to this oral insult, and we need to just buy some time....expressing
colostrum or pumping it and feeding to the baby with a teaspoon helps both
mom and baby (set them up with LOW expectations of volume as they will likely
extract very little from the breast).Lots of skin to skin (literally works
best!) and allowing baby to lay against the breast, licking and nuzzling, but
with no "pressure" placed on the baby to succeed.

     If I can talk the nurses out of formula, I try to do so, encouraging
them to focus instead on how the baby acts, wets, stools and weighs first. I
review the parameters of when to worry, rather than being too quick to feed
(ask the pediatricians to back you rather than arguing with the nurses--mine
usually will allow us to wait on "food" as nature does not provide ounces for
these newborns so why should we). No fingers, bottle nipples or pacifiers
should go into the mouth--if the baby wants to suck, it should be offered the
breast, EVERY TIME!!
    Mostly, "tincture of time" fixes these problems. If the baby has
significant weight loss (>10%), low blood sugar via blood test (or symptoms
that suggest doing one), no wets, lethargy or significantly increasing
jaundice, then I find it necessary to "feed" the baby, and encourage the
parents to insist on cup feeding for these babies.

good luck....

Kathy in NJ IBCLC RN C (Maternal-infant), APN C (Family Nurse Practitioner)
 PhD student hoping to study labor and lactation issues

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