I was helping a mother with a very similar situation last week. Baby had nursed well (according to the mother) until the mother's milk came in (she'd had a lot of IV fluids and says she was very engorged). At that point, when baby wouldn't/couldn't latch, they began supplementing with her pumped milk. When I saw her, she was no longer engorged but the baby wouldn't take the breast at all. 

I explained to her that her baby was just learning, and in the past couple of days had gotten the idea that milk comes from bottles. When she put him to the breast, he was confused - he was wondering where the heck is that nice bottle with the milk in it? So he would cry/fuss. We kept him skin to skin, and moved him up (vertically) on her chest to calm him. Of course, after a bit, his instincts clicked in and he started to move towards her breast. She was thrilled. But when he got there, he started to cry again. We calmed him and helped him latch and as soon as he got the nipple in his mouth she did some breast compression and getting that little squirt of milk started him sucking. He fed very well - good sucking and swallowing. But when we tried the other side, we again had fussing and crying until he calmed down and once again he found his way to the breast, latched on and fed well. 

I think when we call it "breast refusal" it sounds very final to the mothers. But in my mind, we just have a baby who is confused. At birth they are so primed to "find food, find food, find food" and if they learn that food comes from a bottle then when we offer the breast they just don't appreciate that milk can come from this very different source, too. So they cry and get upset. I find that if we can be patient (not always easy for the mother, but I think my job is to help her understand what the baby is telling her) and do the things (like skin to skin) that help trigger the baby's instincts, often it will work. This baby continued to cry and fuss even with the nipple in his mouth, but we persisted and gave him encouragement and little bits of milk from compression, and eventually he caught on. 

Teresa Pitman


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