Hello everyone
I have been away from Lactnet for a while, and am now trying to re-establish the habit of browsing the posts.

I wonder if anyone would like to comment on the management plan that you would advise in the following situation.  I ask this, not because I am unsure of my own practice, but because I would like to know how others advise.  I know that amongst my own colleagues (LCs, midwives, doctors) here in Melbourne there would be a good deal of variation.

The situation is:
a newborn baby, weighing 2700 g (6lb), at term - looks skinny
an uncomplicated homebirth 
without use of any narcotics
Mother has another child, aged 3, who was breastfed.
Baby breastfed well in the first hour

I encouraged the mother to rest and to feed baby whenever she was interested in the first 24 hours.  Baby was quite sleepy and nursed briefly at about 4 or 5 hourly intervals.

When I saw them at about 30 hours, I considered that
1 Baby was clinically well, not jaundiced, placid
2 was sleepy at the breast,
3 Attachment at the breast was sub-optimal (minimal effort)
4 Feeding was infrequent and for brief periods.

How would you advise this woman, at 30 hours postpartum?  You will be visiting her again the next day, and she can phone you at any time if she is worried.  At what stage would you talk about expressing milk and how would you manage that?

I will tell you how I advised in a later post.  Thanks for your responses.

Joy Johnston, FACM IBCLC
Midwife and Lactation Consultant
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www.webrider.net.au/~aitex/joy.htm