Dear all:

Probably no one practices slower than I do and I would absolutely refuse to do it any 
other way.  I concluded this one day when I and the mother nudged a baby to eat for 
about 2-1/2 hours.  The opinions I formed about how that baby ate during that 2-1/2 
hours were completely misguided --- even without the scale (which verified my 
observations) you could tell she was barely getting tenths of ounces before conking out.  
She was simply not ready to eat.  When she finally perked up on her own, she chowed 
down and ate 3-1/2 ounces in about 15 minutes.

When I was in training, they pushed the limits of 3-5 visits per day.  Given transportation 
times of up to 1 hour depending on where the mothers were locating in New York City -- 
this meant you had to finish quickly.  Far too often, I arrived at a mother's home to find 
the baby screaming from ravenous hunger because she was holding off the feeding.  This 
distorts the observation.  Equally often, we would have to call the next client to let her 
know we were late because the baby had been fed shortly before arrival --- and we'd 
have to wait for the baby to wake up or nudge and prod the baby.  Nudging and prodding 
distorts the observations as well.  

Since so many babies I see have been supplemented before I see them, and since so 
many of these mothers were told NOT to use the pump while they were pouring 2 ounces 
down their babies throats at every feed (just saw one of these today who responding 
amazingly well to just one day of pumping) --- I also see a huge number of mothers with 
pump trauma.  So, I feel that an assessment is not complete without watching the 
pumping.

Today I saw a baby that had an unmedicated birth.  But because she was not ready to eat 
when I arrived, my visit took 3 hours.  When she woke up, she fed fabulously well and 
with a quarter inch tweak of an angle in the initial positioning, the baby was able to self 
attach with no pain for mom.  She downed 3 oz in 10 minutes on day 6, calmly and 
efficiently and proceeded to interact with mom for a solid 20 minutes of quiet alert 
afterwards.  I wouldn't have missed that last 20 minutes for the world --- but I suppose I 
could have interrupted mom and baby to go over her instructions and sign the paperwork 
--- thereby finishing in 2-1/2 hours.  I'd say most visits in such situations where no 
pumping or supplementing take 1-1/2 hours or less.  But sometimes the feedings are just 
off as was the case this time.

I am far less stressed if I allot a full three hours for a visit, particularly for supplemented 
babies.  Then, I have time for call backs if the visit takes less time.  I never have to call 
someone to tell them I am running late for the next visit; I never have to force a baby to 
eat when he or she is not ready;  I can always watch the pumping if a mother needs to 
supplement to make sure it is not causing trauma.  

I really do not think that it is possible to do a full assessment of an infant's feeding in 45 
minutes.  You could only do this if the baby was ready to feed the instant the visit started 
and ONLY if the baby were an efficient feeder.  Most newborns take between 20-50 
minutes.  Add charting to that picture --- and also time for the newborn to be ready to 
feed are you are past 1 hour even if you use ever second of your time efficiently.

Best, Susan

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