Denise Fisher is concerned about preserving the lactation if baby is
uninterested in suckling the first day or two.
She also asks whether unmedicated babies are as slow to get started, and
whether we should accept a medication effect as 'normal'.

I tried to address stimulation of the breasts in my previous post, though my
gut feeling is that the first 12 hours are not the most crucial.  One of the
Swedish BF researchers (can't remember which, excuse me!) has shown that
milk volume on day 4 is directly related to frequency of feeds on day 2.
Day 1 seems not to matter as much.  Lots of babies sleep most of the first
24 hours after the initial wakefulness subsides, and I prefer not to be
aggressive or even very active in that time.  If the baby doesn't wake up
and start showing real interest in the next 24 hours, I recommend expression
and offering the expressed milk to the baby until baby gets the point.  It
is rare for this to take longer than 48 hours.  My strong preference is not
to use bottles because of the imprinting in a baby who doesn't have a
breast-in-mouth experience, and because of how it undermines mother and
because of how much expressed milk is wasted on the surface of the
container.

Babies who don't have it figured out in the first couple of days seem to be
the hard-to-convince variety.  My personal record (from own practice) was 8
weeks before first complete meal at the breast, after which I didn't hear
from the mother until child was 8 months and she phoned to ask for
suggestions about how to get him interested in solids as she was working
again and he simply fasted in her absence, sometimes taking blueberry juice
in small amounts as a very last resort while waiting.  That has continued to
be typical of his personality-- cautious about new things.
If we stop worrying about the ones who sort it out on their own, and we can
set two days as a limit for watchful observation, with all the good
suggestions others have posted for how to make as many opportunities for
baby as possible, then we will have time to give the exceptional babies the
attention they need too.
It shouldn't need saying but I will say it: the really cautious ones are
ABSOLUTELY not receptive to forceful tactics.  They need an order of
magnitude more patience, skin contact, and opportunities to practice before
they settle down for the duration.  So there are many babies in this group
who will need some alternate method of ingesting milk until they start
really breastfeeding, and of course they should be followed closely for the
entire learning period, to keep mother's confidence up and to make sure they
are getting enough nourishment.  I can think of at least five ways to check
that without making holes in a baby's skin and I bet you all can too.

As to what unmedicated babies do, I have never seen a healthy undisturbed
baby who wasn't eager to get its mouth around the first available breast
within the first 30-60 minutes, and these babies seem to nurse a lot more
the first 24 hours.  So I can't make a case for the indifference of
medicated, otherwise healthy, babies being a normal variant, but I do think
we can safely give them at least a day to sober up before getting pushy.
The first baby I ever caught at a home birth weighed just under 6 lb at 37
weeks on the dot, and she weighed the same on the third day as she did at
birth.  By the end of a week she had gained 300 grams (10 ounces) over birth
weight.  And she was her mother's first child too.

One last admonition: read Righard and Alade's research on 'delivery routines
and timing of the first feed'.  It will make you wince every time you see a
baby separated from its mother, even for moments, before they have connected
through breastfeeding.  Sometimes it can't be avoided.  Most of the time it
can, and we should respect that.  THAT would be protecting the
breastfeeding.

next in line for the soapbox, it's all yours!
Rachel Myr
Kristiansand, Norway, where it is Still Raining.  Last month the ferryboat
to Denmark tore loose from its moorage, and yesterday 50 meters of rail
tracks suddenly found themselves with no ground beneath them.  Not a place
to be if you fear flying!

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