June writes:
Baby had been feeding non-stop for 6 hrs , mum was tired, fragile, and
nipples were tender - I observed a breastfeed and found that although
the latch was deep baby wasnt wasnt swallowing. his output was Ok .did a
breast assessment on Mum, showed Mum how to hand express and mum had only a
few drops of colostrum on the end of the nipple.

All of this is in the realms of normal behaviour and findings June.  In
fact I'd suggest that being able to express a few drops of colostrum after
6 hours of feeding on the first day is pretty good.  You have a risk factor
there for hypoglycaemia (though even that I have seen refuted in the
literature in babe's whose mother's GTT was normal), but with all that
feeding he's not likely to be hypoglycaemic anyway.  Average intake in the
first 24 hours is only a tablespoon full or two (please don't ask me for my
reference on that - I can't find it, but would love it if someone could
give it to me), and I'd guess this baby was well on the way to getting that.

My suggestion for management would be to tuck the two of them into bed
together - caesar noted, and undoubtedly under the influence of drugs,
therefore see if family member can sit with them while mother dozes and
baby sucks himself off to sleep.

June asks why she is so pedantic in the first few days of that postpartum
period.  I think answering the question "What will happen if the baby
doesn't breastfeed in the first 24 hours?" will help you to deal with
that.  As far as I can determine the two major concerns are for
hypoglycaemia in the baby, and poor breast stimulation for the mother.  An
excellent paper is "Hypoglycemia and the Breastfed Neonate" 2001 AI
Edelman, published in Pediatric Clinic of North America.  There are other
excellent papers available on this topic too.... check out papers published
where Cornblath is one of the authors.  From these papers you are able to
conclude that in well, full-term babies with no risk factors, hypoglycaemia
will NOT occur as a result of insufficient nutrition in that first 24
hours.  These papers also say that by giving an external source of
nutrition that isn't breastmilk it will delay the baby's own ability to
achieve glucose homeostasis.
However ... there's no excuse for poor breast stimulation.  If the baby
isn't breastfeeding then hand expression every few hours will help to
prevent engorgement later, and facilitate the laying down of those
prolactin receptors (if that theory is proved).
Denise

PS: Congratulations on those new initials after your name!

Denise Fisher
mailto:[log in to unmask]
http://www.health-e-learning.com

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