I too thought of maybe a birth injury, dislocation, or nerve injury as one
possibility. I am glad Jay brought up about "jumping the gun" to formula. I
would love to have some discussion on this. This is a very hard decision
becoz, as was discussed earlier this week or so, sometimes intervention is
begun too late (as in too little, too late). I have asked this question
before on lactnet (I've been away awhile) so I'll ask again:
What is better (or worse) situation for the baby (also I guess for the mom)?
a. wt loss or no gain x several days or weeks, but receiving only
breastfeeding or ebm?
(how much is too much, jaundice levels etc)
b. minimal wt loss and quick regain/surpass but receiving some formula for 1
or more days? (always of course preferring breastmilk when available)
Often no interventions are done the first 24 hrs or so, maybe 48 hrs if the
baby is healthy term, thinking of course this will all work itself out, but
then it doesn't, and you are a little "behind" now.???
This to me is the very difficult decision. Please realize that most LCs are
not the primary hcp and many many pediatricians are not "really" supportive
of bf, (meaning they are very ok with formula and bottles and so are
parents) so that it is often difficult for the LC to strictly avoid formula
use, unless the mother has an early abundant supply (of course we try to
facilitate this). Even if I was in total control of the "management" of the
dyad, I would still have trouble with choosing between a and b above. Please
Jay share your thoughts. Would love to hear from all of you on this dilemma.
I will admit I tend to err on the side of caution (use formula), being in a
very unsupportive environment, and mostly talking about 35, 36, 37 wk babies
who are 5 to 6 or so pounds. Would this change your approach any?
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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