Sarah V writes "As I understand it, one of the official bodies (I
think it's the RCPCH in the UK) now recommends dropping the weight
checks between 2 and 8 weeks
as unnecessary.".  Lisa writes "At current, our clinic process for
seeing a new breastfeeding mom/baby does not include a baby weight
check."

What I have gathered about the recommendation in the UK is that it is
the *routine* weighing of a healthy baby between 2 and 8 weeks they
are talking about, but that a baby who was giving cause for concern
would be weighed as needed to determine whatever measures were needed
to ensure the baby's health and a lot of resources were being used on
unnecessary weight checks when those efforts could have been better
used supporting breastfeeding in a more nuanced way.  Lisa, in your
setting I think you could easily make a case for including a proper
naked weight at the first visit, as part of the routine baseline data
collection, and there should certainly be some mention in your
procedure manual about which babies would be weighed on the first
visit, if there is a decision not to weigh them all.

An exclusively breastfed baby who is demonstrably gaining weight by
day 5 and whose mother is feeding comfortably, knows the signs that
the baby is getting enough milk and has unimpeded access to competent
care in the event those signs are absent, or if she has any other
reason for concern about the baby, probably doesn't need to have any
routine weight checks between two and eight weeks.   Up to the two
week mark, I think babies and their mothers deserve  frequent,
personal attention, including weight checks as necessary, until we see
they are indeed thriving.

I've practiced through several major changes in the organization of
maternity care in Norway, the most momentous being repeated quantum
cuts in the number of days women stayed in hospital after birth.
Despite the hospitals universally shortening duration of stay from
about 5 days in 1990, to one or two days now, there has been no
corresponding strengthening of resources in the community to follow
them up.  The law requires that the local PHN make contact within 10
working days of discharge from hospital, and the law has been the same
for decades.  When it was written, women stayed in lying-in homes for
a couple of weeks, so ten days after that was undramatic.  But being
in limbo with a new baby, no named person or agency to phone with
questions, no planned follow up from the hospital, from day two until
day 16 (if you count weekends) is madness, in my opinion.

My hospital was the first one in the country to implement mandatory
discharge less than 72 hours post partum, and we started an outpatient
clinic at the same time.  One of the reasons was precisely to weigh
the baby as part of the assessment of how breastfeeding was going.  We
thought the clinic was a temporary thing because we assumed the local
authorities would get something up and running.  They haven't to date,
but it's only been 19 years :-p.  The rest of the country has
experienced the same kinds of cuts in postpartum stays but most
hospitals haven't bothered to offer any follow up so most new mothers
are even more poorly served than in my area.

I'd like to see a regulation here requiring that the health services
have a system for daily, individual contact by maternity service
personnel with every newborn and its family until it is clear that the
baby is feeding well (satisfied, growing, exclusively breastfeeding,
mother not experiencing discomfort that is impacting on frequency or
duration of breastfeeds).  Phone or e-mail contact could be used to
determine which families needed an in-person visit.   The most
important things, I think, are that someone knowledgeable is asking
the right questions and taking the right actions based on the replies
- and that it is not up to the parents to judge whether they *need* to
call someone, because such a system is fraught with uncertainty.  The
'someone' will call them, every day, until it's no longer necessary.

Rachel Myr
Kristiansand, Norway

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