The question is:  WHO is going to pay WHOM to make these calls?  That is what it boils down to.  There is no free.  Unfortunately. I am working at 110% speed, giving every single minute I can to moms.  I don't have the time to make these calls.  You are appealing to an economic need.  Who will pay for this?  Now we get into politics and taxation.  Which lies at the bottom of every appeal for more services and help for those who can't figure it out for themselves.  It is truly a difficult situation.  And there aren't any good answers.  

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Rachel Myr
Sent: Friday, February 24, 2012 10:07 AM
Subject: weight checks

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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