Carol wonders, "i noticed that no one in other countries such as australia wrote in to say that, yes, mothers there routinely let babies die or feed them (what would it be in australia instead of dr. pepper, fosters?) horrible stuff in bottles. somehow i think the protestations about "we don't want babies to die" is an expression of our acculturation to use of abm and bottles, and of that as a feeding norm. if we just ceased to think of it as normal and acceptable, we would use our energies to think of ways to make the change possible and support the mothers and babies in other ways." Amen to that Carol! However, I thought of you all this weekend when I was referred a 3 week old African baby recently discharged from the ICU in our large teaching hospital, into a paediatric ward. The baby had very nearly died. He had been born full-term in a hospital that was certified as baby-friendly a couple of years ago. Mom "collapsed" shortly after delivery due to blood loss and the baby was kept overnight in the Neonatal Unit and given to mom the next day. However, to my horror, she told me that no-one assisted her to breastfeed or to express her milk during her 3-day stay, or even to check if she was producing milk. It seems as if mom and baby were discharged home on the third day with baby exclusively "breastfed", weighing 14.7% less than he had weighed at birth, but neither the hospital staff, nor the parents, attached any significance to this. Once home, things obviously went from bad to worse. The baby seemed to be breastfeeding for hours at a time, but cried a lot. Mom's breasts became very full and sore, so she "expressed" the milk on to a towel (!!!) (awful technique, scrunching breast with both hands from up near the chest wall down ..) and fed the baby "mineral water" to pacify him. They took the baby off for his 10 day check-up, where it was found that he weighed 30.29% less than he had weighed at birth. The paed referred them to me at this point, but they didn't call me at this time. On the 11th day they took him to the Casualty Dept of the large hospital because he seemed so sick, whereupon he was admitted to the ICU where he remained on a drip for the next 8 days before finding his way into the paediatric ward. When I saw him 4 days after this, referred by yet *another* paed, and still 11% below birthweight, he was still "breastfeeding" and mom had been expressing 20ml EBM every 3 hours to go down the nasogastric tube which had just been removed. But *still* no-one had assessed the breastfeeding, so he was about to go downhill again. It seemed pretty fraught. The baby had that *very* alert, watchful expression, and moved very little, and didn't cry, just moaned politely, urine and stool output were low. He was pretty wasted, and the family were all very caring, but obviously had no idea what to do. A breastfeeding assessment showed that he was tongue-sucking - eureka! The breasts looked very involuted, but mom was able to express (corrected technique) in multiple little jets and I showed them how to finger-feed, which mom and baby both loved straight away. I gave specific instructions about topping up with formula - they had bought their own tin into the hospital, but hadn't used any yet. On the way out I asked the Sister-in-Charge if there was any particular *reason* why no-one had yet suggested that this baby receive formula supplements???? She looked very uncomfortable and said that "In this hospital we promote *Breastfeeding*". Aaaarrgh. Anyway, lots of phone calls later I had "permission" to use the formula, and relayed it to the parents. However, when I followed up the next morning I found a miracle. Mom had been able to more than *triple* her output by expressing every hour, as I'd suggested, and baby had had exactly what I had recommended in terms of volume, but it was all EBM. He was fast asleep with that "drunk", full expression, he'd stopped moaning, and his output had increased. Mom's eyes had that soft shiny look that tell you she's proud and happy to be able to able to feed her baby at last. From now on? I've left lots of recommendations, given lots of anticipatory care, and will do my best to keep track of this baby for a while, but realize that the parents may not keep in touch, so I just have to hope. Sorry so long. I thought you might like to know about this baby who seemed to fall through a crack in a system that's supposed to be perfect, but isn't. And yes, I've reported this shocking case to our National BF Co-ordinator. Thanks for listening. Pamela Morrison IBCLC, Zimbabwe *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html