I get so annoyed when I start hearing about rules in breastfeeding.
They are wrong and they don't work.  Instead of getting health
professionals to learn rules and argue about rules.  "Ten percent is
okay".  "No, only 7%".  How about 8.5% to split the difference.

We are so so enamoured with technology we even believe that scales are
never wrong.  Here are a few examples, just in the past couple of
weeks.

1. A baby goes on the scale, the weight is marked down, by an
experienced observer, as 3.6 kg (8 lb).  Dr. Newman looks at weight,
sees baby is only 4 days old, was born at 7lb 6oz, and on day 2 at
discharge weighs 7 lb even.  Dr. Newman figures something does not add
up here.  Reweighs baby who weighs 3.19 kg (about 7lb).

2. A baby is born at 3 p.m. and is weighed at birth.  Weight 3.6 kg.
Discharged next morning and weighed at 7 a.m.  Weight?  3.3 kg or a
loss of 300 grams (almost 3/4 pound) in 18 hours.  Who believes that?
That's close to 10% weight loss.  Start supplementing?  Come on!

3. A baby is seen 10 days ago for poor weight gain.  Started various
measures, and over past 10 days has gained *2* oz/day on our scale.
However, if compared to doctors scale one week ago, the weight gain
over the week was only 3 oz.  Mother is hysterical.  Dr. Newman tries
to calm.

The point is that if we spent more time evaluating the adequacy of
breastfeeding, and helping mothers and babies so that when the baby is
on the breast he actually drinks, then there would be no problem.  I
have seen babies who apparently lost more than 10%.  I help with the
latch, use compression, and if the baby drinks well, then they gain.
That's what it's all about.  Not percentages.

While I'm on this rant, the baby must feed every 3 hours gets my goat
too.  This is strictly covering my bottom information, and does not
help the problem.  If the baby is drinking well, there is no need to
wake up a well feeding well gaining baby.  And if the baby is feeding
so poorly he won't wake up on his own, something needs to be fixed and
quick.  Feeding poorly 12 times a day is not better than feeding
poorly 6 times a day.  12 times zero is... just like 6 times zero.

See article in JHL June 1996.  And does anybody, besides me, actually
use the Breastfeeding Decision Tree?

Jack Newman, MD, FRCPC