about 3 hourly feeds:
Karen, I don't think you gave the wrong impression from what you wrote, as
it was clear that this mother was feeding on cue and topping up the baby at
the breast without waiting for some predetermined period of time to elapse.
It just seemed like a great opportunity for me to get out my soapbox and do
a little preaching about that phrase.  If we instituted 3-hourly feedings
for the staff on my unit I am sure we would all lose weight, because we nosh
constantly, especially on evening shift but even on days.  And yet we
persist in calling the babies needing extra frequent feeds '3 hour babies';
it baffles me.

about pre- and post-feed weighing:
I wasn't specific enough myself.  I do not EVER advocate this practice in
routine care, for all the reasons you give and because only the baby knows
whether s/he's had 'enough'.  It is still far too widespread where I work,
esp. on the 3 hour babies (!), despite the fact that we give lip service to
feeding on cue.  Would you like to come here and try to eradicate it?  I
have a nice guest room you could stay in and it will be summer soon, which
is a beautiful time of year!

In the case of a baby who is under close surveillance because of slow or no
gain, I do find it useful when observing a feed, to either confirm or reject
my impression about milk transfer.  We use electronic scales accurate at 5
gram increments and I have every reason to believe they are sufficiently
accurate in the ranges at which I am using them.  I don't use the number of
grams as a criterion for whether baby has gotten 'enough' since no one in
the world knows the exact energy content of a given feed, nor the baby's
exact needs at that feed.  Except in the case of a baby who is losing weight
and is so lethargic that I get alarmed, I feel safe trusting the baby to
tell us whether it was 'enough' or not.  Again, all I would use pre- and
post-weighing for in this case would be corroboration of my impression that
milk transfer was or wasn't happening, and it would be one piece of data
among many.

We await the next installment with interest.
Rachel Myr from up over (opposite of down under, right?)

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