Diane Wiessinger asks: 
If problems prevent the delivery of either baby or placenta by a certain
point we intervene because we know there will be more problems if we don't.
What about putting that bolus of colostrum in the same category?  Does this
make sense to those of you in hospitals?

Unfortunately, Diane, it makes all too much sense.  I can see it now, a new
stage of labor, just ripe for having its normal duration strictly defined
and procedures in place to ensure it doesn't get protracted.  Along with the
intramuscular or intravenous pitocin to hasten delivery of the placenta, we
will see staff feverishly squeezing breasts to glean the bolus within no
less than 15 minutes after delivery of the placenta, drawing it up in a
syringe and measuring it, recording the amount in the mother's record,
administering another dose of pitocin and attacking the breast again if the
colostrum bolus is less than 18 ml, or recommending cabergoline if they get
out 40 ml because it could mean the mother has a brain tumor.  Of course you
would expect them to tell the mother about how abnormal she is if the bolus
deviates from the mean by more than a certain amount, along with some
prediction about which problems she is likely to encounter in the early
days, oversupply or undersupply.  We can only hope they remember to feed it
to the baby at the end.  In my vision of this culturally warped fourth stage
of labor, the mother's accompanying person would be given a bundled up baby
and the syringe of colostrum and instructed to get busy and bond while
mother has a shower.

This would also be a prime opportunity to tell the woman how suited her
nipples and breasts are for breastfeeding.  Oh, I see your left one is a
little larger!  Don't worry, you'll probably produce enough anyway, even
though the right side is undersized.  Gee, your nipples aren't very elastic,
are they?  Oh, didn't your areolae get any darker than this during
pregnancy?  Don't worry, it could just be a normal variant...

We could just have formula packs in the delivery room to hand over to all
the mothers who produce less than the minimum defined acceptable amount!  

No, I prefer the Baby-Friendly guidelines calling for undisturbed skin to
skin contact between mother and baby immediately after birth, before other
routine procedures are carried out, PREFERABLY until the baby has latched
and suckled.  We just have to push things back a couple of hours, so that
instead of waiting until the mother has had any necessary sutures, we wait
until this last stage of labor is completed before opening the floodgates to
visitors.  In a pinch I could accept showing the mother how to fingertip
express but only if the situation makes a natural opening for doing so.

I wish we were as protective of mothers and babies as the zookeepers in
Seattle were in the early 1980s when a baby gorilla was born there.  No one
was allowed in to view them until the baby was a month old, because they
were afraid the mother would reject the baby if she were disturbed by all
the gawking.

Rachel Myr
Kristiansand, Norway

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