>Breastfeed often
>Respond to early cues
>Establish optimal position
>Assure wide mouth/deep latch
>Sucking is active and rhythmic
>The milk is flowing
>Feel, hear, or see swallows
>Evaluate output
>Enjoy your satisfied baby
>Daily weight gain averages about 1oz
In a message dated 1/29/1 9:50:46 AM, self proclaimed "Picky" :-) Heather
makes some good points and ask good questions:
<< 'The milk is flowing' - i) how does the mother know
that as a separate point, and ii) should she be worried if when the
baby breaks off for some reason it's a trickle not a flow? (Answers -
i) she doesn't really ii) no, not really.>>
I believe there are some clues/signs that the milk is flowing when baby is
BF. This is just one part of a BF eval.
In the early days, when BF, moms may report feeling sleepy, thirsty, or
uterine cramps as a related sign of MER. This combined with other
assessments, like wide mouth/deep latch, see, hear, or feel swallows etc, is
a reassuring sign. Later, maybe after day three PP, they may notice the
"tingle" or "rush of fullness" sensation, or see the other nipple dripping,
or see milk in the baby's mouth as a sign of MER. This would be part of all
the teaching that could then include a BF acronym (my 9 yr old is saying this
may be an "acostic" instead of an acronym?).
I also use a variation of "milk is flowing" as part of a relaxation technique
after breast massage, position and latch, I do a little touch relaxation on
our new mom's shoulders and say to these often uptight early PP moms "now
close your eyes, take one deeeep relaaaaxing breath, and think about rivers
of milk flowing towards your nipples". 99.9% of the time I see them relax,
then look up at me and smile.
So, if I were using the acronym I wrote, the line "The milk is flowing" would
hopefully make them aware of some of the related MER signs we talked about,
and also trigger a relaxation response or a thought to remember to relax
while BF.
Heather says:<<Daily weight gain average of an ounce - well, no surprise that
I am
uncomfortable with that ; )It may or may not be true - we just don't have the
proper
reseach-based data. But even if it is tue, it can't be used as an
assessment of bf, as plenty of babies aren't average.And why weigh babies
every day unless there's a problem? >>
Why indeed? Hence the word "average". It is the *average* I would want to
emphasize when doing all the teaching related to an acronym. With the
high-L&D-intervention moms I work with, I do recommend a weight check in the
first week and include a guideline of "back up to birthweight by about 2
weeks". If the baby is not nearing birthweight by about two weeks I would
want to know and assess if there is a problem or not.
Other options for the letter D:
Determine average weight gain of ~5-9 oz per week
Determine weight gain of at least 5 oz per week
or, leave it broad after the individualized teaching for that particular pt:
Determine appropriate weight status
Dial our phone # and lets chat about appropriate weight status :-)
But, if there is a real problem, the "evaluate output" line, which the pt
should have learned about prior to D/C from the hospital, should trigger a
call way before the weight is an issue.
An acronym without teaching the details could be misleading and confusing to
new parents. This why I have not used one. It may have a good use in some
situations, but, I feel more comfortable using a more comprehensive BF eval
guideline sheet that details how to BF and how to evaluate BF.
Getting a BF eval "scoring" system through our multi-facility system-wide
documentation committee and into our hospital charts would take years I
think. I am happy that our latest BF documentation/charting section is a
progressive improvement.
Debbie (picky too) Tobin
RN BSN IBCLC LCCE
Springfield, Virginia USA
In the suburbs outside the Washington DC beltway
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