Maria,

<I have a professional here in town that thinks because mother's are
laboring
NPO, with dextrose IV due to epidural and inductions.. hospital policy;
that
the babies of these mothers are born starving and need formula in
addition to
colostrum because they have been deprived of nutrition during labor? OK
this
is out of my league as I am a non-medically trained IBCLC but it sounds
way
out to me . Any comments?>

The situation really has less to do with the mom being NPO during labor
than it has to do with IV's running rapidly. Mom's blood sugar gets into
a range high enough that the placenta is absorbing glucose from her blood
stream perhaps before her own pancreas can deal with it. (Her insulin
does not cross the placenta.) The baby is getting a "sugar high" so to
speak.

This causes the baby's pancreas to put out a lot of insulin to metabolize
the sugar into energy/glycogen/fat and keep the baby's blood sugar in the
normal range.

When the cord is cut, bingo! end of sugar high, but infant pancreas takes
a while to adjust, and in the meantime, fetal over-insulin secretion may
cause sudden low blood sugar in the baby, which can have potential
consequences that scare the pants off of HCP's.

In the past, some have erroneously given glucose H2O, which aggravates
the situation. Protein is much more stabilizing to the blood sugar,
partly because it digests slowly enough not to provoke a sudden blood
sugar rise.

If colostrum does in fact transfer into the baby early and frequently,
this fills the bill. But as we all know:
    * we can't measure if or how much colostrum is
       transferring into baby.
    * hospital routines operate much less stressfully
      (for the HCP) with quantifiability etc.
    * A measured amount of formula seen going in
      allays the anxieties of the HCP in question.

So, at least you have a better insight into the comments she makes. It is
not a matter of starving, per se. It is a matter of iatrogenic neonatal
low blood sugar, that is, a infant's pancreatic reaction to too rapid
infusion of maternal glucose load.

I can't cite any references off the top of my head, but I used to do
maternity staff inservices for all departments many years ago. Hope
someone can provide you with references on which you and she can find a
common ground to address practice.

Jean
*********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio

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