Martha writes:


>  At our
>facility, we give the baby a full 24 hrs to learn to breastfeed, check the
>blood sugar if they haven't latched by 8hrs, and don't consider
>supplementation until the 24 hour mark, unless baby has a blood sugar <36,
>or has dropped >10% of birthweight.

Not commenting on you here, Martha, as I know protocols can be an
amalgam of different influences....

But why the time limits and the other numbers? 24 hours is a very
short time for a baby who may be recovering from a drugged birth, or
an extremely quick one, or forceps/ventouse, or a long and struggling
labour. Blood sugar levels are controversial - there is a wide margin
of 'acceptable' (see Jane Hawden's work) and would it not be better
to observe the baby for clinical signs of low blood sugar (healthy
term babies are not at risk of hypoglycaemia in these first hours
after birth, surely) rather than test and then get results about
which there is no consensus?  Testing itself is an intervention.

In the UK, there are also protocols bf supporters feel uncomfortable
with, too. Here, it is common for the baby's birthweight to be a
deciding factor, regardless of other issues. I think institutional
maternity care all over the world relies on protocols for feeding
management.

Yes, it *is* hard for institutional care to look at mothers and
babies individually and to individualise their care based on careful
observation and communication, but I would love to see a time when
this happens. It is essential to ensure breastfeeding is protected.
The Baby Friendly 10 steps is a good start to getting protocols which
are evidence-based and which can be translated into practice.

Supplementing with formula is a Big Deal - quite apart from the risks
of even one feed of formula, we know it impacts on the likely
maintenance of breastfeeding.  It should only ever be done by
mother's genuine, informed choice after discussion, or on
research-based clinical grounds...not to comply with protocols which
are (in my experience) very rarely research-based.

Baby Friendly is permits formula when medically necessary, but of
course it's then up to practitioners to make sure that medically
necessary really is necessary.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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