Dr. Leeper, you have a great opportunity to make 2 important points using
evidence from the research lit. Four slides and a bag of walnuts will cover
your main points. (I'd forget about talking about benefits. I just start
out by saying "There isn't anyone left alive on the planet who doesn't know
we have the evidence to prove that human milk is the most appropriate food
for newborns."
Then hit them with some laughs. I always pass around a bag of walnuts, have
each resident take one out to hold without telling them why. I just tell
them to "hold onto their nuts," because residents are always very into
gross humor (in my experience;) The point about small physiologic intakes
in the first few days postpartum is well made by Wang in a J. Tropical Peds
article. The full ref. is:
Y Wang, et at: Preliminary Study on the Blood Glucose Level in the
Exclusively Breastfed Newborn, J Trop Peds 1994; 187-8.
The authors looked at 60 normal newborns (gest age 37-41 weeks and weights
from 2500-3999g with Apgars of 8-10). 30 were assigned to exclusive bfg, 30
controls wer fed by mixed feeding or exclusively formula fed. There was no
significant difference in the baseci blood glucose levels between the
groups. Group A (the exclusively breastfed) showed greater loss of weight,
but weight increase started slightly earier and total weight gain by the
sixth day was higher in Group A.
The article states: "The capacity of the newborn stomach after birth is
very small in the first 2 days. In a 3-kg baby, for example, the average
physiological capacity of the stomach is 6 ml on the first day and 12 ml on
the second day after birth, while the average volume of mother's colostrum
is 25-56 ml on the first day and 113-185 on the second day. Although the
amount of colostrum secreted is not voluminous, it can still meet the needs
of the newborns...Frequent sucking in the first several days can increase
milk secretion up to about 500 ml per day after the third day, thereby
allowing a rapid weight increment in Group A."
I would make a slide with this info, reinforce the visual and auditory
message with the tactile experience of holding the walnut (as an
illustration of the size of the newborn stomach) and make the point that
large feeds on Days 1-2 are non-physiologic.
Then, I'd refer (in a slide or overhead) to the findings of the article that
describes a tool for predicting the women who are at risk for premature
weaning. These authors have good evidence that the following significantly
undermine bfg: Young maternal age (< 20), long intervals between feeds,
early use of bottles, previous bfg failure, any kind of latch difficulties,
and vacuum assisted deliveries and hypertension.
If these factors are systematically screened for and early intervention
instituted (hopefully by skilled LCs) then a lot more bfg success would
occur which is what their professional organization's policy is that they
help ensure. The research will make the point for you without having to
challenge the nurse directly. The ref for this article is:
Hall, R, Mercer, A, Teasley, S, et al: A breast-feeding assessment score to
evaluate the risk for cessation of breast-feeding by 7 to 10 days of age, J
Pediatr 2002; 141:659-64.
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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