Phyllis asks:

<In the past, when babies were not fed for the first 24 hours, at least
in
the US:

First, as I remember it in our hospital, in the days of the baby boom,
twilight sleep, no or few IV's and mostly gas anesthetics in OB, no
babies were fed anything for 12 hours. Too mucousy and gaggy, for one
thing, and often sleepy, and not acting hungry in the least. (Moms were
not gotten up to the bathroom for the first time for the first 8-12 or
more hours either. No parents were allowed in nurseries, and babies could
only be seen through the window 1-2 hours a day. Parents were never able
to touch their premie babies till the day of discharge.)

The second 12 hours, they were fed (possibly even some degree of forced
feeding by the "deep throat" method that many nursery personnel may still
be using today!) 5% GW every 4 hours for 3 feedings. This acted as a
laxative, and they did in fact seemed to cramp and get rid of mucous (one
way or another) and more liquefied meconium fairly soon. The word
dehydration was never heard.

At 24 hours, or the first 2, 6 or 10 o'clock feeding thereafter, formula
babies then were switched to formulas made 4-5 x weekly by the
hospital-karo syrup, or sugar (in at least one hospital, fatally
accidentally mixed up with table salt) homogenized milk or evaporated
milk diluted with water to the desired strength, and poured into 3 oz.
bottles, (2 oz. for premies),  capped with re-usable latex nipples,
sterilized in the formula kitchen's autoclaves, stored there in
refrigerators, and batches transferred before feedings to mass bottle
warmers that partially submerged the bottles in warm water, changed maybe
once a day after rinsing out the trays. (Later research showed these
warmers to be excellent incubators innoculated with all kinds of colonic
bacteria from the fingers of personnel after having changed multiple
diapers with little or no handwashing unless fingers felt or appeared
dirty!)

Term babies were swaddled, placed in carts with 7 bins each, wheeled to
their mothers at 4 hour intervals for 20-30 minutes or so before being
returned to the nursery.  Moms were told put on a firm bra, or ask for a
binder, pull up their top sheet to cover the bottom sheet, intimidated
with the fear of the deity if they dared to unwrap their baby because of
"germs on their sheets". Mothers were handed, I believe, alcohol wipes
for their fingers, and breastfeeding moms were given cotton balls
saturated with boric acid solution (now known to be poisonous if strong
enough), to cleanse their nipple.

They were told to "get the whole circle" in the baby's mouth, and nurse
only three minutes on just one side per feeding the first day, five
minutes the second day, seven minutes the third day, and by the time
discharged on the fourth day, ten minutes (still one side). C. section
moms stayed 7-10 days and got to the sore nipple stage in the hospital
where nurses could see it.

Any breastfed baby who acted hungry on return to the nursery was
automatically fed a p.c. of whatever formula was routine for his doctor,
and mothers were strongly encouraged to have the baby kept in the nursery
all night at least for the first 2 nights, and fed two full formula
feedings, with almost all bottles routinely propped at least at night,
and breastfeeding babies were brought out again at 6 a.m.

By the third night, many very full moms left instructions to have their
babies rolled out to them at 2 a.m. (How I remember, as the only nursery
nurse, with one nurse's aide on 11-7, how hard those carts full of babies
were to maneuver onto the elevator when I was 7 months pregnant, before I
ran back down to the premie nursery, propped 9-13 premies, went back and
burped and diapered and repropped them till feeding time was over, then
left them alone for the next 2 hours, ran back upstairs to collect the
breast babies and maneuver the cart back down the elevator, and prop the
p.c. feedings as necessary!)

1) how common was jaundice? (today it's a Sentinel Event per JCAHO)

Well, I guess there was jaundice. These babies were nice and quiet and
content, hardly ever fussed, needed "encouragement" to take their
bottles. Jaundice was a term I only associated with the cirrhosis
patients on the med-surg floor. I don't remember hearing it used in OB.
But due to "efficient" feeding (i.e. "deep throat" individual feeding of
the sleepier ones, and others gulping it down to keep from choking while
propped) many babies got much more fluid and calories of one sort or
another by 24-48 hours than today's babies do.

2) how common was jaundice-related brain damage?

I can't accurately speak to that, since once a baby left the hospital,
the nurses in OB never saw or heard of most of them again (unless they
were our own or those of our friends). Complication rates, especially for
premies were very high, with few or no interventions beyond poorly
engineered incubators, poorly measured oxygen, some early antibiotics,
and hyperdermoclysis (subcutaneous infusion of fluids when necessary. No
bili-lights in our hospital till 1969.) I'm sure the ones with subsequent
complications (blindness, cerebral palsy, etc.) provided impetus for
continued research and eventual development of the perinatology and
neonatology specialties in the late 1960's/early 1970's.

3) what did hosp staff do about hypoglycemia?

What's that??? we'd have said. I think blood sugar monitors may have
barely yet been invented, and it's likely we didn't even recognize
anything wrong unless a baby had severe jitters or seizures. Besides,
with all the glucose water (which is capable of making hypoglycemia worse
by stimulating insulin) and lavish use of formula, there may not have
been as much as we might think now.

4) did this have any known effect on mom's milk supply?

What with the initial delay and the regimented limitation of suckling and
the ubiquitous supplementation, moms were usually very full and leaking
by the third or fourth day although they all received a shot of ergotrate
at delivery, and one pill of it every 4 hours x 6, then 3x daily for two
more days. We now know it is of the same medicinal family as
bromcriptine, a potent prolactin inhibitor!)

For the same reasons, sore nipples were less common in the hospital, but
really "bloomed" once mom and baby were home and feeding for a full 10
minutes at a time. Some edema also showed when the breast became so full,
but only the very sickest moms got IV's (from glass bottles, using
re-autoclavable rubber tubings and resterilized needles), so edema was
not near the problem it is nowadays. Not many persevered very long, and
the routine advice was to start fruit juice at 2 weeks, cereal at 3
weeks, fruits at 4 weeks, vegetables at 5 weeks, and strained meats at 6
weeks, so "exclusive" was a term never thought of, much less to be
desired.

Other comments?

Comparing then to now is even harder than comparing apples to oranges, I
suppose. Remember, most of those babies are now the middle-aged boomers
some of whom may have fought in Vietnam, and who are now running
industry, government, health care, etc. etc. today, some of them
lactnetters or perhaps the parents of today's lactnetters! But we must
deduce that some of them also fill our institutions for the mentally
retarded and developmentally delayed, and are probably also represented
in the population in homeless shelters, and of course, the cemeteries.

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

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