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Date: | Sun, 28 Nov 2004 12:44:06 EST |
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There should be no flames sent toward Kathy. I am actually in a very
similar situation at my work place as you are. I just want to clarify some points
for our LACTNET group.
Slowly and with as much persistence we need to educate the people and
parents we work with. We will have to give in to some pressure and keep within our
scope of practice. That said I still feel we need to continue to point out
evidence based information to all around us so over time they will know we
are always coming from the same direction.
Evidence:
Babies in the first 24 hours only need colostrum, baby's feedings will
have intermittent swallowing of amounts ranging from 7-14cc.
Babies are recovering from birth, this can take up to 3 days.
Mother's milk volume increases every day postpartum with the largest
increase occurring 3-5 days PP.
Babies have an extra layer of fluid on board at birth and can loss up to
7-10% in the first 3-4 days before starting to gain.
Babies respond better when skin-to-skin, showing feeding cues and arouse
better than when separated. Also maintain their temperatures and stabilize
their blood sugars.
Mothers sleep better when their babies are with them.
The sooner and more frequently the breast are stimulated and milk is
extracted, the faster that Lactogenisis II occurs.
These are statements we can continue to repeat. Over time hopefully staff
and parents will hear it and feel confident in it. In the mean time we make
compromises. :-(
The next step we can take and this is what we are working on at our
hospital; are the 10 steps to Baby Friendly. Included in these steps is rooming-in.
I think this is huge. What Kathy and Ester pointed out as problems with
non-latching babies only worsens with mother/baby separation.
Ester your comments about when to intervene with a non-latching baby. I
don't think if they were left with their mothers for 24 hours using skin-to-skin
that they would not make an effort to root. If they are rooting and not
able to latch that is when I would have the mother expressing colostrum into the
baby's mouth or on a spoon. This counts as intake/feeding.
Someday I hope to see the majority of hospitals as Baby Friendly and this
will because of all of you hanging in there fighting the good fight and sticking
with evidence based information.
Ann Perry, RN IBCLC
Boston, MA
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