http://www.nctms.co.uk/prodshow.asp?id=1005&cat=69&scat=81
The above link takes you to a new product called
'What's in a nappy?' which I have co-authored and
edited for NCT. It is a tear-off factsheet on a
pad which includes referenced info for midwives.
The idea is that individual mothers get their own
sheet (it's cheap) and the midwife giving it
informs herself of the ratinale behind the
information on it.
With my co-author, a senior midwife and feeding
specialist at Simpson's Maternity Pavilion in
Edinburgh, I re-worked an existing factsheet,
already in use at Simpson's and evaluated. The
number of re-admissions for dehydration had
fallen significantly in the 18 months the
factsheet had been in use.
In re-working it, we looked again at the
literature and filtered it through our
observations and experience, checked it with
colleagues, and came up with ' 2 or more' stools
a day on day 3-4, and 'at least 2, soft yellow'
stools on 5-6, and on day 7 onwards we're
looking for at least 2 and the size should be
larger than a £2 coin. We have pictures which
back all this up.
So, probably fewer than the discussions here on Lactnet....
We urge that breastfeeding is *observed* and
*fixed* if necessary. We also urge routine
weighing (I can't tell you how that freaks some
midwives out....normal practice in most parts of
the UK is not to weigh at all after birth, for
10-14 days) for all babies, and for the weights,
and the feeding observations, and the talking to
the mothers about baby's behaviour (eg not
sleeping forever), and whether breasts/nipples
are sore to be *put together* to make an
assessment. Anything that gives cause for concern
can usually be fixed by attention to making sure
the feeding is effective.
No need for formula, or stimulating the bowel, or
anything else except in the most dire situations.
Very few babies who don't stool much in the
first week are without feeding problems. A few
healthy, well-fed babies seem to 'miss a day' but
that's rare - but lack of stools in itself is not
diagnostic of anything. It's just a sign that
everything needs looking at closely. On the other
hand, I am very reassured when a mother calls to
wonder if 'my baby is getting enough because he
is feeding all the time' and she tells me she has
full nappies several times a day.
The point of counting and observing stools is to
intervene (by fixing the breastfeeding) early
enough to avoid a crisis later.
Heather Welford Neil
NCT bfc, tutor, UK
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