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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