>I don't know if I missed part of this thread or not, but I am wondering why
>we would "not" supplement at the breast for all babies with weight loss
>issues.
I can think of scenarios where this might not happen. I don't
presume to tell other people how to practice but for the record (and
there are many people on Lactnet who are new to breastfeeding
support), I think it's wise not tp assume there is an
internationally-agreed consensus on this, and to recall that practice
is affected by the culture we are working in.
Leaving aside the mother's right to select on the basis of good
information what she intends to do, I'd point out that
'weight loss issues' are only one aspect of a baby's health and well-being.
Let's take the baby who is (say) 10 per cent below birthweight on
day 5. But the mother is happy to listen to how she can bf 'better'.
So at this stage we explain how skin to skin contact and very
responsive feeding (offering the breast at every feeding cue) can
support building up and maintaining a good milk supply. We would
observe a feed. If the baby is in any way sleepy or lethargic and/or
apparently not transferring milk well, now would be the time to
consider expressing and offering ebm in addition to the bf.
BUT if the baby is alert and feeding well - and this does happen -
and the stools show signs of changing, then there is every chance all
will be just fine, and there would be no need to suggest expressing
and offering ebm (mother needs to know all the stuff about feeding
cues and night feeding and everything else, of course).
In the UK, good practice would be especially careful to take into
account every other aspect of the baby, because for some reason,
accurate weights are hard to obtain here. Too many birthweights are
taken casually and inaccurately, and our crazy habit of working in
pounds and ounces *and* metric leads to transcription and translation
errors. In addition, some community midwives - the ones who would
normally do the at-home weights - still use spring balance scales,
and/or weigh babies clothed. So it behoves anyone working with
mothers and babies to be routiely sceptical about what mothers say,
and what the records state, about their babies' weights.
Speaking culturally, breast pumps are not yet part of every mother's
equipment here, and hand expressing is not well taught. Expressing
can be a big hassle to UK mothers and not something I can assume
they are comfortable with. So it's quite a big deal to suggest this
to someone here...needs careful and sensitive handling, anyway, as
some mothers may decide to stop breastfeeding completely if they
think they have to do this.
Again, in a UK context, it is very easy for any baby to get weighed
at a baby clinic, and to get a check-up from a health visitor or
family doctor at any time. A good midwife and/or health visitor will
keep checking on a baby who is not doing well, and follow-up, once a
problem has been seen, is usually pretty good. That increases the
window for supporting a baby with weight issues (who seems otherwise
fine) without supplementing.
Heather Welford Neil
NCT bfc, tutor, UK
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