>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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