Joy Noel-Weiss asks what we mean by birthweight.  If the mother and baby are
looked after in accordance with Baby-Friendly guidelines, the baby will not
be removed from skin contact with mother for about an hour, or until it has
attached and suckled at her breast.  Often this suckling will lead to
passing significant amounts of meconium.  The baby's recorded birthweight
will be lower than it would if the baby were weighed immediately after
birth, before coming to mother's chest, and the baby will have a bit more
slack because the first meconium will not be part of the magical 7 or 10 per
cent 'allowable' weight loss.  Babies born after CS will have more fluid on
board because they have not experienced having fluid squeezed out of their
lungs and abdomens while passing through the birth canal, and they are often
weighed before suckling or even having skin contact with mother, so they run
a higher risk of eliciting concern for larger losses in the first three days
of life.

Has there been any research to support the idea that a baby's fluid and
electrolyte balance is affected by maternal IV administration in labor? 

I'm much less concerned about the percentage loss than about how the baby is
reacting to it.  A baby who is actively feeding well every time it shows
signs of interest in doing so does not worry me on day three or five, even
if weight loss is more than ten percent.  The parents only need to know what
to expect for the next day or two when they should be able to see someone
who can take a look, hear how things are going, and weigh the baby again.  A
baby who is looking jaundiced, having scant urine with brick dust stains,
and feeding only when prompted and cajoled or coerced, worries me even if
the weight loss may not be more than five percent.  But as long as I am
confident that I know *why* the baby is taking longer than average to regain
its birthweight, and that appropriate supportive measures are in place, I'm
comfortable with deviation from the expected.

It floors me when I get a call from a community practitioner (normally a
PHN, who are responsible for all routine well-child care here from 1 week
until 18 years of age) who has a baby in her office that hasn't gained
anything from day three to day ten, and when I ask about urine and stool
output, she says 'just a moment' and I hear her asking the mother the same
question.  I should be happy that they are phoning us, but I am mostly
concerned that they don't even know to ask these questions first!

Rachel Myr
Kristiansand, Norway

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