Leslie,


About your question on your hospital's current rules regarding formula calories so soon if a baby does not latch and/or no colostrum can be expressed to give them:


I have no current facts to offer. For context, however, I do have some historical recollections, beginning from 1948, in the waning days of the "baby boom" after WW II. I worked in OB in a general hospital where any obstetricians were simply general practitioners who had begun to specialize in care of mothers and babies. We were having 300+ births per month in this hospital, which was one of 4 or 5 in our community. (I worked for 2 weeks in one of them, then finding it even worse, "came back home" to my own hospital.) I worked the night shift, sometimes as the lone R.N., with one nurse's aide, one practical nurse, and a nurse anesthetist asleep in the unit, on call for deliveries. There were occasional nights when we had 8-9 admissions and/or births, more often 4-5. Believe you me, we worked hard, and ran often!



Very few inductions, mostly 42-weekers, some of them with castor oil, hot enemas, and/or a q-tip saturated with pituitrin, inserted intranasally. But no doubt there were some spontaneous late preterm labors. Most examinations for progress of cervical softening and dilatation in labor were rectal examinations. Mothers were kept NPO in labor and no IV's were given. (I remember a few dire emergencies where a venous cutdown tray was opened to start a blood transfusion. Afterward, we washed the rubber tubing, sharpened the needles and autocaved the tray for any future emergency.) Most mothers were given "twilight sleep" (Demerol 100 mg. and Scopolamine 1/150 gr., (maybe they welcomed it after those exams;-) and general anesthetics, (a few spinals or caudals now and then), and most had forcep deliveries (if we didn't misjudge our time to call the doctor, in which case some had precipitate deliveries;-). We had occasional mothers who attempted natural childbirth, but we really didn't know how to support them. All moms received 1cc of pituitrin IM after the placenta (at some point replaced by pitocin, which won the Nobel prize in Medicine in 1955) + 1cc. of ergotrate IM (much later proven to have a delaying effect on L-2)



All babies were bathed in the delivery room, swaddled and taken to the nursery usually before the mother awoke. All babies were kept NPO for 12 hours, then bottlefed every four hours, starting with 3 feedings of 5% glucose water before any baby had the first breastfeed (or formula feed) at 24 hours. This no doubt enabled the mothers to get over any nausea from the anesthetics, and the chance to get up to the bathroom with assistance for the first time 8-12 hours after birth. A few fainted.



Such was the care of many of our current baby-boomers as newborns, perhaps even your own parents! Many of these babies are now still leaders in our government, our civic society, our educational systems, our churches, our health care institutions, our military officers, etc. etc. etc. On the other side of the coin, there were babies who didn't make it, or who were effected with cerebral palsy and other sad complications, and I have no statistics. 

 

I do however want to refer you to some of my recent (within the last 6 weeks) Lactnet posts about the use of 60+ seconds of reverse pressure softening very early if necessary, if here are unsuccessful attempts at latching or hand expression (or pumping) (especially if the mother had IV fluids for many hours before the birth (pit induction, MGSO4, etc.) Feedback from lactnetters has confirmed my observations that RPS, properly used, repeated as often as needed, utilizing anti-graviy positioning, will temporarily reverse the early (invisible) beginnings of excess interstitial fluid/pre-L-2 edema/engorgement for long enough to express some colostrum. If you need any further information, please contact me privately.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome