I wanted to change the subject to 'failure to thrive' but that would break
up the thread.
Is it typical that someone would be able to get hold of an electronic scale
to weigh a baby on, but fail to get hold of someone who could act on the
alarming information gained from such weighing?  What on earth good is the
scale doing when nobody is responding to the fact that the baby in its first
ten days of life (as I gather from the info in your second post, Liane) lost
almost 15% of its body weight and when it finally started gaining, did so at
such a slow rate?  This is just *screaming* 'not getting enough milk'.   I
would have been worried on day 10 to find a baby 15% below birth weight and
I would not have been satisfied to wait another week before ensuring
adequate intake.  Having the mother do pre- and post-feed weights would not
meet my criteria for a complete plan of care.  The first rule is still 'feed
the baby' with 'protect the milk supply' a close number two.  After making
sure both those bases are covered, the next step is to make sure the
mother's confidence is not undermined.  In this case it sounds like the
mother has more confidence in herself than the situation merits; I am
unconvinced that the baby is getting adequately fed and equally unconvinced
that milk supply is being protected.  With adequate feeding these babies
show rapid rebound weight gain and they quickly become better feeders.
Without it they piddle along like this guy.
The mother seems not to realize that the baby is showing lots of red flags
for not enough food.  I'd need to be sure that she knew the baby should be
getting 15% of its weight in milk every day until growth was normal and I
would not expect a baby who is so far behind expected growth to be able to
get himself fed or protect his mother's milk supply on his own.  I'd
want her to keep in close touch if the baby was not gratefully taking in all
the food she was offering while trying to get him back to the starting
line.  I'd expect the bowel movements to start once there was something
going into the baby to digest and not a moment before.

Referring to a pediatric gastroenterologist sounds like going sparrow
hunting with cannons but there is the chance that this doc will have the
sense to look for the source of the problem rather than treating it as
constipation.  We still don't know how often baby is feeding.  If the baby
is transferring two ounces at every feed and is feeding 10 or more times in
24 hours for a total of 20 ounces or about 600 ml/day and still not gaining
more weight than it is, then yes, it could be a metabolic zebra, but my
money is on a plain old horse behind these hoofbeats and that the baby is
simply not feeding effectively/often enough.  Could the mother be
interpreting crying as a sign of vigor and being reassured by it rather than
hearing it as a late hunger cue?  Just wondering - though by now the baby
may have given up on crying and gone into more passive waiting to save
energy.

I'd be really really curious to hear what the midwife has been thinking.  It
seems unlikely that this baby was ever feeding well, and if the woman stayed
in the midwife's home for three days without the midwife even picking up
that the baby was hungrier than normal, that's scary.

Rachel Myr
Kristiansand, Norway

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