>I was just reporting what I saw in a mid eastern USA city.  But it 
>became so customary that it was always there in the back of my mind. 
>This was 20 years ago or so and deliveries weren't as medically 
>managed, not tons of IVs, few epidurals etc


I think a lot of us have the experience that when birth is interfered 
with less, breastfeeding gets going better, more quickly. It's also 
linked with the postnatal period being interfered with less, too - at 
least it is, here.

>But from my more recent experience as a PNP I still found, not at 
>birthweight by 2 weeks was too far out.    I saw babies 20 years ago 
>at 48-72 hours, ditto for present day.  Weight at 48-72 on 
>consistent scales, consistent clothes, done by me.


But babies should be naked for weighing, yes? Clothing of any sort 
makes it less accurate.

Some babies not at birthweight at 2 weeks (the babies in the original 
post were 10 days, and 'close' to birthweight) are indeed 
demonstrating on the scales that all is not well, and there are 
almost always other signs of this, in my experience - the scales are 
merely one sign. But even at 2 weeks, I'd still be looking at the 
*whole* picture - if the baby's weight trajectory is clearly upwards, 
if the feeding is normal (frequent, effective, responsive, day and 
night)  in every way for mother and baby, if the mother and baby are 
doing well...then where's the problem?

Heather Welford Neil
NCT bfc, tutor, UK





>
>
>----- Original Message ----- From: "heather" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, November 11, 2011 5:29 AM
>Subject: Re: bowel movements
>
>>  >For starters: 1. I'm of the opinion that 10 days or 2 weeks is 
>>too long >for a baby to regain to birth weight.  I wasn't in a 
>>position to study >this when I got my MSN in 1994, but while 
>>working on my MSN I did home >vss for a hospital that did 24 hour 
>>discharges with a home vss on day 2 >and 4. Invariably I saw babies 
>>who were nursing OK on day 2 to be back to >birth weight by day 4. 
>>If they weren't back to birth weight by day 4, I >considered baby 
>>at risk and could get another vss.  If they weren't back >to birth 
>>weight by day 4, it was usually a problem in baby or mom.
>>>2. A baby at 10 days, below birth weight, not having adequate 
>>>stool, would have all my red flags waving.  Something is wrong 
>>>with production (mom) or transfer (baby).  Pat in SNJ
>>
>>
>>Pat - the overwhelming evidence is that return to birthweight is 
>>not fixed in stone at an early stage. The  WHO weight and growth 
>>charts (from data taken from excl breastfed babies)start do not 
>>start until 2 weeks for that reason.
>>
>>I think the evidence is pretty clear: the key to assessing how well 
>>a baby is doing vis a vis his weight gain is *trajectory*, not a 
>>date by which the baby achieves birthweight....birthweight can be 
>>i) badly recorded ii) artificially inflated - see the recent paper 
>>on maternal intra-partum fluids .
>>
>>A newborn should be *gaining* weight, for sure, after about day 4-5 
>>- there are a number of  studies that confirm this -  but I don't 
>>know of any studies (and I have done a fairly recent trawl of the 
>>literature on this for a piece of work I did for my organisation) 
>>that indicate failure to reach birthweight by day 4 to be a sign of 
>>being 'at risk'. If there has been more recent work done on this, 
>>I'd be interested.
>>
>>All mothers and babies should be supported and their feeding 
>>effectiveness assessed throughout the newborn period, as part of 
>>normal postnatal care. So stooling is *one* part of the picture. A 
>>baby 'close to birthweight' at day 10, whose  feeding is going 
>>well, whose weight is going upwards,  who is being seen by someone 
>>capable of assessing this (as opposed to listening on the phone to 
>>the mother's report, which may not be accurate)....that baby may 
>>also stooling 'inadequately' but be ok. The stooling or lack of it 
>>is a red flag to check all that other stuff out.
>>
>>To check for  'achieves birthweight by day 4' is  to set a very 
>>high bar indeed,  IMO, and risks worrying mothers and HCPs 
>>unnecessarily. Far more helpful at that stage is to ascertain that 
>>feeding is going well (or on its way to going well - we can 'allow' 
>>some learning time for both mother and baby if everything else is 
>>ok :) )
>>
>>Happy to hear other comments about this from others!
>>
>>Heather Welford Neil
>>NCT bfc, tutor, UK
>>--
>>http://www.heatherwelford.co.uk
>>
>>http://heatherwelford.posterous.com
>>
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-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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