Loving this topic and all the great posts. Just a few comments:
Jarold - Love your comment that 1 ml colostrum contains 13 trillion cells. I think I have another good thing to tell parents who are worried about colostrum not being enough for the baby. Thank you. I wonder if the new Compendium is also considering the newer study by Santoro published in Pediatrics in 2010 that said the volume of colostrum day 1 is 15 ml total daily intake? That would make a total caloric intake day one of about 8 calories. Whether it is 30 ml or 15 ml total on day 1, or 8 calories or 20 calories, I think doesn't really matter, right? This is an estimate. The point is that it's really, really small and it's normal.
Tom - Yes, I agree that it is at a least a possibility that some babies may learn quickly that the milk comes from a bottle, syringe or spoon and not the breast. So if it's not broken we shouldn't try to fix it. But if it is broken, this is the best way to fix it. Hand expressing colostrum and spoon feeding to the baby. I would make the case to do this routinely with all the babies less than 6 pounds and less then 37 to 38 weeks. Teaching hand expression is a requirement for Baby Friendly hospitals because there was a study showing that when women learned this skill in the hospital, they were more successful with breastfeeding. However, just teaching it doesn't mean that they need to use it if there are no problems. I do think that all women should learn this skill in the hospital, though not necessarily use it.
Pat - Yes, thank you, I also think every 2 hours would be better for feeding preterm babies, I agree. Nils Bergman said in a lecture that when he advocated for 1 hour feedings for preterm babies, staff thought it was a good idea, but the nurses said that the doctors would never agree to it. And the doctors said the nurses would never agree to it, haha too funny.
Julie -. Here is a link to a study about amniotic fluid volumes.http://www.nature.com/jp/journal/v25/n5/full/7211290a.html
"Removal of AF is predominately accomplished by fetal swallowing (200 to 250 ml/kg fetal weight/day)."
So maybe more than 500 ml/day that the baby swallows. But in small amounts and it's quickly turned into fetal urine which makes more amniotic fluid, so unknown how much is actually in the baby's stomach at once. I've heard a theory that this is why babies nurse in that suck/suck/pause pattern for the first few days, because that's what they did in utero with the amniotic fluid. Swallow a little water and then rest, pretty continuously while awake.
Loved Henya's post on having a baby in America. I would love to take your post to work and read it to staff because I feel like this is exactly what is going on where I work. I wish people would stop and think about what they are doing more. Now that hospitals are becoming more "supportive" of breast feeding, I feel like we are starting to over-manage it a bit.
Some have commented that studies show better outcomes when babies breastfeed in the first hour. I'm completely on board with skin to skin immediately and attempting within the first hour. However, I think we need to do a better job of explaining to women what to do if the baby doesn't latch in the first hour because many of them are really stressed if it doesn't happen. I think they are interpreting try to feed the baby in the first hour as "you must breastfeed in the first hour or breastfeeding is doomed." In my prenatal class, I tell parents to attempt feeding through baby-led, laid-back feeding position. But don't panic if baby doesn't latch. Just put baby back skin to skin and try again when baby shows cues. We will get another chance, for goodness sakes the baby is only hours old. But I see many women at delivery, they barely catch their breath after pushing the baby out and they immediately grab baby and start pushing baby to the breast because they've been told breastfeed in the first hour. And then they are distraught if the baby didn't latch. I think nursing in the first hour is great, but don't forget that parents often take things very literally and they think these are "rules."
I think there is a big difference between a mother whose baby is in the NICU and won't be breastfeeding for weeks or months and a healthy baby in mom's room that just needs a few hours to learn to breastfeed. Research does show that moms who pump at 1 hour made more milk than those pumping at 6 hours, but the healthy term baby is going to latch (most likely) and then make all the milk it needs, so it's a completely different situation. Apples and oranges, I think.
Thanks for all the great posts. I learn so much here.
Tricia Shamblin, RN, IBCLC
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