Judy Knopf writes

>Most of your questions should be answered by the RNs and LCs >who work in
hospitals

Well, I AM one of the RNs/LCs who work in hospitals, and unfortunately I
don't know the answers.  I've also contacted a good many other hospitals with
this question--everybody seems to be playing it by ear. Certainly I haven't
found anyone who has written protocols.

>we have discussed this issue from several different
>standpoints on the net already, since it really is SCARY when
>these little bitsies won't eat

Amen.  Scary it is.  I'm a recent subscriber to Lactnet, so I must have
missed the discussions.  Is there any way for me to get past posts?

>HOWEVER, as a plea from one who
>works "out there" (mom and junior/junielle are out of the
>hospital and on their own), try to think gently and as non-
>interventionalistically (wow!) as possible. Very bluntly
>speaking, I cringed when I read your question about "sequential
>blood sugars". Seems to me that a baby, after going through the
>trauma of birth, would shut down pretty solid if he was stuck
>every hour or so. We've already discussed what can happen when
>you push/force the baby's face into the breast. It takes a
>loooong time to unlearn aversions, if ever.

I couldn't agree more.  My questions were theoretical--I don't WANT to
intervene any more than is absolutely necessary.  However, as the LC charged
with writing policy for the institution which employs me, I have an
obligation (not to mention a burning desire!) to ensure that what we do to
and for our patients is safe.  Our actions also need to be based on
scientific/objective data so that they will stand up in court in the event of
a lawsuit (and the staff nurses need to be able to say, in court,  "I was
following the correct protocol")---this is an unpleasant fact of life for
medical/health professionals today.  I KNOW that I'm too aggressive in
dealing with a lot of the moms and babies who leave our hospital.  I
encourage lots of skin contact and sleeping with the baby and unlimited time
at breast and watching for hunger cues and responding to the infant's
needs--but I also teach pumping and finger feeding and supplementing and
recommend a log of feedings, voids and stools, all of which is certainly not
conducive to relaxing and letting nature take its course. But these women are
going home less than 24 hours after delivery--often to no help and no
support, with no experience, and with an infant that has barely (or never)
demonstrated the ability to attach and suck at the breast.  It would be
criminal for me to just usher them out the door with the reassurance that
"the baby will eat when he's ready, honey." I had a really frightening
experience with this sort of baby shortly after I began this job--too long to
add the whole story to this post, but the baby came into the ER, seizing and
with a blood sugar of zip between 48 and 72 hours of age, about 15 hours
after discharge from the hospital, and spent some time in PICU on a
ventilator.  He was worked up for sepsis and metabolic disorders but was
never diagnosed with anything other than hypoglycemia secondary to inadequate
intake.  Miraculously he survived, apparently unscathed (God knows if he has
subtle brain damage), but I lost a LOT of sleep over that kid, and I don't
want to feel responsible for that happening to another family, if I can
prevent it.  We're working on opening an out-patient clinic to offer some
follow-up in the first few days after discharge--but it's a bandaid for a
problem that merits major surgery. So....what do we do?  Believe me, I'm open
to suggestions.

Now, on a lighter note,

>nice to have Judy Dunlop with
>us! but could people address us as JK and JD? "Other" Judy, what
>say you?

There are several Judys on the unit where I work (we're all about the same
age--our forties--I'd bet nearly every Judy in this country was born at the
zenith of Judy Garland's career).  We usually add our last initial to
informal written info, so perhaps you and I could be Judy K. and Judy D.  Or,
my ego can support being Judy #2, if you'd like to be Judy #1  :-)

Judy D. (or Judy #2)