On Sun, 7 Jan 1996 12:44:10 -0800 Donna Zitzelberger BSN, CLE wrote:
>
>        Thanks to all for your valuable info.  I will be bringing printouts
>of your responses to the next meeting (for those of you who are worried
>about this being a protocol, no decisions have been made yet - we're still
>in the planning stages).  I wholeheartedly  agree that recommending
>supplementation has dire consequences.  However, here's the problem:  Our
>hospital has a very early discharge program of 12-18 hours.  When it was
>first implemented, we had some horror story dehydration cases and the
>neonatologists were quite upset.  Instead of this taking the logical course
>(returning to longer stays), formula supplementation became the norm.  The
>breastfeeding rate dropped from approx 75% to 50%.   I began doing lactation
>rounds 3 1/2 years ago to counteract this and refer moms to our hospital LC.
>It proved to make the difference (breastfeeding rate went from 50% to 84% in
>the first month and we've maintained a rate of 70-90% since.). We also began
>calling all moms within 48 to 72 hours of discharge to catch any hydration
>problems.
>
>         I also don't like numbers and putting babies all in one category.
>However,the doctors are adamant about preventing newborn dehydration. I am
>too as well as all of you are.  I feel it's important that nurses, doctors,
>and LC's be consistent in patient instruction so that there is less patient
>confusion and lack of confidence in health care providers.  Let's face it -
>if the doctor says to supplement,  most  moms will put whatever I've said on
>the back burner. I'm working toward a goal of getting the doctors to
>instruct moms, "if you feel you must supplement your baby, please call the
>lactation consultant immediately".  So far, they are beginning to accept the
>first stage of this goal-- and are beginning to  instruct, "if you
>supplement beyond 24 hours you must call the lactation consultant for
>assistance."
>
>        I know some of you will be annoyed at such slow progress but
>whenever I seem to make progress against supplementation, another bad
>situation occurs. Llast summer a midwife who's babe was urinating barely 4
>times per day on day 10. Then, a  couple of months ago we had a baby with
>esophageal atresia.  It was discovered at 12 hours of age when the baby
>began to spit up breastmilk.  Every neonatologist (except one) made it a
>point to corner me and  take delight in  politely explaining that "this
>would have been discovered 12 hours ago if she were bottlefeeding -- this
>just proves what a small intake these breastfed babies get on the first day!"
>
>         Somedays I feel like the hospital LC, one incredibly supportive
>neonatologist, and I are the only ones who know that breastfeeding does
>work!  I've been on Lactnet for a couple of months and thank God for it.  It
>is really great to get all this wonderful info and support.
>
>        With early d/c becoming the norm around the country, I agree that
>this early voiding/stooling pattern definitely needs research.  We have a
>great  set-up to do research at our hospital since we call all d/c'd moms
>within 48-72 hours after delivery.  I will be discussing this with our
>hospital LC and that one incredibly supportive neonatologist!!!

I am unfamiliar with the ins and outs of HCdelivery, but from what I've read
here,
it appears that the ideal solution is to see the baby the next day.  Would it be
possible to substitute this (a brief next-day office visit with a
nurse-practioner) for
supplementation in the protocol?

Jonathan