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Subject:
From:
Glenn Evans <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 15 Nov 1997 10:21:27 -0800
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"Is this more theory than fact?"

I would ask if this is more myth than fact.  Isn't a theory something
someone is working to prove or disprove.  Whereas myths just accepted.
We like to blame epidurals, IVs, pitocin, and all manner of technology for
every ill that befalls mom and her baby, but I think there are many variables
at play that have to do with factors of mom's pregnancy and the baby's
development in utero, than to blame it all on the last 30 hours.

I too would like to see some references -- I haven't noticed this edema/
weight-loss in babies.  Nor do I see it is particularly the larger
babies who have excessive weight loss, when you go by % lost.

If anything, my observation is that it's the smaller babies who lose
more.  My understanding is they have less body fat, and therefore have
smaller reserves.  Fat weighs less than muscle, so the bigger new born
would lose less weight while providing energy for the ADL.  The exceptions
 in this observation are the IDMs, who have more going on than just being
big, and may in fact lose more weight.  I don't see enough of them to really
judge.

 I think a lot more has to be dealt with than mom's IV fluids.  Just
because she GETS a lot of fluid, doesn't mean she RETAINS a lot of fluid.
For most moms in labor, I = O, especially when you include in insensitive
water loss (sweating and breathing).

We do give mom big boluses of fluid before epidurals (1000 cc).  But
again, between mom's voiding and sweating and open-mouthed breathing,
she also usually gives it all back. ( Granted moms on epidurals do less
sweating and open-mouthed breathing, but that isn't what causes mom's
bloating, I don't think.)  Otherwise mom's don't get flooded with fluids, by
and large.  At least in my hospital -- Mag is given in a very concentrated
solution, so mostly moms get 50cc an hour of that.  And pit is so
concentrated, that even when we are giving 30 mu/min, it's still only 60
cc/hr.   If mom is on both, that's still less than a four ounce glass of water
per hour.  Over 8 hours mom on Mag would get less than a liter of fluid.
Fluid restrictions for Mag moms (who are the only moms we routinely
restrict fluids on) is 1200 cc per shift.

Pre-eclamptic moms, who are probably the most susceptible
to retaining fluid, are monitored very closely as to their output.   We expect
to see an increase in output on Mag, especially if moms have been oligo-
uretic -- that is part of the effect of the Mag.  We hope to see an about
equal intake and output of fluids, or even a diuresis.   If moms's I & O close
 to balances out, why would the baby be at risk for edema?

And if mom is getting edematous from the fluids, isn't this due to the
fact that fluid is going in between the tissues, and not into the blood
stream.  And if it's not in the blood stream,  how can it be getting to the
baby?

Just thinking back over my experiences -- if anything, moms who are
preeclamptic, especially if they are severely pre-elamptic, tend also to be
oligohydramniac, and the babies tend to be IUGR as opposed to big or
edematous.

All of the above is without references.    It is my set of observations,
that doesn't tally with the observations of others who have posted so far.
Depending on the types of populations we see, we could develop very
different impressions.

So, does someone have references that have already done the factoring of
 multiple variables, including IV use in mom, as related to babies weight
loss, that might introduce more understanding of the subject?

Chanita, San Francisco

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