Dear Lactnet Colleagues,

The comments regarding wondering just what exactly is normal with regard
to frequency and amount of nursing in normal newborns caught my attention,
as well as some other comments along that line.

As a midwife/lactation consultant/primary care provider for women and
babies, I have counseled for years that there is a huge variation in what
is normal for babies after birth just as there is truly a huge range of
variation in normal labors.  I have seen babies who latch once after birth
and then sleep deeply with little nursing in the next few days to babies
who are mostly attached from birth onward thru the next few years (if mom
is into unrestricted feeding) all within the range of normal and without
subsequent problems if mom was not medicated or separated and if no one
tried to "help" by introducing bottles, pacifiers, etc.  And yet, in
pondering questions like, "how many wet diapers should we expect in the
first few days from the normal nursing newborn?" and what range of feeding
behavior is "normal", I am sort of astounded at the lack of basic research
and documentation of these issues. I feel that a great deal of what I know
and feel comfortable with is based on observation over many years of
unmedicated, unseparated, un-messed-with births and postnatal times.  Then
I think about all the interference typically seen in the US birth scene
(many hospitals, at least) and probably in other places in the world that
have tried to imitate our technological bent, and I think that I would be
suspicious under the circumstances about data collected and assumptions
made under these conditions.  Interference in the process of birth and
breastfeeding seems to be pretty much the norm in hospital settings rather
than the exception, so much so that workers in those environments are
often not aware of that they are interfering.

I do believe that if we turned our attention to it, that data on normal
breastfeeding frequency, duration, and other info (like how many wet
diapers are typically seen in the early days of uninterfered with nursing)
could be collected, however.  One way would be to utilize existing
services such as birth centers, home birth services, or even hospital
centers where there is a reasonable rate of unmedicated delivery and
non-separation of moms and babes and enlist practitioners in keeping such
data. I believe a tool could be designed for such a purpose, and if care
were taken with data collection, that it might provide a starting place
for not only looking at the range of breast feeding behavior in normal,
unmedicated, unseparated mother baby pairs but also for beginning to
assess the impact of common interventions on feeding (ie labor meds,
separation, etc) in a later step.

Such a study would not be experimental -- it would be observational, would
depend on concientious data collection, but now that we are aware of more
variables which can potentially impact on feeding, it should be easier to
design a data collection tool to screen for such things.  To be applicable
to a large group, one would need large numbers of mother infant pairs
included in the observations but this could be accomplished by recruiting
providers into the study and collecting data from many practices over a
period of time.  I believe that with the growth of the internet, it might
even be possible to collaborate with others on such a study via
cyberspace.

Anyhow, if there are others who are seriously interested in collecting
such data, I would be interested in helping coordinate the effort,
assisting in designing a tool and so on.  Maybe someone out there knows of
a source of funding to help support such an effort?  Seriously. We have
the tools and the useful technology with in our reach that makes it
possible to collect this basic data, and there are a whole bunch of
talented people on this list alone.... I bet it could be put together....
and can you imagine the response that such a collaborative effort might
generate?

Ione
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                        C. Ione Sims, CNM, ARNP, MSN
                          Community Nurse Midwife
        Sensitive, Personalized Care for the Childbearing Year and Beyond
                        contact: [log in to unmask]
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"A person is only limited in what they can do by their sense of confusion"
- Ralph Sims, 8/7/97