I think all the points discussed are valid. It is always a judgement call
which intervention to use. Can we just improve the latch? Increase the
frequency of feeds? Teach mom more responsive bf? Use breast compression? Or
is the baby too far below birthweight (again a judgement) and too weak
(sometimes very obvious, but sometimes a judgement call) to be able to
transfer milk well? Will a supplementer at breast work? Is baby too weak or
disorganized? Does mother wish to use this method? When I teach aspiring LCs
I do emphasize that, in all but the most serious cases, these are
judgements and please do not present it that this is the ONLY way. What is
extremely important is this: FOLLOW-UP. For 2 cultural examples we see
that In the UK, followup is usually good. In the USA, it may not be, and the
individual LC must see to it that followup is done.
I also want to mention that we have discussed how babies breastfeed -- to
feed well, the baby must actively root and latch, and suckle. The mother can
facilitate this, but really can't MAKE the baby breastfeed or PUT the nipple
in baby's mouth. Baby has to do it. This is where I see a bottle can be
useful. You can work with the firm longer bottle nipple, moving it slightly
or rotating it a bit, or tugging on it a little, to get baby sucking. And
since the flow is faster and doesn't depend on a letdown, the baby gets some
milk in the mouth, and may start actively feeding. You should, of course,
elicit the rooting reflex and wide gape for the bottle, but you can "work
it" to get and keep the baby feeding. Please be gentle with all these
maneuvers and practice the principles of "paced bottle feeding."
Kathy, while not disagreeing with you about when bottles are helpful, I did
want to mention about percent weight loss, for those who might be new to
this field. I would not consider 7% to be an excessive amount of weight to
lose, maybe not even 10%. The key being -- if things were "turning the
corner" -- but it would definitely be a red flag and need follow-up. Kathy
recognizes that the important part is "weak babies" and "very poor intake,"
and if that is the case, a baby MIGHT need expressed ebm (not necessarily by
bottle) even before 7%.
<<<Kathy Eng said "What I find is that those weak babies who have lost 7% or
more and who
the test weights show very poor intake, must be fed by another method">>>
Laurie Wheeler RN MN IBCLC
Mississippi USA
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]
|
