>She was being discharged, so would not be monitored by
>knowledgeable people.  She is in danger of spiraling downward and then not
>having the energy to work to achieve good feeding.


Aha. I think this may lie at the heart of the difference in outlook
this case has revealed.

Mothers here have free midwifery care for up to 28 days post-partum.
No mother goes home, without the certainty of seeing someone the
same, or the next day, at home (I am not going to sing the praises of
the system too loudly, though, as we have a shortage of community
miwives, and *routine* daily visits for more than a few days are now
rare. Most mothers' care is transferred to the health visitor at
10-12 days, but the HV also visits at home. Any mother who needs more
care will usually get it).

So a baby who is not feeding at 2 days will be watched and supported
for some time after discharge - and maybe this gives us in the UK the
'luxury' of patient, watchful, supportive waiting, and spiralling
downwards should not happen.

In fact, some babies do slip through the net - not because someone
knowledgeable has 'allowed' them *not*  to have formula at 2 days,
but because someone who *thinks* they are knowledgeable has failed to
recognise ineffective feeding, and has just let things slide.

It is also very common for babies to be given formula in hospital,
but this is often in the absence of knowledgeable bf support. The few
hospitals we have who are Baby Friendly would probably not give
formula after 2 days, unless the mother requested it, or unless the
baby was at high risk in some way, or showed clinical signs of
dehydration or low blood sugar (both unusual, surely, in 2-day-old
term babies of appropriate weight).

I really can't see that an adult who hasn't eaten for 2 days (Jan's
point) is comparable to a new baby. We can't extrapolate from the
adult experience and say therefore that the baby will be the same.
Babies *are* born with good nutritional resources to tide them over
short-term crises.

This is hard to 'prove' with scientific research, though.


No one is going to do an RCT with 100 babies fed from the beginning,
and an 'intervention' group deliberately left unfed for 5, 6, 7 days.

We only have the barest of anecdotal evidence that babies are ok with
very little (even nothing)

* The fact that colostrum volumes are small
* The  Mexico City earthquake babies who were declared fit and
healthy after being under the rubble for 9 days (the maternity
hospital was buried). But AFAIK, no one has followed up thoe babies
still less looked at their bf experience.
* bf advocates have known many babies who have taken longer than 2
days to feed effectively, or at all, and with support, have gone on
to have long and happy bf experiences. But this is here...

Please note I am not saying 'no one needs to be at all concerned
about the baby who fails to feed at all in 2 days.'

I *am* saying  that the sensible measures Lori was suggesting in her
first post - skin to skin, careful attention to positioning and
attachment - might need time to work. Expressing colostrum - we tend
not to pump in the very early days, here, but  do it manually, as you
get to keep every possible drop then - is obviously important.

Giving formula is a Big Deal, which we *know* (from research) is a
risk to the baby's health and to the long-term chances of
breastfeeding.

  Of course, in some situations it is needed - when EBM cannot be
obtained from the mother or a donor, and/or when the baby starts to
show clinical signs of dehydration or low blood sugar, or maybe, as
in this case, when the baby is about to leave for home and no one
knows what sort of back-up or support will be available for the next
X weeks.

>
>
>Each client, each situation, each breastfeeding must be evaluated on an
>individual basis.  I love to hear other suggestions from Lactnet members
>about specific situations, but we need to trust the LC working with the BF
>couplet to make the right decisions.

Barb, I made it clear in my post that I acceoted these situations are
often a matter of judgement, made by the person there who knows a lot
more than we can ever do, at second-hand. But Lori did ask us what we
thought.

Heather Welford Neil
NCT bfc Necastle upon Tyne UK

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