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Subject:
From:
Johnston <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 15 May 1998 15:50:00 +1000
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Judy wrote:
We have identified some of their barriers and the main one seems to be how to
be compliant with Perinatal Guidelines, which require numerous procedures to
be carried out on baby within the first hour of life (ie: glucose heel stick,
vitamin K, eyedrops, vitals q 15 minutes, etc.)

Can you change the Perinatal Guidelines?
Is there any evidence to support such an attack on the baby? 
This is the very issue that the Baby Friendly Hospital Initiative attempts to address - hospital practises which may have a negative impact on breastfeeding.
When you look at the WHO recommendations there are statements such as 
"Healthy term newborns who are breastfeeding on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids"  
and
"For newborns at risk, the blood glucose concentration should be measured at around 4-6 hours after birth, before a feed, if reliable laboratory measurements [ie not glucose-oxidase based reagent strips] are available. ..." (Both from Hypoglycaemia of the newborn.  Review of the literature.  WHO 1997)

Also there is ample evidence that early skin to skin contact between mother and child and support of initiation of breastfeeding in the first hour improve outcomes.  (Care in Normal Birth.  WHO 1996)

Vitamin K should not be available at the time of birth.  If required it should be administered quite separately.  This is an important procedure, as there were a couple of drug errors in Victorian hospitals in which babies were mistakenly given oxytocic instead of Vitamin K.  This was a dreadful thing, and one baby died, another had severe seizures.  There is no urgency to give Vit K - it seems to be done more for the completion of paperwork than for any advantage to the baby.  Once again hospital practises must be for the benefit of the client, and at least do no harm.

The eye drops are not routinely administered in my community.  How many babies are likely to benefit from such an invasive procedure?  Do these mothers give consent to such treatments.  Do most of the mothers have untreated STDs?

I hope you are able to make changes in your hospital practices.
All the best
Joy Johnston
Midwife and lactation consultant
[log in to unmask]
www.webrider.net.au/~aitex/joy.htm




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