Mary Ann,

I am going to respond to the entire list on this because I have gotten
many requests like yours. Here's what we do, for normal term babies, in
a nutshell:

At birth babe goes directly onto mom's chest and remains there untill
the first feeding has taken place. Assessments etc. are done on mom's
chest and an infant warmer is right next to her bed in case it may be
needed for some kind of resuscitation or something.  Once the first
feeding has taken place (usually within the first two hours) babe is
taken over, placed under the warmer and wiped off, given eye drops, vit.
K, Hep B.... whatever the family has agreed to. I typically see mom get
cleaned up and dressed at this point. Then everyone goes off for a long nap.

If, for some reason, babe does not latch within those first two hours,
there are frequent "offerings" of the breast beginning at about 6 hours
of age (or before if babe is awake.) Mom is shown how to manually
express and drip a few drops into babe's mouth.... while coaxing a
latch. If there is no colostrum to be had at this point, the RN would
need to assess for risks related to hypoglycemia and symptoms thereof.
We do not offer formula at this point unless we document a low sugar or
some serious evidence thereof. Almost never happens.

My feeling (and the one I have conveyed to the staff) is that a normal
newborn baby should figure out how to feed often and well by day of life
two. Remember, that in the 50's babies in US hospitals were NPO for 24
hours! They will not die from dehydration or get braindamage from
hypoglycemia during this time frame! So, up until hour 24, we will
generally continue the above protocol. If the 24th hour arrives, and
babe has not gotten his act together we (meaning the RN staff) start the
pumping and cup feeding. Formula may be added at this point if there
isn't much colostrum yet.  All the while we are encouraging skin to skin
and latch.

If a mom must go to pumping and cupping.... the LC is referred to. We
assess why the feeding has not progressed as it should have. And we come
up with a plan that can involve any number of interventions.

As for the question about weights: Babies are weighed as soon as mom is
willing to allow it and then every morning. Remember, there is no
nursery... so it is all done at moms bedside. Even a circ can be done
there if mom wants that (otherwise we have dad come to the level 2 with
baby.) And... as for the squeezing and tweaking that someone said the
nurses do to get PKU's... that is a no, no! Ask the health dept. in any
county. PKU's should be, indeed must be, freely dripped to be accurate.
Any health dept. can educate as to how this is achieved. I did PKU's in
homes all the time, parents held their babies, I warmed heels and used
gravity, and we rarely had crying.

I have to be honest and tell you: when I taught the nursing staff how to
handle poor feeders I borrowed heavily from Linda J. Smith. And they
definitely know their ABC's! Some of our RN staff have taken Linda's
courses too. That helps.

Can moms sleep with babies? That's a sticky one. The best I can advise
is: try not to have any policy at all on this one. Once you involve the
legal dept. it's all over. Of course, who's going to know if mom and
baby are in bed together? I'm certainly not telling. ;-)  I will tell
you that I know the baby-bunk people are working on a "side car" for
hospital beds. Haven't seen it used yet.... but seems like a possible
solution.

Susan Keith-Hergert RNC, MS, IBCLC
Holistic Natal Care
Cincinnati







Krainz, Mary Ann wrote:

>hi Susan, I just read your recent note on Lactnet. First off,
>congratulations about becoming Baby Friendly. How soon after delivery do you
>become worried about not nursing? You said at 5 hrs you have them express
>some colostrum. What if she can't get colostrum out?
>
>At what point do you have them pump?
>
>At what point do you add in formula?
>
>And when do you weigh the baby?
>
>Trying to change some policies here. Thanks for your help and Happy New
>Year, Mary Ann RN, IBCLC in central WI where we have about 1200 deliveries
>per yr and a level 3 nursery.
>
>
>

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