Sue Pace asks about weighing babies after birth, and describes a situation
much like what we had before budget cuts which led to much shorter
postpartum stays.  Here, the shorter stays were not accompanied by better
preparedness in the community, to close the gap, and we have become more
obsessive about weighing as a result.  
Our procedure is to weigh baby at birth, and again on the third day of life,
meaning baby should be at least 48 hours old.  If mother and baby are
discharged sooner than that, the baby is weighed at discharge, though the
value of such a weight is debatable.  We are generally more skittish now
than before, and more worried that a mother outside our watchful gaze won't
manage to do right by her baby.
If the baby has lost more than 10% of birthweight on day 3, we are supposed
to make sure feeding is actually taking place, and this assessment is
another juncture at which many 'creative' judgment calls are made.  We are
also expected to make a date for follow-up within a couple of days, so
nobody falls through the cracks.
When a baby goes home before 60 hours of age, we will see them again within
a couple of days anyway to do the PKU screen, and we weigh them again at
that contact.  The way these two post-birth weighings are interpreted is
worth a study in itself.  Some people will assume that the baby should be
heavier on day 4 or 5 than on day 2, and get all panicky and start to make
the mother doubt whether she is feeding the baby enough, if not.  Some will
have the sense to ask the appropriate questions and observe a feed, to find
out whether the baby is likely gaining or continuing to lose weight.  And
some of THOSE people will have the knowledge to interpret the answers and
their own observations well, while some will not.  Believe it or not, even
asking about stools is not a standard question in the maternity services here.
The thing that drives me crazy the fastest, is when maternity care staff
behave as though the third and the eighteenth days of life are equivalent,
so that a baby who is 10% below birthweight after a couple of weeks, does
not elicit any more concern than that weight would on day 3.  It's like they
don't remember that babies aren't supposed to maintain a stable body weight,
they are supposed to GROW.  Alternatively, they start suggesting
supplementation on day 3 when weight loss approaches 9%, without regard to
any other indicators of effective feeding.
I've sort of stopped calling it 'physiologic' weight loss, and started
calling it 'acceptable' or 'unconcerning' weight loss, at least to myself. 
I don't think we really know what the physiologic norm for human infants is;
most of what we know is about the range of weight change in babies born in
institutions where there are many practices impacting how effectively they
manage to meet their metabolic needs.
WHO are trying to develop charts to help inform decisions about supporting
breastfeeding in the first couple of weeks of life. The aim is to identify
those babies who are in trouble and fix things before the breastfeeding is
threatened, while not interfering with the ones who are simply experiencing
an acceptable weight loss.  It's more complicated than one might think,
since these charts will also need to be usable by people who don't have 20
years of reflection on experience caring for breastfed babies in the first
week of life.
Rachel Myr
Kristiansand, Norway

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