Dear Jennifer and Gonneke (rather long - may need coffee) Gonneke, you use
the term "bottom line", though I doubt the pun is intended, I think it
appropriate. I wonder how much the fluid shift shows up in the diapers...
Certainly the Crossland article I referred to was in hospital and probably
not "normal" births, but there is normal (biological imperatives) and then
there is normal (what usually happens), and we need to be able to assess and
help moms with their situations...knowing the majority are not optimal.
Fortunately, mother nature seems to overcome many less than optimal
circumstances. Yes, I agree that a birth with no interventions could be the
reference point. [I am a great proponent of keeping life natural - though
after 20+ years of hemodialysis, I realistically must say that natural for
me is dead - so I am thankful for bizarre far-from-normal technology that
keeps me truckin' along.] Keep in mind that using births with no
interventions might set us up to have the wrong expectations, and we might
be doing a disservice to the majority of moms. One of the great weaknesses
of the systematic review was that my research question was built to get data
about weight change patterns and the data was not linked to mortality and
morbidity - the, you might say, so what? of weight loss. Interestingly, in a
few studies that I came across where they were using >10% as the inclusion
criteria when looking at dehydration in the breastfed baby - many of the
included babies did not have hypernatremia...I did not explore this element
much but it was food for thought. The confounders are something to consider,
though we should not rationalize away signs we need to pay attention to.
While I agree with Gonneke that weight can be a valuable assessment tool, I
want better information about how to interpret it. On the topic of scales, I
have a new hypothesis I want to test - I think when women have care and
control of the scales, they are not intimidated - their confidence is not
shaken. It is not the scales that are the problem, it is being judged (i.e.,
taking your baby to a physician or nurse for weight measurements - do I
pass? am I a good mother?) or having to deal with an unexpected or difficult
situation (i.e., when babes are not gaining and moms only find out when
their babies are weighed by an HCP). Of course, any woman whose baby is not
thriving will have her confidence tested, with or without scales. On the
topic of charts (WHO or otherwise), I find it interesting how everyone seems
to want to see the babies in the top 50 percentile. This goal puzzles me.
Mathematically, if the bottom 50 gained enough to be part of the top 50 then
the whole group would move up in real numbers but someone would still be the
bottom 5th percentile. Remember, when all the marks of the graduating class
from medical school are charted on a centile chart, the grads in the 5th
percentile are still called Dr (from a wise LLL Leader I once met). I assume
all the babies on a centile chart are healthy - just some are little and
some are big. It is lovely to share thoughts with you both. You give me much
to think about in my work. Joy 

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