Jeanette;

Regarding the baby's change in skin color to gray.  My experience with the
baby in the nursery is that the nurses don't look at the baby nearly as much
as mother does.  I wonder if they would have noticed the change in baby's
coloring as quickly as mother did.  New mother's are so in love with the baby
that they usually can't take their eyes off them.

In a message dated 95-11-02 23:31:13 EST, you write:

>I would like feedback on this type of situation from you -
>And how many diapers *should* a breastfed baby wet days 1-3?
>How many stools?    We are very careful to educate about wet diapers and
>stools
>from day 4 on, when babies go home, but were leaving the rooming in
education
>to
>the nursery nurses who take the babies to the mother, give her a chart, and
>explain the policies of rooming in.  What type of education do you give?
>
>
This is an issue that I have been working on at the hospital I work at.  I am
the outpatient LC who does follow-up calls about 65-100 hours after birth.  I
have been meeting with a neonatologist and the inpatient LCs and discussed
this issue in depth.  We have not found anything in the literature to fully
support what is written, eg, 1 wet on day 1, 2 wet on day 2, etc.

The neonatologist feels that there are other issues that are not being fully
addressed.  Namely what was the infants hydration level at birth.  Fine if
the baby is born well hydrated, but what if the baby doesn't have the 10% of
extra fluids at birth.  Also what about the baby that pees like crazy on day
one but by the end of day 2 is very dry?  What about babies whose moms don't
have much colostrum?

We know that if there isn't much stooling and the meconium isn't passed
within the first couple days the chance for jaundice increases dramatically.
 But some babies seem to have lots and lots of meconium, others a few
meconium stools and they are off to normal bf baby stools.

I have noticed that when baby isn't urinating and/or stooling they either are
frantic and feed and feed and feed or (more often than not) they are sleepy
and lethargic and feed poorly.  Not at all conducive to bringing in a good
milk supply.  For now we educate mothers to look for a minimum of one wet and
one poopy diaper in 8 hours.  They are told to breastfeed every 2-3 hours,
waking baby if necessary.  If 8 hours go by and there is no urine and/or no
stool they are told to breastfeed one more time and then give a supplemental
feeding allowing baby to take as much as the baby needs.  This usually
stimulates urine and stool.

Then they are told to continue breastfeeding every 2-3 hours with no
supplement.  If another 8 hour stretch goes by without urine or stool they
would repeat the proceedure.  Normally they only do this one time because by
then the milk is coming, baby is feeding more vigorously because of the
calories from the supplement and they move on to breastfeed fine.  I am
beginning a follow-up sequence that will more fully examine this.  For now,
however, this is a compromise that keeps the dr happy and seems to be
preventing some breastfeeding failure that I saw due to early introduction of
supplement with no clear guidelines of why, or when to stop.

I'd really love to get away from the issue of "every 2-3 hours" and get
mothers to connect with babies better, hold them more, handle them frequently
those first few days.  But we see a real problem with mothers wanting to feed
the baby and put the baby down.  I think they often miss early feeding cues
and baby just goes back to sleep rather than crying.  I work on this issue a
lot but it is a more complex expectation.  Hard to teach to a first time
mother or a mother who hasn't spent much time breastfeeding other children.
 The LLL Leaders do this the best.

We are looking at this issue.  I would like to hear what the response is.  I
suspect others on Lactnet will share my interest so I have posted this both
privately and on Lactnet.

Denise Parker, BA, IBCLC (La Crescenta, CA)