At the hospital where I work, initial water feedings have only been
eliminated over the past year. We are usually quite slow here in
Northeastern PA to pick up new
and exceptable procedures. (It sometimes seems that we are at least 5 years
behind the larger cities.
It is still difficult for some nurses to allow the baby with a low blood
glucose level to go to breast first and note how well the baby nurses before
giving the baby formula.
On the subject of first feeding, I determine when I get concerned about a
newborn becoming dehydrated by looking at size of baby, gestational age of
baby, shift assessments, frequency of voids and BMs, and weight loss. My
thoughts are that if the shift and other assessments of the baby show no
signs of dehydration, I wait. I want to see a good nursing before the mother
goes home on day 2. If the baby does not nurse well, the baby is given
formula by an alternative method. The mother and support person are
instructed on tips to work with the baby to aid in latching on and the
alternative feeding method. I follow up with the mother following discharge
with an office visit and phone calls. What are the purposes of assessments
if we don't use them as a tool to assess hydration.
Most babies, the night before discharge, finally wake up from his/her sleep
mode and nurse well.  My concern with giving formula is the mad circle that
can occur, formula is given, baby sleeps for x hours without nursing, so
baby is given more formula because baby has slept for x hours, etc.  Baby is
so sleepy from the formula that he may never nurse before discharge, or
maybe not nurse after either.
Comments?
Helen from PA
RNC IBCLC CPCE