Thanks Janie for giving more crucial information about this case.


>The weight loss was not the only criteria on which decisions were based,
>by day five with 15% weight loss the babe was looking very hungry and
>with borderline voids and only one dark green stool.  Mucous membranes
>were dry, babe was feeding frequently and vigorously with few audible
>swallows and no open-pause-close type feeding.  By the next day babe had
>begun to be less vigorous at breast and very sleepy.

*Of course*  this means the situation needs attention - but normal practice
here is for that not to be *necessarily*  intervention with formula,
pumping and  SNS.

I am *not* saying oh, just leave it, it will work itself out, just keep bf,
and stay relaxed.

And I am not saying we have it right here, either - too often, HPs are *too
relaxed* about bf that's not going well in the first days and weeks.

For example, I am seeing a mother today who called last night. Her baby's
birthweight was 7 pounds 6 ounces. At three weeks he is 7 lbs 3 ounces.
Mother and baby seen regularly since birth by midwives and health visitors
- all of whom, as far  as I can judge, have been very 'supportive' of bf,
but *clueless* on how to get it to be successful. But while knowing the
weights was useful, and a clear indicator that this mother and baby need
help *now*,  and not tomorrow or Monday,  it was clear from everything else
the mother told me that bf was going very badly - baby never satisfied,
difficult to settle, endless feeds w/o baby ever coming off the breast
spontaneously, extensive use of nipple shield since day 3, cracked and
bleeding nipples when shield not used, extensive use of pacifier. Mother
distraught. It was not a bit surprising the weight was what it was.

>We do weigh babies frequently and the vast majority are up to and beyond
>birth weight by one week.  But weight is not viewed alone, it is only
>one piece of the puzzle.

I am unconvinced of the value of *frequent* weighing.  No matter how often
weight is done, though, a 'satisfactory' weight gain is *not* a guarentee
of happy bf, and 'poor' weight gain in the first week (or even beyond) is
*not* a definite indicator for intervention with formula, pumping and SNS.
It is, though, an indicator that the situation needs attention of some
sort.


As Janie says,  weight is one piece of the puzzle.

And we do need some decent baseline research that demonstrates the value
(or otherwise)  of frequent, or infrequent, weighing...and some good idea
of what the spectrum of normal might be.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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