hi pam
what a frustrating chain of events! as we so often see in lactnet
discussions, interventions often lead to other interventions, and lots of
things are iatrogenic, ie caused by the health care system.

however, i do have a couple of comments. f/u on day 4 is great! in my area,
f/u is 2 wks, even for many at risk infants. i think by day 4 you would see
a wt gain, and lots of wets/dirty diapers, and good hydration. yes, there
may be jaundice, but not dehydration. usually what i see is a little wt loss
in hospital and then a good rate of gain. at least this is what i want to
see. so what i would suggest is to look at and address, if possible, the
barriers to establishing bf in those first few days. what i mean is babies
should bf w/i 1 hr of birth and thereafter room in and feed on cue. also
make sure the staff know and know how to teach mom effective vs ineffective
fdg and when to intervene if not effective fdg. (beleive me, i am not
getting my institution here yet, but still trying). but i believe i am
convincing some key people that this jaundice/dehydration/wt loss scenario
is not a given w/ bf babies as many hcps think, but becoz of barriers and
lack of effective bf.

when you get a consult, do you send a written report? i have found this to
be a great teaching tool becoz you can point out the things that have
interfered w/ effective bf. for example, this mom was not able to initiate
bf for 12 hrs; poor positioning and latch were identified and corrected;
etc. just simple straightforward bf 'management' stuff. i also try to
include the moms goals, saying something like 'mrs jones states she would
like to bf this baby x 1 yr' so the hcp would not be justified recommending
she go to formula. good luck changing the system.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA


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