In a message dated 2/10/02 8:19:31 AM Eastern Standard Time,
[log in to unmask] writes:
> The nurse left her feeling very
> discouraged, indicating that NG tubes, pacifiers for "painful procedures"
> such as heel sticks, etc., WOULD be likely with a 36 weeker.
>
Lyla,
I have seen many 36 wk babies who have had no problems & stayed with mom
during the hospital stay. (Hopefully the baby will not have any respiratory
problems related to premature delivery.) The big advantage for this baby can
be the planned c-section. They usually do the epidural/spinal just prior to
the surgery, so baby doesn't get drugged up. The baby may do fine with
breastfeeding.
It would be rare for a 36 weeker to need NG tubes! Any baby delivering prior
to 37 wks gestation is technically a preterm baby---but that does NOT mean
that the baby will have to spend any time in the Neonatal Intensive Care
Unit.
Most hospitals are obliged to do glucose testing according to policy--preterm
babies are usually tested. Are you in the USA or Canada? Labs may have
different methods of measuring. In the USA, most want blood sugars above 40.
I have also heard that some use 35 & some are using 45. At our hospitals, any
baby who does not maintain a sugar above 40 will get an IV. If initial sugars
are below 25, they get an IV. Our blood glucose screens are done by heel
stick (after warming the heel), but anything below 40 gets a venous sample
that goes to the lab. I think that requesting venous blood is a resonable
request for an initial sugar & to back up any that show below the accepted
levels. I would not want a baby treated with an IV based on heel stick
glucose.
"if the hospital staff is insisting on oral
glucose, can we presume it is not an emergency, and insist back that mom
express colostrum" --Yes. If oral glucose is needed, then you could certainly
insist upon expressed colostrum. Stand your ground & get all the info you can
to back you up. You have an important & potentially difficult job ahead of
you.
Some pediatricians order supplemental feeds on preterm or small babies. It
would be good for the mom to talk to the pedi & ask that this order NOT be
given. I think that she could also discuss different scenerios & how they
would need to be treated. If you have agreement by the pedi & orders to
follow, this can avoid a lot of hassles with the nursing staff. Do realize
though, that the staff are obliged to follow hospital policy regardless of
doctors orders & can go to the chief pedi to override orders. She can agree
to express colostrum if her baby is too sleepy to breastfeed in the first
day. (I doubt that any nurse will let this baby go without eating for very
long--most won't let a full term baby go for long without feeding.)
Now for my little personal story. My grandson was born on Jan. 22, 2002 @ 5
pm by emergency c-section at 37 weeks. He was 5 lbs, small for gestational
age & his mom was gestational diabetic. That is 2 reasons to have a series of
blood glucose tests done. I stayed with the baby to make sure that no one
came near him with any formula. He went to breast for the first time at 3 hrs
of age, stayed skin-to-skin & breastfed every at least every 2 hours
throughout the night. His blood sugars were good from the beginning & stayed
good. No one ever mentioned supplementing with formula. Of course, I made
sure that they knew I am a maternity nurse & a lactation consultant. At his 2
week doctor visit, he was a pound over birth weight. I am so proud of my
daughter & her son! They are doing so good. Luckily, no problems with
breastfeeding.
Laura Hart
Winter Park, FL
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