I have had a number of breastfed newborns with excessive weight loss in the
hospital lately and am trying to figure out why.  Most of these infants have
been otherwise healthy, no glaring red flags for breastfeeding trouble, and
have had approximately 10% weight losses before turning around and gaining
(or before weaning shortly after discharge which is pretty common around here.)
I am trying to figure out what in our routine in the hospital can be causing
this, and I think I've got it.  Although we do a good job of encouraging
immediate first feed, and frequently feeding during the day, many moms send
their babies to nursery at night.  Our nurses are good about not
supplementing with formula, but they tend to take baby out to mom no more
than every 3 hours, and only if they can't console them any other way.  I
know my own babies tended to be more wakeful and hungry the first few nights
after birth than they were during the day.  I'm thinking those frequent
night feeds the first day our two are important to establishing milk supply
and keeping babies from losing too much weight.  I'm often faced with a
sleepy newborn during the day who we have difficulty waking to latch, who is
not gaining weight, and is spending the night in the nursery being consoled
by a nurse instead of eating!
The problem is, I'm the only one who seems to feel this way.  The nurses see
it as helping moms get some rest, and moms seem to feel they are entitled to
this rest.  Very few moms, even with urging will keep their babies at night
here.  Anyone have some good pearls on encouraging moms to keep their babies
at night and feed frequently?  Our unit doesn't bother moms about
co-sleeping, so these babies could theoretically all be in bed with mom
instead of in the nursery!
I had a refreshing change this week, though.  A gestational diabetic mom,
who had a section for fetal distress, ended up with an SGA baby who weighed
just 5 lbs 5 oz.  Mom had large nipples, and despite baby having pretty good
instincts, we had a hard time keeping her from sliding down to the base of
the nipple where she seemed to not be able to move any milk.  Mom was
getting frustrated, and baby lost about 10% of body weight.  This mom,
though, was determined to make it work.  She hung up a do not disturb sign
and refused all visitors (she even stepped out in the hall and told several
extended family members that showed up unannounced that she and the baby
were tired and couldn't handle any visitors!)  She called the nurses for
help with latch every feeding, and kept the baby in bed with her the whole
time.  24 hours later, the baby had a small gain and was nursing
beautifully.  And mom felt more confident and actually better rested.  Now
if I could get every mom to do that instead of wearing herself out with
visitors and then struggling to care for the baby!

Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03

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