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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 6 Jun 2009 11:31:37 +0200
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Katherine in Atlanta posts about a case in which the fully breastfed baby of
a mother who has undergone reduction mammoplasty, after an an initial
somewhat prolonged drop in weight, began gaining well at just over two weeks
of age and has continued to gain normally thereafter.  The baby, according
to the pediatrician, 'looks great, is healthy, happy, sleeping well and is
appropriately alert' but this same pediatrician fears that the mother is
sacrificing the baby's health 'on the altar of breastfeeding'.
Say what?!  What would it take to convince the doctor that the baby is
thriving?  (And last time I visited my local house of breastfeeding worship,
infant sacrifice was definitely *not* part of the liturgy.  What faith does
the doctor think the parents adhere to, anyway?)  Of course I guess the
concern is understandable, since slimness is a major public health menace in
the world today.  (!!)

My short answer is that I agree with you, Katherine.  The problem has been
solved and everyone can stop worrying about the establishment of
breastfeeding in this case, and look forward.

Regarding the events of the first two weeks, it sounds as if the baby was
carefully followed and was not in danger at any time.  There is very little
solid evidence to inform practice regarding atypical weight losses in the
first two weeks of life, which is surprising considering how much practice
is engaged in during this period.  I think with a shudder of all the
uninformed measures I know of during the first two weeks which definitely
jeopardize child health and long-term breastfeeding, particularly
supplementing without a clear plan or goal beyond making the numbers in the
display window on the scale change quickly.

Whenever I see a baby who is nearly ten percent below birthweight at a week,
I want to know why.  In this case I would have chalked it up to the delay in
the big surge in milk supply which IME is common in women who have known
physical factors affecting breast function.  I would have wanted to see the
baby to satisfy myself that the baby looked good - bright eyes, happy to
feed, peeing a lot if not pooping copiously yet, and that the parents truly
fed the baby at every sign of hunger.  It sounds as if this was done, and it
sounds as if the parents are realistic, and not trying to implement
three-hourly feeds lasting fifteen minutes each, or not feed the baby all
night, or some other ridiculous wrench people sometimes throw into the
machinery.

And when the baby started gaining like gangbusters after two weeks, I would
have rejoiced with the parents, congratulated them on a job well done, and
QUIT WORRYING.  The doctor can measure the baby's length too.  Usually when
weight gain in a thriving child slows down, it's because the child is
growing in length that week instead.

Cheers
Rachel Myr

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