Germaine said:
 
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<<Hi All, there has been discussion lately about not supplementing  for
weight loss until 12%. Does anyone have any parameters, research  or
information about this in their practise. thank you Germaine  Lambergs>>

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When, oh when are we going to start looking at the whole picture and not  
just a number on a scale or a percentage?  Some of our pediatricians and  
nurses have started saying to moms in the hospital, "Oh, your baby is down 7%  
today, we are going to really have to watch it."  I actually had a mom come  
see me, and when I asked what the baby's weight was in the doctor's office, 
she  said, "I don't know.  He just told me she was down 10% and I needed to 
see  you."  
 
What do I mean by looking at the whole picture?  Well, how many times  has 
the baby peed & pooped in the first couple of days?  How much fluid  did the 
mom receive?  Was she induced or augmented with pitocin?  How  much edema 
does she have?  Maybe the baby has an overabundance of fluid and  is just 
recalibrating back to normal?  Was the birth weight accurate?   Is this really 
a breastfeeding issue, or is it related to something else?  
 
In the olden days (and yes, I have lived thru them), we used to weigh  
diapers to determine baby output.  I think we need to go back to  that.  Then we 
can decide if 7% or 9% or the "magic" 10%, or even the 12%  Germaine is 
mentioning is even valid.  
 
It's 48 hours.  Baby weighed 8# at birth.  He is now down to 7-2  (11%).  
Panic city.  Call the doctor!  Call the nurse!! Call the  lady with the 
alligator purse (full of formula)!.  But did ANYONE look at  the output?  Did 
anyone look at the baby?  Is he dry?  Is he  lethargic?  Has anyone watched the 
breastfeeding technique?  Now -- if  this mom was induced/augmented and has 
a lot of edema, the possibility exists  that her milk is not going to "come 
in" for 96 hours or thereabouts.  Has  she done RPS?  Is she hand 
expressing with pumping?  How often is  baby going to breast?  
 
So -- a very long answer to a very short question.  And the short  answer 
is, "stop looking at numbers and look at the baby."  And if your  
observations tell you that the baby isn't doing well regardless of the numbers  -- then 
the second short answer is "Feed the baby!"
 
Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education  Consultants
Wheaton IL

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