Mary asks:
 
just have one question. She had no drugs during the labor or birth.  Cou=
ld the=20
meconium staining have anything to do with a large water  retention? I kno=
w=20
pitocin can, as can IVs and other drugs given in  labor, she had none of t=
hese,=20
however. It is possible that this baby  was never meant to weigh 9 lb 1 oz=
at=20
birth. I don't  know.=20

Mary, the passage of meconium in utero which can result in  meconium staining 
is a sign that baby is stressed in utero--could be from a  number of causes.  
I don't think there's any association  simply between meconium staining and 
fluid retention in a  newborn. I've seen pitocin and large amounts of IV  
result in  fluid retention in mom but until someone can explain the physiology to  
me or I see a study proving this I just don't buy that  normal newborns are 
born with more than  the expected amount of  fluid on board. Sometimes babies 
are born with extra fluid--kidney  malfunction or hydrops, but we don't  see 
this in a normal  newborn.
 
You're an experienced LC so your "sixth sense" that's there more than meets  
the eye is very likely true.  Mother may well have had a normal supply to  
begin with but inadequate intake by baby has resulted in  down  regulation of 
supply.
 
If mother's supply is indeed adequate and baby is taking adequate  amounts 
for growth but is still not gaining weight than something else is going  on. 
First it needs to be determined if baby is taking sufficient  milk.  The urine 
and stool output is reassuring, but I've certainly been  fooled by this.  
 
This baby may be flow dependent--will not suck unless there is flow.   A 
supply line at the breast could fix this.  If you determine that baby is  getting 
adequate intake and is still not growing then it is time to look  further. 
Also a baby below birth weight a 3 weeks will have low stamina--as they  gain 
adequately stamina increases.  And then of course there's your  very experienced 
inner voice telling you there's more going on.  My  first guess is that 
despite everything you've observed this baby is not getting  enough to eat.  If that 
is not the issue than further studies need to be  done. If it is the issue, 
then after intake is increased and baby is gaining  adequately you can look 
into what caused this in the first place.
 
Finally, do listen to that important sixth sense but make sure  all other 
bases have been covered.
 
Kathy Boggs, RN, IBCLC
Mountain View, CA



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