I have similar experiences as other postings. In the early 80s, the
hospital I worked at as an L&D nurse had a true ABC (alternate birth
center) concept: labor, deliver, recover, postpartum, early discharge
(2-24 hrs postpartum), with a 3rd day home visit (even w/e and holidays)
*all* managed by the L&D nurses (ie, nursery, postpartum and Visiting
Nurse Association nurses NEVER took care of these patients). It was the
golden era in hospital births I think. Parents delivered in a regular
kingsized bed, we had wooden cradles instead of infant warmers, labor
was minimally medicated, no IVs (so mom had to drink clear liquids
including juices, etc). Anyway, the L&D nurses were unique in their
(our) influence by midwives (we kept a copy of Spiritual Midwifery on
the unit) and by several staff becoming midwives at USC. It was there
through Kittie Frantz's lectures that they brought back excellent BF
knowledge and we all became experts at initiating THE first feeding and
first day BF.

Our ABC moms were encouraged to nurse a minimum of 15 minutes per side
(total 30 minutes minimum)whenever the baby seemed hungry including
*through the night*(!) from birth. For the times, this was radical
(still is in many hospitals I work in): locally (in the community and
even on our own postpartum floor) the instruction was "5 minutes per
breast followed by an ounce of water every 3 hours, and we'll feed the
baby in the nursery at night so you can rest. Increase time at breast by
2 minutes a day until you reach 15 minutes per breast." The results
should have been a "no-brainer".

The "usual" (non-ABC) "BF" babies lost significant weight, struggled
with jaundice, and often did not regain birth weight until 3 weeks pp if
not already weaned to bottles, and moms became terribly engorged. The
ABC babies rarely lost *any* weight at all (at least not that I can
remember) and were usually demonstrating an admirable gain by the 3 day
visit, never had physiologic jaundice (and the ABO incompatible jaundice
was less severe), and as an added bonus: the ABC moms seemed to rarely
experienced engorgement when the mature milk came in; if they did , the
engorgemnet was minor, lasting 6 hours or less. I came to associate
BFing through the night from birth the reason for minimal/no
engorgement. I now believe that engorgement is iatrogenic and abnormal,
and a clue that BFing didn't start optimally and may still be less than
optimal. But I digress.

Obviously, this was a select sample of mothers  (criteria for ABC
delivery was term, no complications of the pregnancy, childbirth
preparation, and OB/peds approval). Unfortunately, nobody kept
statistics on this. Yet, from this experience and population, I came to
believe this scenario (the ABC delivery) represented the "norm." I have
since applied this learning of mine to any mother or hospital setting I
have worked in with great success. As a registry nurse working wherever
I am sent, I am in no position to change policy, but I can change the
experience for my patients, one at a time. All of us can do - and do -
this much.

I think weight checks on BF babies at 2 weeks is too late, for we miss
many precious days to correct problems easily before the parents become
insane with worry. I do weight checks on all my BF babies, create a
weight graph and teach the parents what it means and how to use it. I
also immediately communicate to their peds that I am working with the
baby and what the weight is on each visit. I do not do pre/post feeding
weights in the home and do encourage the parents to let me check the
weights on my visits only (ie - they are not to purchase a scale and do
their own wts - another crazy-maker for them). Following weights is very
concrete information and helps the peds know in an instant what his/her
liability is for any baby - whether to "monitor and wait" or intervene.
I could live quite happily as an LC without nipple shields or feeding
devices, but would not want to go without my scale. By the way, its my
dream to own a "real" quality scale (like Medela's) but what I travel
with is the nursery spring scale (around $20) sold to parents in baby
shops. It is "close enough" and accurate to itself; I do tell parents
all scales differ in small amounts. Even within the peds office, there
will be different weights from scale to scale, and parents should insist
that weight checks always be on the same scale from one visit to the
next.

Usually the charts are ok, but we must be sure of their appropriateness.
I know one project Mrs. Jeffille had been working on was the collection
of weight gain data on exclusively BF infants, in order to establish an
approproate weight-gain chart for these nurslings. I once worked with a
Chinese "slow gainer" below the 10%ile according to the NCHS charts, but
was "right on" at the 50%ile on Chinese charts, which fortunately the
father had copies of, having been a physican in China prior to
immigrating to the USA. I am amazed at the number of Down's babies who
are expected to follow the usual weight charts because HCPs are unaware
that there are charts specifically for Down's babies/children (in all
fairness, many peds do not regularly manage Downs and would not know of
this). I help parents obtain these special charts when working with
them. (National organizations for special syndromes or diseases can
provide information). This is another area of enlightenment whereby we
can serve...

Katharine West, BSN, MPH, IBCLC(expired and saving money)