LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 4 Aug 2011 18:26:01 -0400
Content-Type:
text/plain
Parts/Attachments:
text/plain (60 lines)
June, re: your request for articles involving newborn output:

I have no research articles to offer, but clinical practice spanning back 6 decades. I take it that you, too are not a researcher. That having been said, I will share a fantasy;-) I could be "talking through my hat", but somehow feel I'm on a trail here.

Back in the late 1940's and well on into the 60's, in our hospital, we had crib cards with little tabs to tear off for various indications. One was to tear off the first time baby voided, and if there was no voiding within 24 hours, then someone took note and investigated for observational errors, or fed more fluid. 

Mothers for the most part did not get IV fluids, but they were NPO during sometimes long labors, very few mductions, mostly with castor oil, got twilight sleep and general anesthetics and were often nauseated for hours, so took in little, and many with long labors were no doubt, somewhat dehydrated at the time the cord was cut, and for hours thereafter! 


Babies were completely NPO for the first 12 hours, then received 3 four-hourly feedingxs by bottle of as much 5% glucose water as the nursery nurses could cram down them. 


Then, at 24 hours, they were taken out to their mothers, strictly kept swaddled for fear of "germs"  and "permitted" to breastfeed for 3 minutes on one side, then soon back to the nursery. 4 hours later, they were rolled back out in a huge 7 bin cart and "permitted" to breastfeed for 3 minutes on the opposite breast! The next day, permissible time was upped to 5 minutes on one side!! Etc. etc. leading to much supplementation, complementatation, eventual engorgement, and at home, damaged nipples when they were "permitted" to move on to 7-10 minutes of breastfeeding on one side each time, every 4 hours;-) (These babies are the citizens who are now governing our society, running our justice and economic systems, administering our schools and hospitals, etc.etc. and about to burgeon the rolls of Social Security and Medicare;-) Scary thought!!!


From various assignments within the hospital OB culture and public health over the next 62 years,  I have been able to observe many changes over the decades.


Right now, I believe I see a trend that has not yet been researched - or at least, not with the necessary variables.


I have been reviewing A&P and chemistry and other subjects with fascination. I never realized that osmosis is a process involving only water molecules. Not electrolytes, only water. I suppose the chemistry teacher's method of bringing this home to us may have confused me. If I remember correctly, cake coloring was dropped into the water on one side of the permeable membrane, and the ensuing color change as the stained water passed over to the more concentrated fluid on the other side of the membrane must have given me the impression other things (than the water and watery dye in the plain water) was involved. At any rate, this brings the thought to my mind:


When a mother receives over 200 cc. of crystalloid IV fluid per hour, (per Nommsen-Rivers et al) or by my reckoning, more than 2000-2500+ cc. of crystaloid intravenous fluid in each 24 hour period before the cord is cut, especially if pitocin induction or augmentation is acting as an anti-diuretic on the mother, I have observed that nature responds to the dilution of the plasma colloid osmotic pressure by moving excess fluid out of mom's circulatory vessels and into the interstitial spaces. 


But it further occurs to me that at the interface between the maternal uterine arterioles and the placental venous capillaries , osmotic pressure differences probably cause nature to seek to even this out through water molecules passing through the maternal arterioles and available to the placental venules and thus into the baby's circulation. No matter what else may or may not pass by any other means, as many are suspecting, this may at least account for increased urination by the baby within the first 1 or 2 days.


I don't know that anyone has yet gone to the trouble of weighing a dry disposable diaper, and a single large plastic bag, then keeping a baby's diapers separate in the bag, then said bagful of diapers, minus the weight of the plastic bag, then subtracted the weight of one dry diaper x the number of diapers used, to figure the weight of the baby's urinary output per 24 hours. Stool, would of course complicate things;-) Never mind that the baby would also be losing fluid through the lungs and skin, but it would certainly seem much more exact than simply counting the number of diapers, which would depend on how often the baby's caregivers changed diapers! Certainly too much trouble to weigh each wet diaper, subtract dry diaper weight and do the calculations that way!


If this would be too much for a nursery staff to manage, it would at least be interesting to see if you could engage the L&D staff in making the mother's crystalloid IV fluid/pitocin intake known from the time she was admitted up to the time the cord was clamped. I understand that there is at least one Ohio neonatologist now insisting this information be on the baby's chart. And of course, any oral fluids she had too. Some research has simply counted input versus output in the intrapartum period, but output would reflect lots of what the mother already had in her system before the IV's were commenced or the pitocin was acting as an antidiuretic. 


Nevertheless, if you could succeed ONLY in comparing (and PREDICTING!) the relative outputs of infants whose mother delivered with a minimum of crystalloid IV fluid intake before the cord was cut, with the outputs of infants whose mothers received 24-48 hours of crystalloid IV fluids (with measurements as accurate as possible of total intake), especially if she received hours of IV pitocin for induction or augmentation, I bet the results in the relative mounrts of voiding the babies do in the first 24-48 hours would correlate in some obvious way with the relative amounts of crystalloid IV fluid the mothers got (or didn't get). 


I recently had an exchange with Dawn Hunter (I'm sure you must know of this NZ midwife) about some observations she made about the correlation of albumen levels in the mother with the onset of L-II back in the days when it was routine to do certain blood work postpartum. I believe there is so very much more yet to be researched, and I believe firmly that close clinical observations give important clues as to what variables should be included in research!


Thanks for letting me ventilate my fantasies;-)



K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome

ATOM RSS1 RSS2