I second what Cathy Genna wrote, about visual assessment of the palate being
far superior to digital palpation for finding clefts.  It is also what I
learned in midwifery school nearly 20 years ago.

I was taught in 1988 to insert a gloved finger into the baby's mouth just
after the head was born, to check for a bite reflex, if the head emerges at
the end of a contraction and it can take a couple of minutes before the next
contraction, when the shoulders will be born.  A baby who bites you is
supposedly in fine shape and you can relax and wait.  Lack of such a
response was interpreted to mean we needed to rush to get the shoulders
delivered because the baby was getting compromised.  Today I think this is
nonsense, as long as I know that the fetus has been fine throughout labor up
to that point.  Virginia Apgar recognized that you should do a systematic
check no earlier than one minute after birth.  A lot of babies are floppy at
birth but fine a minute later, with no intervention at all, and we shouldn't
be poking them or slapping them or suctioning them, just waiting.  It takes
experience to see the difference between a baby who has just landed on earth
and hasn't got its bearings, and a baby who really needs resuscitation, but
you can get a good sense of it within the first fifteen seconds or so.  We
don't suction vigorous babies unless there is really thick meconium, or the
baby is gurgling a lot and having trouble breathing.  Then we use a DeLee
suction catheter, believe it or not.  I have never seen a vigorous baby get
laryngoscoped at birth for meconium, though I understand this has been
common practice in some countries.  Babies who need resuscitation are
handled differently, according to Advanced Life Saving procedures.

Again, we weren't doing this to assess suck, it was to check for the biting
reflex.  After birth, routine care is for baby to stay on mother's chest
until it has latched and fed.

A lot of our pediatricians, who are the ones who do the newborn exam, which
is not done before baby is at least twenty-four hours old, do routinely
insert a non-gloved finger into the baby's mouth for a fraction of a second,
and they seem to think this gives them some useful information about suck.
I have asked them what it is they are trying to find out and they sometimes
start to laugh when they realize it tells them nothing at all.  They also
shine a light into the baby's mouth to examine the palate, and I have yet to
meet one who is aware that if you use a tongue depressor to try to force the
baby's jaw open, you will have to use so much force that you risk drawing
blood, while if you simply tickle the baby's upper lip, most babies will
open wide with no trouble.  Brazelton's techniques for eliciting a baby's
best responses are unheard of here.  

Rachel Myr
Kristiansand, Norway

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

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