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Subject:
From:
"Shirley Morris, RN, IBCLC, LMT" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 20 Nov 2000 10:57:52 EST
Content-Type:
text/plain
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For Linda Pohl,
Regarding the blood sugar issue.  This is my understanding, and my experience.
Heel warming usually does increase the glucose level in the blood sample, so
you will have a more accurate heelstick.  A central blood sugar is of course
the most accurate, and sometimes there is a glaring difference between the
heel stick results, and a central sugar.
Most hospitals consider 40 or higher to be normal.  Auerbach and Riordan
state that 20's for premies and 30's for term babies is normal.  The medical
community has for the most part decided to raise the standard ten points for
a margin of safety.  Each hospital has it's own interpretation of all this.
Nurses where I work who work in the Level II nursery, call a 43 "falling" and
want to supplement to prevent a low blood sugar. This is definitely not in
the written policy.
Until clinical directors place value on successful breastfeeding, and teach
and discipline nurses who do not follow the policies, this won't change.  It
is very hard to teach a nurse who doesn't want to be taught a concept.  There
is no other part of newborn care that is so polarizing, and where competance
is not required by the system.  What's new?
Maybe what needs to happen is that informed patients request a copy of the
blood sugar protocol before delivering, and have an advocate to assist them
in seeing that the policy is followed.  I think in general, the policies are
fairly appropriate, but the nurses often sabotage the patient with threats of
brain damage, etc.  We need parents to organize together to bring their
concerns to the hospital nursing managers.  This is hard, because the moms
are so vulnerable, and busy with their own care, and adjusting to their
babies, that they seldom follow through on complaints.  We just need to keep
on gently advocating for the moms,
babies, and dads who deal with this every day. Hope someone else has more to
offer. Shirley Morris, RN, IBCLC, LMT

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