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LACTNET  July 2007, Week 4

LACTNET July 2007, Week 4

Subject:

Nina's question

From:

"Jaye Simpson, IBCLC" <[log in to unmask]>

Reply-To:

Lactation Information and Discussion <[log in to unmask]>

Date:

Sun, 22 Jul 2007 23:40:51 -0700

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (104 lines)

Hi All,

 

I'll attempt to answer Nina's question with my own interpretation.  I
believe Nina is correct to ask what do we do with the info?  In my
professional experience there is actually a lot we can do with the info a
scale gives us in the right circumstances.  How can we tell is 55 ml is
enough?  I think we have to look at both the numbers and the actions of the
baby.  We have this nice little formula - 2.5 times the baby's weight that
gives us a guideline for intake over a 24 hour time-period.  I tell my
parents that baby may not always take in the exact same amount at each
feeding, but that in some circumstances we need to make sure they get at
least a minimum feed of some amount (that depends entirely on the size and
age of the baby).

 

For example:  I have a baby I am working with currently who exhibits
inconsistent abilities to get a full feeding.  First feed (3 hours after the
last feeding) baby looked like she was doing great - audible swallows,
looked good, felt good for mom - finished after 15- 20 minutes of an
observationally good feeding.  She appeared completely satiated. Slept
peacefully for 1.5 hours while parents and I chatted and waited for her to
wake up and do one more feeding.  She drank only 4 tenths of an ounce that
first feeding (which was why I stayed for the next feed).  She is an 8 pound
baby.  Clearly, 4/10 of an ounce is not a decent feeding for a 7 day old 8
pound baby.  Next feeding appeared to be almost exactly the same as the
first.  15 - 20 minutes, audible swallows, looked great, felt great.  But
this time she took in 1.8 ounces.  We didn't change anything - but baby
apparently had.  Parents are using pre-post weights to monitor intake and
supplementing as needed to maintain baby's weight gain and intake.  Baby
clearly needs to be monitored while at breast or she is at risk of not
getting enough to eat while looking like she is doing great.  If baby had 10
feedings in 24 hours and the consisted equally of 0.4 and 1.8 ounces then
she would only be taking in about 11 ounces when she needs more like 20.
This baby will need supplementation in my book until she can stabilize her
skills..

 

I have also worked with many circumstances where breastfeeding started off
so poorly that parents simply don't have a clue, no matter what I tell them,
how to observe a good feeding and to make matters worse - don't know how to
trust themselves or the baby enough to believe that baby really is doing
well.  Case in point:  Baby ended up bottle-feeding due to weight loss as a
result of poor latch and positioning.  Mom and I worked together and baby
learned to breastfeed just fine and was doing great within a day or so - BUT
(here is the caveat) mom is so worried about baby's intake (due to the
initial weight loss) that despite all the positive signs (wet and poopy
diapers, baby satiated, etc.) and my words of encouragement that all really
is well, she was still trying to force baby to eat more by supplement all
the while baby is refusing.  So, I encouraged her to rent a scale for a
week, do the pre and post weighs, gave her a guideline of how much baby
should be taking in over a 24 hour time period (based on 2.5 times the
baby's weight) and told her to really watch baby's cues and behavior at
breast.  Within the week, she had learned enough by watching not only the
baby but the numbers on the scale and the fact that baby was truly taking in
more than enough, that she finally learned to trust herself, her body and
her baby to work together well.

 

I am sure there are other scenarios out there and these are only a couple my
tired brain can write down right now.  I have had so many other situations
where the scale was such a phenomenal tool to protect the baby and the
mother - simply by being able to track how much the baby was taking in at
breast and helping parents to learn to trust the baby and themselves and
watch as baby's BF skills got stronger and stronger, and to get off bottles,
supplementing and pumping.

 

Nina, I hope this answers your question.sometimes it isn't necessarily about
the numbers - sometimes it is about the confidence.  Sometimes it is about
the numbers and knowing how to use them to support breastfeeding and
continue making progress towards NO scale and NO numbers.  :-)

 

Warmly,

Jaye

 

 

 

 

 


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March 2002, Week 3
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