It's interesting how often people in other places are working on similar
issues to one's own!  I like what you had to say, Winnie, and may I use your
words to help reassure our staff?

We have tried very hard to find out any specific recommendations with
respect to "when to supplement" for the first 24 hours of life, and there
are none out there!  We think we are too quick to supplement babies here in
those first 24 hours and since we couldn't find guidelines to say when you
should supplement, we decided to identify those reassuring
characteristics/signs that tells us we DON'T need to supplement.  Here is a
copy of our first draft:

Reassuring Signs for Breastfeeding In the First 24 hours
Draft, May, 2001

If one or more of the following are present within the first 24 hours, we do
not need to supplement the baby:

Wakes spontaneously at least every 3 hours or comes awake when awakened
Quiet and alert at breast (not screaming frantically)
Licking/nuzzling at breast
Doing skin-to-skin at breast

The following should also be present:

Normal vital signs
At least one wet diaper
At least one poopy diaper


Choices for supplementation are, in order of preference:

Mother's own expressed milk
Banked human milk (not readily available here now, but may be in the future
so let's not forget about it)
Infant formula

Please feel free to critique this.  I already think we need to modify the
"wakes spontaneously every 3 hours or comes awake when awakened", but this
is our first attempt!

Wanda Mertick, RN, MN, IBCLC
Maternal-Child CNS
Madison, WI

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