At the risk of really beating a dead horse, here's a real life test wt.
situation I've been involved in over the last couple of days. Baby, full term,
birth wt. 7-12, first baby, born by vaginal delivery at a different hospital
than the one where I work. Readmitted to our hospital on day 3 with 10% wt.
loss and bilirubin of 17. Mother had been exclusively breastfeeding since birth.
Baby 0+, Coombs negative, no bruising, no other risk factors for jaundice.
Baby admitted late Saturday and not seen by LC until Monday. Infant breastfed
every three hours in hospital and then supplemented with formula per MD
order. Mom and baby were never separated. The baby was readmitted to pedi and mom
stayed in room with him. No one started mom pumping until she was seen by LC
on Monday.
Baby 5 days old when I first saw couplet on Monday AM. It had been three
hours since baby had fed. Breasts moderately full, everted, elastic nipples.
Baby latched readily and latch looked good. Sustained rhythmic suck with bursts
of deep jaw excursions and intermittent audible swallowing. Each time baby
became sleepy, I helped mom with breast compression to enhance flow. Test wt.
after 35 minutes (baby now sleeping and unwilling to bf any more) showed 12
ml intake. Test wt. was done on Baby Weigh Scale with conditions the same
before and after feed, e.g. no diaper or clothing change. Breasts somewhat
softened at this point. I advised mom to pump to supply supplement--she did so
with hospital grade pump and got just enough milk to cover the bottom of the
bottle. Plan: Breastfeed on cue, but at least every three hours. Use
compression and massage to stimulate flow. Pump after to fully empty to stimulate
supply. Oh, and by the way I would have guessed from the way the baby nursed that
he got much more than 12 ml.
Today, end of day 6. Bili down, baby ready to go home. Three hr. since last
feeding again. Nobody was limiting this baby to 3 hr. feeds but that is when
he woke up. Same scenario, only this feed baby took 15 ml. and mom pumped
about 15 ml right after. Estimated milk supply at this point is 8 oz. per
day--low and not enough for this baby at this point. Mom has no risk factors for
low supply. Milk is in but quantity is low. It very likely will increase over
next week or so. Meanwhile baby will need supplement with pumped milk and or
formula until supply is sufficient. She has no hx of infertility, has normal
shaped breasts, good breast growth during pg., no health issues, normal post
partum bleeding. Baby has strong coordinated suck on digital exam and no
evidence of oral abnormalities.. My guess is there was poor milk transfer
early on for whatever reason and this contributed to low supply. And when bili
was so high baby probably did not breastfeed effectively and no one started
mom pumping. But it can be difficult to determine what came first the chicken
or the egg--low supply or poor transfer. And it's still very early.
None-the-less, test weighing certainly helped me to analyze baby's intake and to
determine mom's supply is somewhat low. I would not have done a test wt. on a
normal thriving baby. But--this baby had lost 10% of wt. and had pathological
jaundice--most likely lack of breastmilk jaundice. Test weighing did not
discourage this mom. She already knew things were not going well. She just wanted to
know how to fix it. And importantly for me, test weighing disputed what I
thought I saw--adequate intake at breast. It also caused me to explore further
to determine that mom has low supply at this point. Test weighing and pumping
after helped me to determine that baby is taking most of what is in the
breast.
So-- sorry for the long discourse, but I am definitely a fan of judicious
test weighing in the context of a full breastfeeding evaluation.
Kathy Boggs, RN, IBCLC
Mountain View, CA
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|