Several thoughts:
I read the article that Linda cited and it gives us a good idea of the
variability of normal BF. We can use this to talk to inexperienced moms
about what they can expect. Haven't we been doing this already? New moms do
like to have some idea of what to expect, and I think they deserve it. So if
an exclusively BF baby only BF 4x in 24 hours, this would be red flag.
Similar to the advice about turning the clocks to face the walls, I use this
analogy when talking with moms who worry about when to feed the baby (some
may have heard this from me already). I ask them to pretend they are on a
tropical island with no clocks, calendars, bottles, formula, or pacifiers.
They have plenty to eat because their partners are bringing them fish,
shrimp, mangoes, pineapples and the like. I ask them this, "if your baby has
BF on the right and then the left but seems hungry again in 20 min, what
will you do? Will you give him the shrimp then?" No, they say they would BF
again. Right! This is to show they don't have to grab a formula bottle in
this case. This is sort of a light-hearted discussion of baby watching and
trusting your body.
Re wrong info with strict feeding times and lengths: I am cynical and think
maybe this is a concerted effort by some people who do not support BF. Why
all of a sudden, with much new and evidence-based info about feed
variability in journal articles and conferences, are we seeing this kind of
info taught at CLE courses????
About test weights, again. People usually do not check their blood sugars or
carefully meausre their food intake, however sometimes this is done when
their is a disease process or something out of the norm. Same applies with
test weights. They may be useful for preterm infants or non-thriving infants
to help assess and monitor their feeding effectiveness. The usual thing is
to NOT be obsessed about these things and to just "feed the baby." Again, as
in my first paragraph, the moms do need some guidance about what to expect,
and I think we do a good job with this. They need to know there is going to
be variability, again the article recently cited showed this: sometimes baby
will take one breast, sometimes two, and sometimes "switch nurse" or cluster
feed. Some babies develop a pattern of always taking only one breast, some
babies always take both, some vary. Aren't we already talking to moms about
this normal variability?
One last thing: A scale is probably not necessary in a truly BF supportive
facility, culture, country. Even for a tiny preemie, he would be kangaroo'd
and just learn to BF over several weeks. This is just not done in most
places in the USA. Even "normal" mother/baby dyads are not allowed the
access and synchronization either in hospital or afterwards. I can't begin
to tell some of you how far from the ideal many places are. It seems to me
that the European and Australian LCs are in a more BF supportive place than
the USA. In USA, Birth centers with midwives are very different places than
typical maternity hospitals. I think that's why some of us use scales
because the normal BF behaviors don't happen and then the downward spiral
happens so quickly and then more intense interventions are needed. Also, the
availability of follow-up is not really there. How many LCs get to see a
mother/baby dyad having trouble, repeatedly, say every few days for a few
weeks??? This is what it would take to really follow up and get them going,
without having a scale. This would be great, but it is just not feasible in
lots of settings. Hospital LCs don't usually have a lot of time set aside
for lengthy followups. If the pair goes to the pediatrician for follow-up,
breastfeeding can often get derailed. So, the whole culture has to support
Bf - that's the bottom line.
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA
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