In our hospital we use a thirty percent sugar solution mixed up by the
kitchen as pain relief for heel sticks done by the lab staff and for the one
vaccination we do here on at-risk babies, BCG, which is injected
intracutaneously.  The baby gets about one ml of the solution.  I've never
noticed any difference in willingness to come to breast afterwards.
For heel sticks done by midwives, who do the newborn blood sampling in our
early discharge and breastfeeding clinic, we use breastfeeding as pain
relief.  A very few mothers prefer to breastfeed during the BCG injection
but many find it difficult to watch us injecting it in the baby's upper arm
and prefer to let a staff person hold the baby and give the sugar solution.
The sugar option requires one person to administer the sugar and one person
to take the blood sample or do the injection.  The baby's heel also needs to
be warmed up ahead of time.  Still, you need to be attentive to the baby's
movement and reaction, and they usually do try to pull their foot up or move
away.  When doing heel sticks during breastfeeding the mother is attending
to the baby's comfort and all we have to do is aim well before we stick, not
a big challenge.  I don't warm the heel anymore since I noticed that a baby
who is guzzling milk generally has great perfusion of her/his extremities
and collecting enough blood is no problem.  I scarcely need to squeeze,
ever.  Only rarely does a baby let go of the breast long enough to cry out
and then almost never for more than a brief moment.  Mostly they carry on as
though nothing has happened, though I may feel a twitch in the foot right at
the time of the stick.  It makes a difference when you do it.  I am mostly
doing newborn metabolic screening so the babies are at least sixty hours
old, with observable swallowing.  I wait til I see that, as it bothers the
babies far less, if at all.
The overwhelming response by parents is that they far prefer for mother to
be able to breastfeed during blood sampling.  I don't think this is because
the mothers are eager to undress in my office.  What they say is that the
baby seems much less bothered that way.  I like it because it conserves
resources, saves time, spares me hearing crying all day long that is my
fault, AND because the parents go away just that little bit more confident
that they have what their baby needs to feel safe and comfy.  Not to mention
I can observe baby feeding without making a big deal of it. 
Today I had the real pleasure of doing the PKU test on the first grandchild
of another member of my BF mothers' group.  Baby was sixty-two hours old,
and her eighteen year old mother was Ready To Go Home.  Baby's weight at
sixty-two hours was forty grams (one and a half ounces) ABOVE birth weight
and it wasn't because she hadn't peed or pooped since birth either :-)  

When is someone going to do a study on milk volume the first week postpartum
and maternal age?  For all I know it's been done already, please enlighten
me if so.
Rachel Myr
Kristiansand, Norway

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