Marla Newmark asks for references about this, and says 'We have MANY babies
that loose greater than 5% of birth weight in the first 24-30 hours of
life.  Then within the next 24 hours they loose an addition 3-4% making the
total well over 8-9%.  And then of course the scenario goes that babies
quickly get supplemented, parents panic that they are starving their baby,
"no milk", etc.'

I share Marla's frustration, because as we reduce the time mothers and
babies are in hospital after birth, our discharge weights are now being done
on day two or perhaps early on day three and, DOH; we are seeing more weight
losses approaching ten per cent below birthweight.  This is not because more
babies are losing too much weight.  It's because we are weighing them too
early by at least 24 hours, sometimes 48.

Isn't it odd that people doing the fearmongering about weight loss, and
often setting policies and procedures for maternity units, are so CLUELESS
about lactation phyisology?

We know that the amount of colostrum secreted in the first 48 hours is
small, and we know that newborns have stomach capacity for the amounts
typically secreted by the breast in the first couple of days.  We know that
it is almost never possible to produce transitional milk or mature milk with
its higher water and lactose contents, until about 48 hours after giving
birth.  And we know that babies empty their gut of meconium during that same
48 hours.  In hospitals, it is considered 'frequent' if a baby feeds eight
times in 24 hours.  In eight feeding encounters a baby doesn't have a chance
to ingest as much colostrum as the amount of meconium and urine that come
out.  It has been observed that when babies feed effectively and frequently
right from birth, they sometimes do not have a recorded weight lower than
their birthweights; rather they seem to gain right from the start.  How many
babies born in your hospitals would be able to do that?  I know the answer
is 'hardly any' in mine.

We know that if the volume going OUT of the body exceeds the volume going
IN, there will be weight loss.  The weight loss will continue unitl the
volume IN exceeds the volume OUT.  It is unlikely that the usual events of
the first few days of life are an example of poor design
or absent-mindedness on the part of a Creator.  Volume IN exceeds volume
OUT when lactogenesis II starts.  Why on earth would we expect a baby NOT to
have lost this amount of weight?
If a baby has unimpeded access to its mother and she knows enough to keep
baby at breast, and baby is actively feeding and seems content and healthy,
I'm not at all bothered by a ten per cent weight loss on day three.  I
expect the baby to start gaining within 24 hours and unless the mother is
scheduling feeds or is so sore that she is limiting feeding duration or
freqency.  Soreness of that severity is a 'problem' in my book and I'd do my
best to fix the problem.   Feeding formula is not normally part of my plans
for how to fix breastfeeding.

For the record, while I am comfortable with weight losses of ten percent on
day two or three, I'm very concerned about five percent losses on day ten.
I expect the baby to regain the lost weight about as quickly as it was lost
and a baby who doesn't do that will need a closer look from someone
knowledgeable about both babies and breastfeeding.  But what would the
danger be in waiting until after babies are actually FEEDING before passing
judgment on the quality or amount of the milk?

We lack charts for this, unfortunately.  But the acceptable loss relative to
birth weight changes from day to day in accordance with the phsyiology of
lactation.  Too bad it is such a monumental task to teach health
professionals why this is so.  Parents, on the other hand, seem to take the
information in rather well.

Good luck, Marla, and if you manage to get your point across where you work,
I'll try to get my hospital to hire you to come and tell us about it.

Rachel Myr, Kristiansand, Norway

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