Joy,
I wonder if you considered that only babies born at home reflect the physiologic 
norm? How can we legitimately ask what might be normal weight loss unless we
look at only normal births? So much is different between the two scenarios, that
the only question you might ask in hospital births is, what is the "normal"
weight loss for babies born in xyz institution or setting? We certainly know 
that the hormonal states of the mothers are different. We know, for example, that
the highest level of oxytocin a woman will ever experience in her lifetime is in the
hours after a normal birth and that when she experiences this peak, oxytocin levels
are higher on day 3 than in other women. How can we think this does not impact supply, 
and thus weight gain? Even the obsession with weight is greatly reduced at home than 
in hospital. How might that obsession impact the mother's confidence and her feeding 
outcomes? Personally, I think early weight gain is very important, but that it mostly
takes care of itself when physiologically normal birth is followed by physiologically
normal feeding. IMO, have no adequate way to assess this issue in hospital births 
due to the confounders of drugs and other interventions. 



 Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network, LLC








Date:    Sat, 6 Jun 2009 09:16:25 -0400
From:    Joy Noel-Weiss <[log in to unmask]>
Subject: Re: Weight gain is never sufficient

Dear Gonneke

You might want to check out this paper by Crossland et al. [Crossland, D.=

S., Richmond, S., Hudson, M., Smith, K., Abu-Harb, M. (2008). Weight chan=
ge
in the term baby in the first 2 weeks of life. Acta P=E6diatrica 97, 425=96=
429.]

Crossland found that 54% of the breastfed babes and 39% of the formula fe=
d
babes had not regained their birth weight by 8 days of age.

I recently did a systematic review to determine physiological (normal)
weight loss in breastfed neonates.  The four clinical practice guidelines=
 I
looked at favoured 7% as a threshold, and I pulled all of their reference=
s
along with my search of electronic databases.=20=20

I found 6.5 or thereabouts was an average/mean loss - this would mean tha=
t
50% of the babies lose more.  How can 7% be used as a threshold when it i=
s a
mean loss?

In the research I am doing right now, I have come to realize that we use
birth weight as a baseline and that might be a problem straight off - sho=
uld
the weight measured within minutes of birth be the baseline or should
babies' fluids settle before the baseline weight is measured?

So I see two issues - 1) what is acceptable loss, and 2) how do we determ=
ine
how much a baby has lost?

I appreciate the importance of weight as an assessment tool, and I agree
that we should monitor closely.  It is best to catch problems early.  Our=

comfort with measurements can lead to clinical decisions based the number=

and not the whole picture.

Joy

 



 


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