Pam writes:

>Her baby was born term (39+5wks), weighing 6#10 ounces, (3010gms)
>uncomplicated pregnancy/vaginal delivery. Mom came in labor, requested
>epidural on admission. She labored about 2 hours getting hydrated before
>epidural placed. At that time Pitocin was started as well. Infant was
>born about 11 hours after admission, had some variables and mom was
>turned on her side a few times, which probably also means that she was
>given more IV fluids. Infant delivered with apgars 9/9. Infant was
>breastfeeding great from the start, good latching, mom had absolutely no
>nipple trauma, infant nursed frequently, about every 2-3 hours and
>nursed for about 20-30 minutes each time.  Mom was discharged at about
>42 hours after delivery (delivery happened at about 2:30 a.m. ) Infant
>was 6#7 ounces (2920 gms) at discharge.
d>
>  This is mom's account of what happened:  At discharge mom states that
>the pediatrician told her  the infant weighed 6#2 ounces and since there
>had been a weight loss of 8 ounces the pediatrician told mom (by the way
>she was discharged at 6 in the evening) to supplement after feedings
>with a formula bottle.


In response to Pam's post:

I am wondering if the MD in this case misread the discharge weight as 6#2 oz 
instead of 6#7oz.
In any case, a simple conversation with this MD might be worthwhile.  Just 
exploring with him the reason for his interventions and offering your 
assessment and recommendations might go a long way to help future clients 
and enlighten the MD about breastfeeding.  I have found that many physicians 
are open to information from LCs.  Also, Pam, did you have the opportunity 
to contact this mother prior to 10 days?  if lactation follow-up occurred a 
day or two after hospital discharge, proper management could be advocated 
with practices to "protect"  her milk supply.  It's very disappointing when 
MDs disregard or are ignorant to the need for the mother to establish and 
maintain her milk supply.

As I see things, a review by the LCs would not affect change in the MDs' 
orders unless they had "buy in" to the proper management of breastfeeding. I 
wonder if Pam's hospital could pursue Baby Friendly Certification as a step 
to strong breastfeeding practices.

I work in an NICU where formula is used routinely when mother's own milk is  
not available. In my experience, each hospital, particularly NICUs, has 
their own approach to newborn feedings.  Unfortunately there are health care 
professionals who believe that breast milk or infant "formula" are 
equivalent.

Along that vein, the newer neonatologists order formula supplementation 
after discharge for breastfed preterm infants born at 32 weeks gestation or 
less. The rationale being that maternal breast milk does not contain 
sufficient protein, calories, calcium, and phosphorous for adequate growth 
for premies.   Is anyone out there seeing this?


Cathy Carnaby, RNC, IBCLC
Omaha, NE
[log in to unmask]

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]