Hi Heather,
My apologies for not responding sooner. I don't really understand the
rationale for not doing frequent weights. Maybe in the UK your moms and
babies are seen more frequently, and thus at lower risk for dehydration or
FTT. Here in our community, the standard of care is that babies go home
from the hospital at 1-2 days of age, and in most cases are not seen by
their ped (or anyone else for that matter) until 2 weeks. The next routine
baby visit after 2 weeks is at 2 months. Our care pattern (home visit at
2-3 days, weekly wt checks available as mom desires, LC phone followup to
all moms in the 1st week, LC visits available as needed) is unique within
our community, and I believe unusual in the US.
Until we began offering the weekly weight clinics that my co-worker Janie
described in her L-net post, we would see several babies each year who would
come in for their 6 week check with the midwife at/under birthweight,
because they'd seen the ped at 2 weeks and all was well, or (more commonly
in these cases) they hadn't seen anyone since hospital discharge.
One reason I like doing the baby's wt at the 2-3 day postpartum home visit
because it is generally the lowest wt the baby will have, and if they seem
slow to gain, and someone advises supplementation later on down the line
based on birth wt, we can refer to that lowest wt, and usually the pattern
of gain looks fine when viewed in that framework.
Thanks for the opportunity to compare practices,
martha johnson RN IBCLC
Eugene, Oregon USA
.
> ----------
> From: heather[SMTP:[log in to unmask]]
> Sent: Friday, June 11, 1999 2:36 AM
> To: Lactation Information and Discussion
> Cc: Johnson, Martha (PHMG)
> Subject: Re: Insufficient milk case history
>
>
> I'm gonna weigh in here, bravely, as I think Martha's case
> (interestingly)
> shows up a difference in practice and in outlook between the US and the
> UK,
> and between IBCLCs and lay counsellors. So bear with me!
>
> > Baby was born (to unmedicated mom) at our out of hospital birth center
> >4/8/99. Birth wt 8lbs 3 oz. Transferred to local hospital postpartum for
> >repair of 4th degree laceration.
>
> Anuthing happen at or around birth (suctioning, unnecessary separation,
> extra formula or glucose feeds, rough handling???)? Might explain
> fussiness
> on day 2.
>
> >Phone followup over the weekend
> >sounded reassuring, w/ milk coming in, better feedings.
> > At next wt check 3 days later (a monday), the baby had lost 5 more
> ounces,
> >and we began pumping 6-8x/day(lactina), and supplementing (ebm as much as
> >possible, formula to make up the balance); and fenugreek 3caps TID.
> Parents
> >offered option to supplement with Haberman or SNS, they chose Haberman.
>
> This is the bigest gap between what would be likely to happen. The further
> weight loss probably would not have been noted - babies are weighed *much
> less frequently* here. So if the baby appeared to be continuing to feed
> well, we would have taken no action except to observe and encourage...and
> there would have been no intervention.
>
> Even if the weight loss was known about, or if it was thought the bf could
> be improved, we would probably just suggest more bf...and as Habermans and
> SNS are rarely used by UK mothers (not liked - too fiddly) these would not
> be on the scene. Nor would the fenugreek. Pumping might be suggested, but
> not at this stage, I don't think....if it was thought enough extra breast
> milk could be got into the baby by more skin-to-skin, co-sleeping,
> following baby's cues.
>
> > Next day's wt check showed a gain of 4 oz. Parents reported poor
> success
> >with haberman, given SNS, this worked well at breast.
>
> Gain of 4 oz in a day? Why not work at reducing supps?
>
> > 2 days later, baby had gained another 6 oz, and I estimated at that
> time
> >baby was getting about 50% of her total daily intake as breastmilk
> (pumped
> >and direct from mom added together). All supplements at breast w/ SNS.
> Baby
> >latching better, much less fussy, archy.
> > This pattern continued for the next two weeks, with mom's milk supply
> >eventually getting up to around 2/3 of baby's total intake, at a wt of
> 8lbs
> >8 oz.
>
> That's okay - baby is 2 plus weeks, and 5 oz above birthweight. We'd think
> that was okay for weight, and we'd be wanting to be reassured the baby was
> feeding well at the breast....and that would be crucial.
>
> We would not be talking about Reglan, or pumping, or SNS....just getting
> the bf going well and happily .
>
>
> > At 5 weeks, wt check showed a gain of only 2 oz in 7 days, mom had
> >decreased pumping due to ductal pain. Increased supplement volumes
> again.
>
> But 2 oz in one week is okay - not wonderful, or reassuring, true. We'd
> look again at how to increase bf. We would prob. not inc. supps. We would
> look carefully at the way the baby was at the breast, how he attached, and
> whether this could be improved in any way, to make feeding effective.
>
>
> >4 days later mom called me in tears due to pain a/w thrush. We
> prescribed
> >APNO, cont'd Fluconazole, and gentian violet. Also taking Ibuprofen for
> >pain.
>
>
> > Baby had been fairly content and fed well at breast, esp with SNS, up
> to
> >now. Now she is restless, fussy during feeds (probably not thrush, we
> >re-treated her a couple more times during mom's long bout with thrush).
>
> Babies do get fussy - no comment on this! Could be the thrush is affecting
> comfortable and effective positioning.
>
> > At our most recent visit, around 8 weeks, baby had only gained 8oz in
> 15
> >days. (10 lbs 7 oz). I recomended that she increase her supplement
> volumes
> >again.
>
> But that weight gain is okay according to our norms. We would not be inc.
> supps. More important to observe the feeding and encourage the mother.
>
> >During this time mom had been on Reglan (still is, tho tapering off
> >now), and pumping an average of 5 times/day, usually 1 hour after
> >breastfeedings. Feeds 10-12x a day at breast.
>
> But it doesn't matter how often if the feeds are not effective.... though
> my guess would be (on the facts as they are here) is that the baby is
> probably feeding okay. Is the mother letting the baby set the pace and
> length of the feeds?
>
> The whole daily regime must be hard for the mother - all the fussing with
> the pumping and the SNS, and remebering to take the Reglan, and all the
> pain and stuff with the thrush...! Phew.
>
> The main difference is that here, we probably would not have intervened
> in
> that first week. And we would be less concerned with what the scales
> showed.
>
> Any other comments from UK?
>
> Heather Welford Neil
> NCT bfc Newcastle upon Tyne UK
>
>
>
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