Lynn Duffy, Cassandra Muff and Jan Riordan presented a poster at the recent
ILCA conf. about research they did looking at the weight loss of infants
whose mothers had received IV fluids in labor vs infants of mothers who did
not receive fluids.   The infants were all exclusively breastfeeding.  They
were weighed at birth, and on Day 2-3 prior to discharge from hospt.  The IV
fluid group (N=46) and the non-IV group (N=66) were controlled for infant
age and gender.  The findings indicated that:  "The percent of weight loss
in neonates of mothers who received labor intravenous fluids were not
significantly different from those who did not.  Likewise, no significant
differences were found when the amount of fluids were divided into levels of
amounts (none, small, large).  The results indicate that intravenous
infusions during labor are not linked with excessive neonatal weight loss
early postpartum in exclusively breastfed infants."

This is a nice piece of evidence to have, because it indicates (esp if
replicated) that it's not peeing off IV fluids during the first few days
that is giving an artificially high weight drop.  But that weight loss that
is observed when baby is brought back in could still be related to the
fluids, but working on the MOM not the baby.  I have theorized (based on
observations of maternal edema) an effect of this swelling that causes
significant delays in the onset of copious lactation.  So if you send a
water-logged mom home, and her milk doesn't come in until the edema
resolves, baby uses up all its physical reserves waiting on lactogenesis
Phase II to occur. Hence the large and dangerous weight drops.

I think the heavy use of IV fluids should be another red flag risk factor
for delayed lactogeneis.  These moms should be monitored (could be done by
phone) to see if their milk has come in and if the baby is stooling/peeing
WNL.  If breasts are still flaccid on Day 4, baby should be seen and maybe a
plan for brief supplementation instituted until milk shows up.  Mom pumps in
the meantime to keep prolactin receptors open, because as baby gets
hungrier, weaker,  and more discouraged about lack of milk, they stop
sucking.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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