Hello, everyone. I have just recently been over to our local hospital for
several lactation consults in the past few days (I don't work there
anymore but do provide them with my services as needed for this).  In the
past several months the physicians (mostly family practice) have gotten on
a real hypoglycemia kick with the newborns and now every baby has to be
tested and if they aren't feeding in a certain amount of time are expected
to be supplemented.  I have done a good deal of teaching at this
institution with staff members, but there is still a number of nurses who
separate the moms and babies fairly soon after birth to do no newborn
routine stuff, and probably 80 to 90% of moms are having meds of some
sort, either nubain IV, demerol IV, or intrathecal narcotics which are
really being pushed by one particular practitioner.

A few of the nurses are distressed about what is happening and have asked
for some help.  I do publish a little newsletter locally about
breastfeeding issues.  I have offered to do some inservices there, again.
Don't know if they will take me up on it or not.

I must admit that when I was in nurse-midwifery school, I felt more
confused than not by the whole hypoglycemia issue. I am aware that babies
of diabetic moms are at risk, that low birth wt and very stressed babies
may also be at risk. The reasons for this and the physiology behind it
makes sense to me.  But it bothers me that every single normal infant is
now being tested, even if totally asymptomatic, and put on this
hypoglycemia protocol. I have seen lots of babies who just were not
interested in nursing a great deal the first day, especially when moms
have had long labors, meds, etc.  My recommendation generally is to stop
fussing so much with the mom and baby, get the room warm, don't separate
them, and keep them skin to skin as much as possible. It has been my
experience that this is a good strategy to get babies nursing and decrease
maternal anxiety.  Of course, if so many moms weren't medicated and there
weren't so many intrusions after birth, that would help, too, but not much
I can do about that at the moment as I am not in practice there.

Many of the nurses tell me that if they try to implement such measures and
the baby doesn't nurse much during their shift, then the next shift comes
on and starts poking the baby and instituting the hypoglycemia protocol
(which often ends with baby in the nursery and supplementation).  This is
so frustrating.


Does anyone have thoughts about how to approach this?  Suggestions for
articles or literature to share? I do have some ideas and am not totally
in the dark, but any thoughts would be appreciated.

Ione Sims, CNM, IBCLC (in sunny, warm --today, at least -- Shelton, WA)