Melissa,
You do not mention if the mom with the 10 lb baby with hypoglycemia had a
dextrose iv in labor.  I suspect that long exposure to dextrose iv's causes
rebound hypoglycemia in the infant.  The fetus produces insulin to metabolize
the sugar he is getting from the maternal bloodstream, then this artificially
high level of sugar is suddenly cut off, and the neonates system does not always
compensate quickly enough to avoid hypoglycemia.  I see this most often with:
long labors due to long exposure to the iv sugar; cesareans with epidurals due
to the fluid loading that is done to prevent low blood pressure with the
epidural; and in poorly controlled gestational diabetes where the mom has had an
elevated blood glucose regularly throughout the pregnancy.  Not all iv's contain
dextrose, and the mom does not always know what she was given...Of course,
immediate nursing is effective in restoring the baby's blood sugar level as long
as it has not dropped precipitously.
        Another issue for informed consent, no?  Sometimes it feels like the
mountain of obstacles to breastfeeding is growing faster than our advocacy for
truly informed consent can erode it.  Lactnet is a lifeline for those of us
struggling with these issues.  Thanks, all.
Catherine Watson Genna, IBCLC