When does birth end?  With the delivery of the baby?  No, because if the placenta isn't also delivered there's going to be trouble ahead.  What about from the baby's perspective?  Does it end when he's out?  No, because if he doesn't breathe there's going to be trouble ahead.  Maybe it ends when he "passes his apgars"?  If he doesn't do well on those, steps are taken to prevent trouble ahead.  So birth isn't over until all those stages have been addressed.  We take care of all those quickly, because while they might be small issues at the moment, they portend serious problems if they aren't completed as a part of the "birth package."

I'd like to see the delivery of colostrum included in that essential "birth package." 

My hospital-based friends tell me that there's generally much more colostrum at that first post-birth feed.  The baby takes a good slug or, if it's known that the baby isn't going to be breastfeeding for a while and the mother pumps in that first hour, my colleagues tell me there's a lot more to pump - maybe 30 cc, while a few hours later all they get is drops.  This says to me that the mother is primed to deliver colostrum in a big way shortly after delivering the baby.

Most of those same friends tell me they like to give the baby first crack at it, and not come in with a big intervention like expressing milk until the mother and baby have had plenty of time to recover and work things out for themselves.  They also tell me that their formula supplementation rates are through the roof.

So how's this:  If the birth was unmedicated and the baby goes to breast well in the first hour, hooray.  If the birth was unmedicated and the baby *doesn't* go to breast right away, the beginning is still close enough to normal birth to expect them work it out over the next few hours.  If the birth was *medicated* and the baby goes to breast in the first hour, hooray.  If the birth is medicated *and* the baby fails to go to breast in the first hour, we've just been handed two major forms of evidence that this is a compromised baby, that he who be helping the mother with the final stage of birth.  After a first hour of skin-to-skin, a nurse slips in to help the mother deliver that first load of colostrum, either by hand expression or (if it works well) with a pump.  We do that *because otherwise there is likely to be trouble ahead*.  Just as we wouldn't wait to see if a baby breathes on his own by the end of the day, or wait to see if the placenta falls out on its own tomorrow, we address the delivery of colostrum in a timely fashion.  That large, easy quantity is apparently part of the delivery itself.  It won't be there later, the baby was supposed to do it himself, and in a birth that has already suffered interventions this may be the kindest and most health-preserving intervention of all.  In a sense, we are making babies suffer nutritional insults because the mother chose an epidural, when much of the trouble is both foreseeable and avoidable.  Are we trying to pretend that epidurals don't have consequences, when we know that they do?  Why would we do that?  

For my part, I think that from now on (unless you can convince me otherwise, and "mother's fatigue" won't convince me), I'm going to consider that first delivery of colostrum to be a fundamental part of the mother's birth process, and will urge birth supporters to help her complete it.

Diane Wiessinger, MS, IBCLC, musing in Ithaca, NY  USA
www.wiessinger.baka.com


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

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html