Heather,
Gee you are persistant, but I sure do appreciate your point of view and
folks like Kathy D who truly offer us a valuable reality check every day. I
wonder if all of us could practice lactation consulting on a desert island
[no diapers, no scales, no tape measures]? I think I could and the rest of
us too.
I very much appreciate Heather's comments re hemoglobin and pregancy weight
gain measuring. I really wasn't aware of these issues. I will admit my basic
education is BSN university and many years of practice in level 3 nicu. We
used to joke that to work in nicu you had to be O-C [obsessive-compulsive]
about measuring etc. So maybe there is some of that in me. Someone else said
how far the nicu environment has to go to be humanistic. I wholeheartedly
agree.
In my practice, if truly natural bf was going on, there would be little need
for measuring. If the norm was no mother baby separation, bedding in babies
nursing UNRESTRICTEDLY, there would be few bf problems. Note that in my
practice setting, this includes preterm/sick babies, high rate of birth
inductions and other interventions, there are no home visits, the dyads are
not seen daily for several days like I think they are in the UK. Perhaps if
that was the case, I could discuss management, and follow every day. Moms
who have a c/s [about 30 percent] are told they cannot drive for 3 wks and
so cannot get in to see me easily. Many do not have transportation. Many
moms are isolated from extended family. So again it is partly a cultural
thing. We practice w/i our culture.
Heather asks about the amount a baby needs: "Breast milk based on an average
calorie value? But calorific value - that is, fat content - of breast milk
is the most widely variable ingredient, especially in the early days." Yes
that is true. I believe it is based on average of 20 cals/ounce. And I agree
that a baby could eat again in half an hour, unfortunately this would be
highly suspect behavior from many of the mom's, nurses', and the
pediatrician's perspective [but not mine] in my experience here in the Deep
South USA.
Heather then asks "Who did the charts? On what evidence? On physiological bf
of how many 1000s of babies - or what? What happens if the baby doesn't
reach his required calorie intake on a particular day, but the mother just
hangs on in there?" Heather I cannot answer this. I am sure it is based on
something fairly arbitrary and not based on "ecological, physiological, or
natural bf" like you or I would define it. Just like there are height and
weight charts, percent of fat we should be, cholesterol levels etc. What is
truly normal for one is not for the other, but again having some guidelines
seems prudent. Physiologic bf is not really practiced by many here.
Attachment parenting type behaviors are the exception here. Even some OB
docs follow the babywise books. If the staff at my hosp knew that I was
still giving "nummies" to my 5.5 yo even tho there is no milk there and that
we cosleep, I would probably be run off as a nut case!
So Heather keep asking the hard questions, I will keep questioning myself,
and I will keep trying to change the world or at least my neck of the woods.
And I know that if my scale was not working I would still do a good job
helping a bf dyad. However, in my setting I do feel it will still get some
use.
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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