Just want to add a couple of observations. In my experience, mothers only
very rarely know (or ask about) that babies are weighed each night. They
only occasionally know or ask about the discharge weight. We counsel them
that babies will lose weight, typically, in the early days and that this is
due to loss of fluid and meconium. We counsel them that frequent,
unrestricted bf and STS will minimize wt loss and risk of jaundice and
result in a sooner increase of their milk production.

I routinely look at discharge weight percentages because I am moderately
obsessive/compulsive about numbers. I will go back and look with another
informal survey and share with the group, but I routinely see about 4 to 7
percent. Formula babies usually lose 2 to 3 percent. (these are the ones
who are on my caseload for bf but never did bf or token bf only). There is
some research about this but I don't have the source, and I think it showed
5 to 6 percent as being "the norm" for well bf babies and 2 to 3 percent
for formula fed babies.

Due to the above, I don't think it is ethical to arbitrarily pick 5 percent
as a marker for introducing (even tiny amounts) of formula supplementation.
Again, in my experience, it is the predominantly the mother asking for and
even demanding formula supplementation. (sometimes a nurse or family
member) I believe there is research to show that mothers who have formula
fed prior infant(s) are more likely to supplement or abandon bf, even if
going well by our standards. These might be mothers who would be counseled
on the ways to use said formula in a baby-friendly way.

The cultural and social and healthcare practices are certainly huge
factors. In the hospital mothers are told to record the times the baby fed
and the voids and bowel movements. Obviously the mother gets the hint that
if her baby is not having many feeds, voids or bowel movements that this is
a problem. The baby is a factor too. These babies who are not latching and
even when being given available colostrum, they do get hungry and mothers
report hours of crying and alot of gassiness (in my experience this is
hunger) which is very difficult for a mother to bear. The case I reported
on yesterday when the baby finally latched at about 36 hrs (continuous STS)
and fed for 50 min or so, that mother reported 5 hrs of crying and lots of
gassiness the prior night. She did have abundant colostrum in my
estimation, but some mothers don't. And she was alone (no family) all
night. She did not use formula but many mothers would and that would be
where the important counseling would come in.

Do we take into account the baby's hunger (I believe this is actual pain)
when the baby cannot be comforted or sated with available colostrum?

Laurie Wheeler RN MN IBCLC
Mississippi USA

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