Felicia,

There are two sections in Dr. Lawrence's book _Breastfeeding:  A Guide for the
Medical Profession_ (1994) that address this.  On page 248 she states that "A
10% weight loss is acceptable if all else is going well and the physical
examination is negative, but it should be justified in the record, and the
infant should be seen shortly after discharge . . ."

On page 362:  "A weight loss of 5% is usually accepted as the norm for
bottle-fed infants in the first week of life, although information in pediatric
textbooks is meager.  A loss of 7% is average for breastfed infants, but when
this occurs in the first 72 hours of life, the clinician should be alert to
breastfeeding problems and review the process.  A loss of 10% is maximum for a
breastfed infant." . . . "Initially after birth the normal infant loses 5% of
body weight before starting to gain, whether breastfed or bottle fed.  In a
study of infants at the University of Rochester, it was noted that breastfed
infants who were given added water or added formula to force fluids in the first
few days of life lost more weight and were less likely to start gaining by the
fourth day than infants who were exclusively breastfed or who were bottle fed."
(No reference for this study is cited.)

If she thinks a copy of this would help and no one around her has the book, I
could mail her a copy.  *However*, if written orders from the physician in the
chart mean nothing to these people, I can't imagine they would pay any attention
to what a reference says!  (Would not the threat of lawsuit mean anything?)  I
still say her best bet is to never let the baby out of her room and get the he--
out of there as soon as possible.  On the other hand, perhaps she could do all
the breastfeeding mothers delivering there a favor and schedule a meeting before
delivery with her hospital's "risk management committee" (or whatever the
equivalent is) to discuss the implications of giving ABM against the expressed
wishes of the parents and without a physician order.  Surely there is "fear of
lawsuit" in Canada as well as around here!

Becky Krumwiede, RN, IBCLC
(feeling like she's in Canada instead of Wisconsin since it's -28F)
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