naturally i did not mean that breastfeeding success is the *only* criteria to
determine successful outcomes (! now really). i also know that weight alone
is not the requirement for when a preemie leaves the hospital and i certainly
would agree that being able to maintain body temperature and breathing might
well be a criteria for discharge (hey, do i look that stupid? i understand
these criteria better than some people seem to think).
in fact this relaxation of the "weight rule" (you know, it used to be five
pounds no matter what, or four lbs, etc.) has been a real help to babies and
mothers. but, at least around here, preemies are not even expected to leave
the hospital breastfeeding; mothers are sent home bottling them (well! they
*have* to bottle before they can *attempt* breastfeeding, okay, i never said
we were on the cutting edge around here) and with the hopes that they will
eventually "transition" to complete breastfeeding. because they are told a
bunch of other garbage and not given much help, it rarely happens.
but what i am interested in here is the reasons for using intrauterine growth
rates as the norm. i do not think that is the "only" standard we have. i want
some idea of what basis is given for this. are there studies? are there
references in textbooks? some looks at outcomes of preemies that specifically
mandate that we maintain them at that rate? i am also interested because this
is one of the justifications for using fortifiers that are caloric and not
just minerals.
also, at the ilca conference last year i was priviledged to hear a
presentation by kirsten nyqvist of uppsala, sweden. if any others of you were
there you will remember the surprise and amazement of most of the audience at
what she had to say. this was nothing compared to HER surprise and amazement.
i was sitting next to kirsten and had a long talk with her. they do NOT use
intrauterine growth rates as their norm for growth, she was shocked to hear
this. they do not use fortifiers. they do not supplement with abm, if a
mother refuses to breastfeed and they cannot convince her to do so, she must
bring in her own bottles and formula. (that sounds to me like the same method
we use to get mothers to breastfeed here in the us: mothers have to fight to
make it successful in some places). they begin putting preemies to the breast
as soon as they are stable enough to breathe. babies go from gavage feeding
to breastfeeding, no bottling in between. they don't go home until feeding is
successful and feeding is defined as breastfeeding.
her study was about when babies are capable of breastfeeding. the other
information that was so astounding to all listeners was just normal for her
hospital. she was so surprised! so tell me, those of you in other countries
besides the usa, how does this work where you are, and is there some evidence
as to a difference in outcomes? i can't imagine that in sweden they would
have these policies if there were a noticeable difference in outcomes. and i
don't mean *just* breastfeeding, i mean short and long term development.
maybe babies in sweden are just healthier?
yes, i am just being facetious, that's *probably* not the reason. but i could
not ask kirsten to "justify" their policy of not attempting to have preemies
grow at intrauterine rates; she asked ME what on earth was the rationale for
such a policy. i am still wondering. that's why i asked, and yes, my interest
as an lc is in successful breastfeeding outcomes; that doesn't happen unless
all the other hoped-for outcomes are being achieved, usually.
enquiring minds still want to know.
carol brussel IBCLC and not an idiot
laura nevada lactation
denver colorado
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