Dear Lactnetters!
I've been lurking for a couple of months and feel like I have to
ogize that I am writing for the first time with a request
for support!  A little intro.....my name is Gabi Avni.  I am an
  RCLC, working full time in labour and delivery in a
level II institution which has between 3,30 deles a
year.  Something happened at work last Friday, and all I could
think of during and after the incident was, I can't wait to tell
everyone on Lactnet about this one.  I will deliver a short case
history.  To those who aren't in the medical field, or aren't
familiar with L&D jargon, my apologies, you can E-mail me pri
vately with any questions. (will put a small key at the end of
m
A primip, late 20's (early 30's?), induction at 40+2 for Gesta
tional Diabetes, diet controlled only, and growth of baby went
from 50th to 20th centile in last couple of weeks.  Induction
started with prostaglandins, ARM a few hours laters, some
meconium stained fluid noted, and then IV Oxytocin. This happen
ed thru the course of the night, and I started the shift at
0715 with IV Oxytocin and Epidural anaesthesia infusing.
The labour progressed, the Fetal Heart Rate Pattern
variable decels, deep, less than 20 seconds long (there were
3 that lasess than 2 minutes)spontaneous recovery, always
average(moderate)vality maintained with accels always
present.  The variables were with a late component consistent
ly, and the obs. resident did 3 scalp ph's on the baby in the
course of 2 hrs.  The results were: 7.20, 7.22, and 7.20 (low
norm?) The obstetrician let the labour take it's course.  At
approximately 0900, mum had 4+ ketones in urine and obs.
ordered a bolus of 500 cc IV D5WRL.  Baby was born at 1107,
vacumn, the mum brought the baby down very nicely, and the
baby needed one small tug and out.  Neonatologist was at
delivery, no meconium below the c vigorous gastric and
oropharynx suctioning done for fairly thick but not parti
culate meconium.  Weight, 2,970 gms.  Mother 4'11", size
4 1/2 feet.  Apgars were 8+8. (I would've given 8+9) The
placenta was small and calcified, and there were no signs
of cord compression, explaining the FHR pattern, probably
classified as a borderline IUGR.
Once mum was sutured and neonates, obs staff and resident
all left room, babe was cuddled and went to breast at 1145,
pink, excellent tone, and nursed 30 minutes on each breast,
sustained latch, rhythmic suck, when the baby came off the
2nd breast, there was some colostrum dribbling down the
side of the cheek.....I listened to heart and breath sounds
and took a temp. while baby was on breast as I knew I had
to get baby to SCN for obs.(policy at our hospital for G.D.)
and I didn't want to take baby off of breast.   Took baby
to SCN at approximately 1245 with dad.  Dad stayed to find
out routines in SCN  went to tend to mum and take her
to PP.  Once in PP, dad met us there, I asked if SCN were
aware to call mum for feeds.  He said, they said if the
baby was fussy, and mum wasn't there, they would feed baby.
I thought there was some kind of misunderstanding, so I
phoned SCN from the mothers r. This is where the story
starts.....(up till now as an intro....)
I barely introduce myself and I hear the foll: "You
kept the baby in L&D too long.  We just did the baby's Chem
Strip and it is zero.  This will not be tolerated any more.
The baby
's mother was a G.D..  There was fetal distress during labour
(!?) If you had brought the baby earlier, we may have been
able to intervene with less invasive treatment.  Now we have
to start an IV..............................."
(There was more, and the tone wasn't as pleasant as it
sounds online)Meanwhile, I'm in the mothers room and I'm
saying: Yes, I hear you, yes , I understand.....the baby
was on the breast, yes..............................

So, I know colostrum will stabilize blood sugar be
than anything.  I think I've heard Dr. Neil Campbell
in Australia preferes to treat hypoglycemia with IV therapy
and breastfeeding?  I'm thinking, would the less invasive
treatment haven a bottle of formula???This baby was
pink, warm, calm, easy breathing, good tone, and had had an
EXCELLENT feehat about clinical signs of hypoglycemia?
Cound the rebound hypoglycemia have to do with the IV bolus
that mum received less than 2 hrs. before she delivered?
I couldn't bring myself to go back to SCN, though did go
see the mum at the end of my shift.  It had been 6 hrs. and
she had been down to feed the baby 2x more, no abm, babe
still on IV and the mum quite pleased.
Then the weekend came...I expect one of 2 things to happen.
The s--- may hit the fan, or we may just get a memo stating
that all babies of diabetic mums (gestational or not) must
be in SCN within 1 hr. of birth.  Definitely not breast
nd friendly policy......it usually takes between 40-
50 minutes to get babe to breast anyway, between suturing
and getting mum comfortable and waiting for babe to show
signs of interest...These babies may end up going to SCN
 not having breastfed, may receive formula once they get
there, these babies stay in SCN for approximately 24
hrs. and it is sometimes very hard to get them on the
breast after......
I'm hoping to haveome kind of conference with our neona
tologist, C.N.E. of both L&D and SCN.  What do you thing?
Are there any breast milk friendly neonatologists online?
I will try to find good research to support what I did.
Any suggestions or support from all you wonderful
Lactnetters out there will be greatly appreciated!
After the length of this letter, you probably are wishing
me back into my lurking closet! I'll be more succint in
the future!

Gabi Avni RN IBCLC
Ottawa, Ontario, Canada
[log in to unmask]

OH, the key: SCN special care nursery. ARM artificial rup
ture of membranes CN.E. clinical nursing educator
L&D labour and delivery