Pat-in-SNJ says,
<< Actually I haven't ever test weighed pre-post feeds (well just once on the
hospital's new scale - I was really curious to see if it worked).
But back to my comment- I depend on output evaluation, general appearance.
I also have a sneaky feeling that some of those who are dependent on scales
may be newer LCs. Those of us who have looked at hundreds and thousands
of babies have a "sixth sense" about the baby who doesn't look quite
"right." >>
I have to "weigh in" here again at least briefly. I see moms in the hospital
on rounds for the (most wonderful) Pediatric group for whom I am an LC. I
would never suggest pre-post weights in the hospital, or before the milk is
in and well established. Those mother/infant dyads on whom I DO inflict pre
and post weights are those that come to me WITH A PROBLEM. So, in one way or
another, it has already been determined that the baby isn't doing well. I
use the pre-post weights for those infants who are way below where they
"should" be at whatever point they "should" be at. And to Heather -- whom I
see erupting out of her chair even as I speak -- keep in mind the context in
which we work in the U.S. Regardless of "who" or "what" determined "how
much" babies "should" weigh and at "what" point in their lives, and "how
much" supplement they should get -- we have to live with that. If a baby
isn't gaining appropriately, the alternative is for the primary health care
provider to say, "Your baby isn't gaining. Give the baby 2 ounces of formula
after every breastfeed." Or worse, "Your baby isn't gaining. You obviously
don't have enough breastmilk. Give it up." Or another scenario, "Your baby
is obviously not getting enough. You better pump and see how much you are
making, and if you can't pump at least XXX number of ounces, then you better
give formula." (or a variation on these themes). It makes a lot more sense
for me to approach in it the way I do -- sometimes we can determine if it is
the mom who has plenty, but baby isn't transferring the milk (I have a couple
of those right now who are faced with what seems to be the problem of the
week: oro-nippular disproportion (to rephrase Jean's wonderful
'diagnosis.'), or the mom's milk supply is low. If a baby, in my office,
transfers only 21 ml on day 8 or whatever, AND this is coupled with scant wet
and poopy diapers, and low or no weight gain, I'm pretty certain that he's
not going to be transferring much more than that even if he does eat an hour
later. And no, it doesn't give me information about caloric intake, and it
does only give me information about that feeding, and not the one later in
the evening or earlier in the morning, but coupled with everything else, I
know this baby isn't getting enough. And IF the mom pumps for me after the
feed, and she seems to pump a lot of residual, then I have a gut feeling that
probably the baby isn't transferring all there is to be transferred. But if
mom can't pump much of anything, perhaps there is low milk supply as well,
and the mother and I can develop a plan of care that meets the baby's needs
as well as hers.
I'm not sure if what happened was that we moved from using ac/pc weights in
problematic cases to the assumption we all use them all the time. (I think
Carol said that the LCs in her area use them all the time -- but she didn't
clarify as to whether or not they are seeing problems or are routinely using
them with all mothers). I see an average of 25-30 new moms a month for our
peds group (it would be more, but I travel and am speaking a lot, so am not
always there). I would guess that out of that 25-30, I will see an average
of 2-4/month back in the office for problems. Of those, perhaps 1 is a
low/slow weight gain, and the rest are a variety of other problems.
Jan B -- who saw 28 new moms in the last 2 weeks, and had 6 back in the
office for problems!!
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