Thanks to all for your valuable info.  I will be bringing printouts
of your responses to the next meeting (for those of you who are worried
about this being a protocol, no decisions have been made yet - we're still
in the planning stages).  I wholeheartedly  agree that recommending
supplementation has dire consequences.  However, here's the problem:  Our
hospital has a very early discharge program of 12-18 hours.  When it was
first implemented, we had some horror story dehydration cases and the
neonatologists were quite upset.  Instead of this taking the logical course
(returning to longer stays), formula supplementation became the norm.  The
breastfeeding rate dropped from approx 75% to 50%.   I began doing lactation
rounds 3 1/2 years ago to counteract this and refer moms to our hospital LC.
It proved to make the difference (breastfeeding rate went from 50% to 84% in
the first month and we've maintained a rate of 70-90% since.). We also began
calling all moms within 48 to 72 hours of discharge to catch any hydration
problems.

         I also don't like numbers and putting babies all in one category.
However,the doctors are adamant about preventing newborn dehydration. I am
too as well as all of you are.  I feel it's important that nurses, doctors,
and LC's be consistent in patient instruction so that there is less patient
confusion and lack of confidence in health care providers.  Let's face it -
if the doctor says to supplement,  most  moms will put whatever I've said on
the back burner. I'm working toward a goal of getting the doctors to
instruct moms, "if you feel you must supplement your baby, please call the
lactation consultant immediately".  So far, they are beginning to accept the
first stage of this goal-- and are beginning to  instruct, "if you
supplement beyond 24 hours you must call the lactation consultant for
assistance."

        I know some of you will be annoyed at such slow progress but
whenever I seem to make progress against supplementation, another bad
situation occurs. Llast summer a midwife who's babe was urinating barely 4
times per day on day 10. Then, a  couple of months ago we had a baby with
esophageal atresia.  It was discovered at 12 hours of age when the baby
began to spit up breastmilk.  Every neonatologist (except one) made it a
point to corner me and  take delight in  politely explaining that "this
would have been discovered 12 hours ago if she were bottlefeeding -- this
just proves what a small intake these breastfed babies get on the first day!"

         Somedays I feel like the hospital LC, one incredibly supportive
neonatologist, and I are the only ones who know that breastfeeding does
work!  I've been on Lactnet for a couple of months and thank God for it.  It
is really great to get all this wonderful info and support.

        With early d/c becoming the norm around the country, I agree that
this early voiding/stooling pattern definitely needs research.  We have a
great  set-up to do research at our hospital since we call all d/c'd moms
within 48-72 hours after delivery.  I will be discussing this with our
hospital LC and that one incredibly supportive neonatologist!!!


        Donna Zitzelberger   RN BSN CLE