Dr Rouw said <<when a baby is thriving, when he is gaining weight, active,
loose stools, for me it is unimportant if, in this special feeding I am
testing, the child is drinking 10 ml, or 20 ml, or 30 ml, or 60 ml. He is
thriving, and that's what counts.>>
I agree and would not even think about doing a pre and post wt here.
Then Heather asks some really hard questions, apropos to why I am constantly
re-evaluating my practice based on my journal reading, conferences, and
lactnet [an international resource - I love that phrase!].
Heather, I think you are right on when you say lots of this is cultural. We
are working against lots of barriers to Bf in USA hospitals and healthcare
providers still giving out lousy info re bf to parents. Babies are in the
nursery alot, pacifiers are used, babies are supplemented alot [mom's
request it even after being counseled agaisnt this], so normal bf is not
really occuring. In the USA birth is very medicalized, health care is based
on the medical model not a wellness model. But I don't see the numbers as a
bad thing necessarily. Lots of stuff in life is measured like blood counts,
hemoglobin, pregnancy weight gain, fundal height. We use these numbers along
with other assessors. Some practitioners intervene when the hemoglobin is
xxx for example, when another would not intervene or do something less.
Now, it IS very hard to say what is a "normal" or "average" intake by a baby
on a test weight. Yes it is just a guesstimate and yes the test weight is
just one "snapshot" in time. But lactation consulting is an ART AND A
SCIENCE, both of which are constantly evolving. The test weight would be
only one of many indicators that I assess on a consultation like gestational
age [another number but we see quite a few not-very-great bf'ers at 37 wks],
birthweight, maternal medical and surgical history, appearance of jaundice,
skin turgor, wet and dirty diapers etc]. If the whole bf picture looks like
we need to intervene and for example supplement the baby, then I might
recommend a particular amt of supplement [ebm preferred] based on the baby's
body weight if the baby took say 6 mls on the test weight. Lets say the baby
is currently 5 pounds [2270g], it is day 4 with no milk surge. If the baby
took 20 mls then I might say feed very frequently do breast compression but
not supps but come back for a reweight tomorrow. For a 5 pound baby they
need about 13 ounces per day. If this were a greater than 7 pound [3178 g]
baby on day 4 then I think less than 30 mls intake would concern me. I base
this on my chart which says a 7 pound baby needs about 18-19 ounces of milk
per 24 hr day. These charts are based on the guidelines of xxx cals/kg
needed. So if I say 30mls x 14 feeds = 15 ounces, this baby would be a
little behind the amts he needs but lets take into account different amts,
different calories, milk supply should be increasing etc. Again, this is not
perfection, but making a judgement call. I will be rethinking this every
day. Thanks.
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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