First of all, a lovely quote from a very old lady who was a retired midwife: "Colostrum is the most valuable food that a baby will ever ingest in his lifetime. Breastfeed your baby early and often."
Weight loss and IV fluids before Birth
A page written by Dr Jay Gordon (you can read it all here) has taught me something I didn't know, but it really does make sense. Perhaps you have some experience of this?
When a mother receives IV fluids during labour, those fluids will also be taken up by her baby. When the baby is born and weighed, it's weight will be artificially high because of the additional fluids. After a few nappy changes, the fluid balance has settled and the baby's weight will appear to have dropped dramatically.
If weight charts are used as the only sign of health & progress in your child, then alarm bells will ring and you as a mother may well begin to doubt your milk supply. Supplementation with formula may even be suggested. (Medical staff caring for you are told to examine cases where a baby loses more than 10% of it's birthweight. The weight gain/loss is discussed as a percentage of the weight measured at birth.) If birthweight was "too high" due to retained fluids, then the percentage loss will be a larger number than is suggested by the health of the child.
Weight gain should be measured against the lowest point on the graph.
Here's a comment placed upon another blog, so I can't verify any sources or details here:
I remember reading that a baby that is bloated with IV fluids can lose up to 20% of their weight and be just fine. The baby should be monitored for other symptoms such as severe jaundice, lethargy, low blood sugars etc. and that if those other symptoms are not present and if the baby is soaking diapers, then it should be assumed that it’s simply the retained water.
ESPECIALLY with c-section babies. Going through the birth canal squeezes all sorts of fluids out of the baby. The C-section baby will lose a higher percentage of weight because of the IV fluids and the lack of squeezing.
Published research article on this issue
A more recent article on Motherwear discusses research (published in Amer Jour. of Pediatrics, Dec 2010) into weight loss after heavy IV use. (This article is written from an american perspective where IV fluids are given as standard to many labouring women.)
The article explains the double hurdle for these women: extra fluids lead to oedema in the breast, which can mean a delay to milk "coming in". Additionally, the swollen tissues around the areola will make latching on trickier for a newborn. (Look up the Reverse Pressure Softening technique, on Dr Newman's pages.)
Remember it is absolutely normal to see a baby's weight decrease for a few days, then increase again to return to their birthweight (generally around week 2 - but we are all different), and continue onwards.
Clinical Research has been performed to confirm this - details below in the Abstract for Prof. Joy Noel-Weiss's talk at the Gold Conference 2011.
"The Ins and Outs of Maternal Fluids and Newborn Weight Loss
This prospective observational study explored associations among three variables: maternal fluids during parturition, neonatal output, and newborn weight loss during the first 72 hours postpartum. We hypothesized that newborns are born overhydrated and weight loss in the first 3 days is related to fluids their mothers received before birth. Data about maternal oral and IV fluids were collected during labour or before a cesarean section. Participants (n = 109) weighed their newborns for 14 days and neonatal output (i.e., diapers) for 3 days. We found positive correlations between output and weight loss and between maternal IV fluids and output in the first 24 hours postpartum. At 60 hours, there was a positive correlation between grams of weight lost and maternal fluids from admission to birth. It appears neonates experience varying degrees of diuresis in the first 24 hours and some weight loss is a fluid correction. When assessing newborn weight loss, we recommend a measurement at 24 hours instead of birth weight should be the baseline measurement used."
So it's useful to have a range of different signs to notice in your child, viewing the weight of a baby as just one measure of his health. Look at his colour, his alertness, his muscle tone, his noise levels! The quote above mentions lethargy, low blood sugars (which would be measured if a hospital were concerned over hypoglycaemia - read more about it here, or in this Lakeshore note), and also jaundice. Jaundice shows itself in a newborn as a yellow tinged skin, which mothers don't always see as it appears quite gradually.
Read more on Jaundice here or in a note by Dr Newman, assuring yourself that the best way to prevent Jaundice is to offer the breast often, and ensure your child has a good latch. This will help the gut to clear itself of Meconium (the first black poos). Aim for more than 10 feeds in 24 hours, and if your child is not asking for more after 4 hours, offer the breast. Keep your new baby with you (skin-to-skin) as frequently as you can. If your baby is very sleepy or ill, then your hospital will advise you about pumping to bring in your milk (>8 times in 24 hours, including through the night), and we will be glad to support, too.
Artificial infant milk is certainly not a cure for jaundice. If anyone suggests that to you - ask them about their qualifications, their evidence, and their reasoning in your case.
Weighing-up
If your entire thoughts about a baby's progress is based on a set of numbers with a very tiny percentage gain or loss, then it makes a big difference to your decisions whether the scales used (at hospital, at clinic, and at home) are well-calibrated and the standard procedure was used as a baby is weighed.
Analytical Armadillo has more to say on Weight issues.
Also an article by the very wise Nancy Mohrbacher, taking a longer-term view on weight gain & growth charts.
Measuring input - Is he getting enough?
You (no doubt) were taught antenatally about the main way to ensure a healthy breastfed newborn baby is getting the milk supply they deserve...
It's all about the nappies! You'll want to take notice of the number of dirty nappies - but also take note of the colour of the poo. It will change from tarry black through green to mustardy-yellow. It's a real sign of the progress you & your child are making.
Ask to see our leaflet on newborn poo at the drop-in groups... it has pictures!!! (Or try this link.)
Wet nappies are an even more immediate sign that something is going into your newborn baby. Expect to see around 6 wet nappies a day (24 hours) after day 7, and that's just a guideline. You don't need to get out a measuring jug... just notice that urination is happening, regularly throughout day & night. Also urine should be a very pale colour.
A big warning sign that your baby has NOT been getting enough milk is that the skin appears wrinkly. Also a dry mouth, sunken fontanelle... check with health professionals if at all worried.
This is serious & needs immediate attention. Your first priority is to feed the baby!
Okay - so there is a final way to find out what your baby takes with each feed. This is something not often taught antenatally. It is best done by the mother.... not because she hasn't anything else to do, but because she will find it the easiest! It can also feel much more immediate, because you can do it with every feed (rather than waiting for the next nappy change!)
Learn to recognise swallowing in your baby.
Not just sucking, swallowing.
Some videos from Dr Newman (which are linked below) are really widely used as the best way to learn this - although you can always watch a friend feeding her child, if you are lucky enough to get the chance. Don't worry about it, though. When you are the mother doing the feeding (every time) - you will learn how to spot a swallow in your own baby. Dr Newman also writes about this - see a description at the end where he explains how to see it in your own mouth.
When you recognise the difference between sucking & swallowing, you can be a really good judge of how well your child is working at the breast. Then you will not be tempted to judge each feed in terms of the time spent at the breast.
- Only 12 minutes? - yes, but she was swallowing lots, there were several let-downs. How marvellously efficient. Perhaps with the next feed she will take her time a little!
- A whole hour? - Hmm, she was only swallowing for two short periods during that hour. OK, the rest was sucking for comfort, and I'm OK with that just now (but it won't be like that every feed).
- She's spent time at the breast but hasn't swallowed at all yet? Then remove her, and make another attempt at a better latch. (Or perhaps you could play a while, or perhaps your child is sleepy?)
Do you eat all your food & drinks at exactly the same times? Do you eat/drink for exactly the same length of time at each meal?? Nor will your baby.
For both of you, your appetite varies across the 24 hours (or across a week) - but you still take in enough sustenance. You were designed that way.
So here are the videos, they show mothers who have visited the Canadian clinic of Dr Jack Newman - very experienced in helping breastfeeding pairs. The links take you to his free website, so why not have a look around whilst you are there, perhaps even make a donation towards his excellent work?
- First, a child who is nibbling not swallowing much... perhaps full up, perhaps sleepy?
- Then, a newborn who begins a feed with just a few nibbles, then shows you some good swallowing when his Mum uses compression. This newborn shows us some of those tiny new colostrum pauses (though he looks a little twisted & uncomfortable).
- And finally, a baby who really knows how to take his milk.
If you'd rather, you can choose from the full set - follow this link.
Try and notice the pause for yourself - look for the baby’s jaw to drop and hold for a fraction of a second. You can also listen for the swallow, but that doesn't always work.
Hope this all sets aside the myth that "You can't tell how much they're getting" when breastfeeding.
Formula feeding has many risks associated with it, and is so much less convenient.
Please don't throw away the advantages of this free breastmilk of yours - just because of a myth.
If this all seems terrifically fussy, detailed, prescriptive, annoying... well it can be, yes. If these measures can reassure you (and those around you) that you are feeding your child well, that will be of enough help to balance the work.
But if your child is gaining weight well & seems fit & alert then you don't need to endlessly count, measure or note anything else.
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| After all, do you count the hugs or the kisses? |
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