First and foremost: towards the end of this article you will find important resources. The first part is meant to encourage you to read them.
A challenge for any professional who is involved in initiating breastfeeding is helping parents cope with the unusual misinformation and hospital protocols that often undermine the process. To illustrate this point, let’s go through the experience of a statistically typical mother who was born in a hospital in the United States and plans to breastfeed. Due to cultural expectations and protocols such as restricted movement, the work feels confusing and an epidural is ordered. In order for an epidural to be administered, the mother must first receive one liter of IV fluid (although she has probably been on the IV since she arrived). IV fluids continue during labor once the epidural is in place as they help reduce the risk of surgery such as B. to reduce a drop in blood pressure.
Any parent who has received multiple bags of fluids will remember the following bloat – when looking back at photos and saying, “Woah – look at my face!” The swollen hands and feet that were aggravated by the added fluids. The frequent trips to the bathroom in the following days when the body strives to reach a normal level of moisture.
Remember when we go forward.
As Doula, I encourage my clients to keep their baby in the room and more and more hospitals are moving towards this practice to keep the nursing dyad as close as possible to learn and enjoy each other in these early hours. The more often the baby effectively nurses, the more often the mother’s pituitary gland sends the message: “Let’s make milk!” to the body. These are some of the main tenants of nursing: effective care and frequent care.
So I’m the Doula. The baby was born, vaginally even – hooray! The family is all together in their room after the birth and it is planned that the baby will stay here. I did everything until I asked them a little bit, and as their Doula you would think I would feel pretty sure where things were going. I am not. Not at all. Because I saw this game so often. I know things are likely to go down unless I go home from one of the few hospitals that are really up to date with their breastfeeding support. I expect the following:
Do you remember all these IV fluids? I marked this earlier for the following reason: Do you know who still received IV fluids? The baby. That’s right, the baby is pumped up like mom’s hands and feet. And the baby’s body knows what to do. So the baby pees. And pees. And pee again.
In the world of breastfeeding, one of the criteria that parents and others are told to evaluate “success” is wet diapers. As new parents, we count wet diapers and even have to log them in the hospital. “Things are going great!” my customer reports. “He already had 5 wet diapers. They say he really cares.” I groan deep in my heart. This would mean something for a baby whose mother had not been given IV fluid. In this baby? A baby whose mother received several bags of liquid in the hours before birth? It means nothing. This means that she received IV fluids that we already know. It doesn’t tell us whether the baby’s tie is ideal. It doesn’t tell us how often the baby feeds. It doesn’t tell us whether the baby is actually drinking. It does not tell us whether the baby is awake and engaged while feeding. But nurses are overworked and protocols rely heavily on the charts that parents fill out. Parents feel safe due to misinformation.
As her doula, I know that this is just the first shoe and soon the other will fall.
“He has lost 8% of his body weight! They say I have to give him a formula.” It is in tears. This conversation often takes place within hours after the first one. Certainly within a day. How can that be? The above Peeing is the culprit. All those wet diapers from the IV fluids that were so soothing? Each of those piss was weight. And after enough, the baby’s weight drops. Basic, logical, and a complete surprise for the staff every time The same birth intervention artifact that was first celebrated has now reached its ultimate goal: crisis and intervention, because as soon as the baby receives the formula, both the breastfeeding mechanics and the parents’ trust are broken, which is why my Doula heart groaned earlier.
For perspective, listen to mothers survey https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894594/Tell us that 67% of mothers have epididymis. The total IV fluid rate would be much higher than this. So that happens all the time.
Why is this constant cycle crazy? Because we know better.
Even if the mother did not receive IV fluid, we have this important study https://web.uri.edu/nursing/2020/02/27/nursing-professors-study-on-infant-birth-weight-breastfeeding-wins-national-award-from-leading-womens-health-organization/ fbclid = IwAR0cKYXt7iLJWTKGFLkHs-xRvrBiB5VrlpBM14IMOZvN_5KvKt1OGeg6nhs This shows that “… the average breastfed baby loses 8% of its birth weight … most babies who lost more than 7% in the first two weeks still gained weight at a reasonable pace over the next two weeks.” This is often the case big crisis actually no crisis. It is an artifact from the cascade of interventions that began with IV administration.
Style expert Nancy Mohrbacher explains the science behind the phenomenon of the inflated birth weight with a good overview: http://www.nancymohrbacher.com/articles/2011/10/31/newborn-weight-loss-and-iv-fluids-in-labor.html
My favorite of the studies Mohrbacher quotes is this: https://pediatrics.aappublications.org/content/127/1/e171?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+loken
In contrast to most studies, these authors actually used their conclusion as a title: “Excessive weight loss in firstborn breastfed newborns is related to the mother’s intrapartal fluid balance”. As I read this, I was referring to the authors, their frustration and exhaustion as I stood up for their cause and the hope that their message would get stuck in the minds of doctors, skim the titles but not read any studies. The obvious choice: make it as easy as possible. What breastfeeding is often when we support and facilitate it … and at least avoid it.
Written by Jackie Kelleher
Jackie is an editorial assistant at Pathways magazine and coordinator of the Pathways group. Her life was a carpet of family support – Doula, lactation professional, group leader and Doula trainer. Her book “Feeding the Family: A Doula Guide to Supporting New Families” is now available.
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