Tuesday, December 21, 2010

Some (semi) good news, and some pretty danged bad news



Two items hot off the presses this week. Which should I start with? The (somewhat) good news, you say?



First, some research just emerged which relates to both birth and breastfeeding. The impact of IV fluids - mother's intrapartum fluid balance - on a newborn's weight loss had been studied, and a connection was found between mother who received more than 200 ml per hour and newborns who lost an "excessive amount of weight" (up to 10 percent is normal and to be expected) in their first days. It turns out that, as many have suspected, babies can take in some of that excess IV fluid themselves.

How does this impact breastfeeding? Neonatal weight loss that is greater than the norm frequently prompts formula supplementation, when in fact feeding issues have nothing to do with the excessive drop in weight; baby is simply shedding the extra fluid. Early formula supplementation is a major booby trap, so it's good to have a solid basis for avoiding it whenever possible.

It's also worth noting that IV fluids often have a second significant impact on the new breastfeeding relationship: mothers who have received IV fluids can also become extremely engorged, beyond the normal fullness of mature milk 'coming in', making it (a) much more difficult for baby's little mouth to latch on, and poor latching can lead to
both inefficient milk transfer and degrees of discomfort for the mom that range from irritating to excruciating; and (b) severe, if temporary, discomfort for the mother.

This is not to say that there isn't a place for IV fluids, when necessary. But though it may not be thought of as a serious intervention in the way that we think of, say, internal monitoring or episiotomies, it is still an intervention, and should be considered carefully, both pros and cons. We now have evidence of another significant con, and it should be factored into the decision-equation.

And, the bad news. Up from 2008's figures, the U.S. cesarean rate climbed once again, from 32.3% to 32.9%. Yup, that's a new all-time high, rising nonstop for 13 years running. Unnecessarean has all the news and blues about that over yonder, check it out to commiserate and lament.

2 comments:

  1. I found this very interesting. When my daughter was born, I was pumped full of fluids, at LEAST 3-4 bags. Of course, she lost over 10% of her weight within the first 24 hours, and the nurse said if I didn't give formula, the pediatrician would "make me." We tried and she drank maybe 1/4 oz. Because she WASN'T starving to death, DUH! My milk came in on day three and it was insane. Rock hard and yes, difficulty with latching.

    When my son was born, I didn't receive IV fluids (I did, however, drink a lake's worth of water!) He didn't lose really any weight. My milk came in very quickly, but it was just kind of there. I didn't have the big signs that "uh oh, the milk is here."

    I'm planning to stay the heck out of the hospital "next time" so hopefully it won't be an issue!

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  2. I have experienced that difference as well, though my second did lose quite a bit of weight while we figured out how to bf. My awesome dr had to take a medical leave just after she was born, and the other ped in the group said, "supplement with formula! We're talking about her nutrition here!"

    I know, I thought, so I pumped instead.

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