This is a good thing to know now, not later:
When mom gets IV fluids during labor, which is incredibly common these days, there’s a decent to excellent chance that she and her baby will develop postpartum edema. That’s a fancy way of saying that both mom and baby will retain water for a little while after the birth. The water will flush out soon enough and it’s fine. But here’s the thing:
The baby’s birth weight will be artificially high and the baby’s weight loss in the first week will be artificially steep. This can lead to concern that the baby is not getting enough breastmilk and formula will be given to save the day. The baby, meanwhile, was just dropping the IV water weight and isn’t in need of formula at all. Formula feeding in the early days can disrupt breastfeeding and also get mom off a very wobbly, anxious path of thinking she can’t make enough to milk to nourish her baby (which is most likely not true).
“One of the biggest reasons that I know of why women start supplementing with formula in the first couple weeks is because ‘baby’s not gaining enough weight.’ While a 5 to 7 percent weight loss in the first couple of days after birth is considered totally normal, 10 percent can sometimes result in pediatricians telling the mother she must supplement. However, recent studies show what many of us have suspected or deemed obvious for years: Babies whose mothers received IV fluids — either to stabilize blood pressure, before an epidural or c-section, or sometimes just because — have babies who lose more weight initially.”
So what do you do? Based on what Haskell suggests and what I know, here are a few ideas:
* Only start gauging weight gain after that’s been flushed out, from about days 3-5
* Watch for what is coming out of the baby– pees and poops– to see how much is going in. Alternatively, have a doctor or lactation consultant weigh your baby before and after a feeding with a super accurate scale to see how many ounces of milk the baby is getting in a feeding.
* Work with lactation consultants since many pediatricians and obstetricians aren’t trained to help with breastfeeding. The reason for this is complicated and obviously doctors vary, but it’s true that though the medical community heavily promotes breastfeeding, this effort is not backed up by evidence-based practices in hospitals. Recently we learned from the CDC that 96% of US hospitals are not breastfeeding-friendly.
* Take a breastfeeding class and read up on breastfeeding before giving birth so you understand how it works. It’s easier to prevent problems than solve them later.
What I find disturbing about all of this is that mothers and babies can get shafted by our compartmentalized model of care. Prenatal health, childbirth, breastfeeding, and postpartum recovery are all a part of one physiological process and yet, right around the time of birth, women can feel like they’re spinning through a revolving door– the OB is out, the pediatrician is in, the lactation consultant doesn’t get in until later today, someone says the baby “is not gaining,” information is not being properly conveyed…. The first week or so may not be make-or-break when it comes to nursing, but it’s so important that our hospitals improve when it comes to helping women get off to a good start with healthy and confident feeding practices. It’s very discouraging to hear, as Haskell points out, just how many woman are told they can’t adequately feed their babies within the first week of life.
For more on this, read “How Doctor’s Dupe Moms Into Supplementing With Formula” by Christie Haskell.