Re: [ozmidwifery] Re: feeds in 24 hours....

[Marilyn Kleidon]

No Jo we don't do gastric lavages routinely anymore 
(not since I have been here at least in 2002). Though have known some midwives 
to do this on the ward to mucousy babies. This baby would have been suctioned on 
the peri and since he was vigorous no further tx was required. He wasn't mucousy 
either but had refused to feed immediately post birth but had fed well 
apparently on the night shift and had  3 apparently good feeds on my shift 
in the first 2 hours: well latched sucking and swallowing for 5 to 10 minutes at 
a time. I was feeling anxious about doing the BSL because I was anticipating an 
arguably normal result in the 1.8 to 2.2 mmol/L range bub seemed stable but 
borderline jittery and to be honest mum was more concerned than I was. Good 
lesson in "listen to the mother" who can often be written off as 
overly anxious. Anyway I am glad I listened to mum.  Of course if this baby 
did have a good counterregulatory response going on then nothing needed to be 
done. From my understanding of the WHO document we just don't have the 
documentation on the truly normal range of BSL's, we also don't have really 
clear signs of abnormal symptoms at least until they become catastophic and you 
can't miss it. I mean "jittery" can mean different things to different people it 
is just not a very precise term but tachypnia, tachycardia, bradycardia, 
hypothermic etc. are clear as is low BSL. Fortunately or unfortunately i will 
have a lower tolerance of "jittery" for a while to come and can actually 
still understand the thought behind protocols that require routine BSL's 
(which seem to vary from 3/24 to 6/24 to random before feeds within the first 12 
to 24 hrs) for babies at risk of hypoglycemia.  I can imagine that those 
midwives and paediatricians who work in intensive care nurseries and see 
the babies who are missed and have gone into comas etc. including those babies 
with unsuspected rare metabolic disorders  can see no harm in routine 
testing. I am just prolly overthinking this one for a while.
 
marilyn

  - Original Message - 
  From: 
  JoFromOz 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, December 16, 2004 4:33 
  PM
  Subject: Re: [ozmidwifery] Re: feeds in 
  24 hours
  Marilyn Kleidon wrote:
  


Thanks Tina: you've actually posted that before 
'cause I had copied it and pasted it into my breastfeeding research file!! 
Found it when I went to copy it again!! I have read the whole thing a few 
times now and am somewhat reassured that the baby I referred to with a BSL 
of 0.6 mmol/L may have had a good counterregulatory response going on since 
he only had "soft" signs of hypoglycemia: some jitteryness and slightly 
increased irritability. Still unsure of why his BSL would be so low (even 
supposing mum had zero colostrum) as his intrapartum stress could 
not be interpreted as intrapartum asphyxia in any way.  I now have a 
high index of suspicion that mum may have actually been gestationally 
diabetic despite her reassuring/non-glucose impaired GTT. In which case it 
would be a transient hypoglycemia and the lab results should show  
hyperinsulinemia right? I hope so. I have been off since so i don't know if 
the hypoglycemia recurred which would be the case if baby had some rare 
metabolic disorder right? Sorry, thinking zebras now (instead of horses, 
when I hear galloping).
 
regards
 
marilynJust thinking 
  about this... this baby was born into Mec, right?  Was it policy to do a 
  gastric lavage pre- first feed?  If so, this could be why the BSL was so 
  low...Jo.

Re: [ozmidwifery] Re: feeds in 24 hours....

[JoFromOz]

Marilyn Kleidon wrote:

  
  
  
  Thanks Tina: you've actually posted
that before 'cause I had copied it and pasted it into my breastfeeding
research file!! Found it when I went to copy it again!! I have read the
whole thing a few times now and am somewhat reassured that the baby I
referred to with a BSL of 0.6 mmol/L may have had a good
counterregulatory response going on since he only had "soft" signs of
hypoglycemia: some jitteryness and slightly increased irritability.
Still unsure of why his BSL would be so low (even supposing mum had
zero colostrum) as his intrapartum stress could not be interpreted as
intrapartum asphyxia in any way.  I now have a high index of suspicion
that mum may have actually been gestationally diabetic despite her
reassuring/non-glucose impaired GTT. In which case it would be a
transient hypoglycemia and the lab results should show 
hyperinsulinemia right? I hope so. I have been off since so i don't
know if the hypoglycemia recurred which would be the case if baby had
some rare metabolic disorder right? Sorry, thinking zebras now (instead
of horses, when I hear galloping).
   
  regards
   
  marilyn

Just thinking about this... this baby was born into Mec, right?  Was it
policy to do a gastric lavage pre- first feed?  If so, this could be
why the BSL was so low...

Jo.

[ozmidwifery] feeds in 24 hrs?

[Anne Clarke]

Dear Alesa,
The evidence I have is that for over 600 births in the Birth Centre per 
annum we weigh our babies at birth and we weigh them again at approx.10 days 
later at their postnatal check up and we have never had a problem.  Our mums 
go home by 24 hrs too, unless they or their baby is unwell.

I am not saying that babies are not having any problems but we pick them up 
sooner and deal with them immediately without the babies being compromised 
and we still don't weigh them we look at their feeding and their output - 
much better and it has kept us in good stead these almost 10 years.  I do 
not have any memory of any of my clients babies loosing more than 10 per 
cent of their birth weight.

Just letting you know what I do and the outcomes that's all.
Regards,
Anne
- Original Message - 
From: "Alesa Koziol" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, December 15, 2004 8:42 PM
Subject: Re: [ozmidwifery] feeds in 24 hrs?


Dear Anne
Fully endorse your practice as sound, safe and yet still covering bases 
for
those infants that dont suckle direct.
I would like to continue this discussion to the management of those babes
who lose weight >10% on third day
...please don't inundate me with info on NOT weighing babes at all
whilst in hospital,  unless you have some great evidence I can use to
challenge that practice:)
Looking forward to the continuation of healthy dialogue
Cheers
Alesa

Alesa Koziol
Clinical Midwifery Educator
Melbourne
- Original Message -
From: "Anne Clarke" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Tuesday, December 14, 2004 6:43 PM
Subject: [ozmidwifery] feeds in 24 hrs?

Dear All,
Regarding a (healthy, full term) baby feeding in the first 24 hrs. If the
babe has had a feed soon after birth we do not worry for at least 12+ 
hrs.
NEVER EVER take a BSL unless baby is symptomatic.  This has never 
occurred
though.

If babe has not had a feed soon after birth we express mum and give via
cup
or syringe a couple of hours or so after birth.
If babe is hungry and has not attached or whatever after the 12 hrs we
show
mum how to express and give via cup or syringe approximately 3-4 hrly
until
the baby attaches more often if the baby wants to feed more often of
course.
We send our mum's home with this plus we ring them at home or if they 
have
any queries they can call us (with a backup to a LC of course or our
breastfeeding clinic staffed by an LC) lots of skin to skin, babe near 
the
breast all the time so not to miss an 'opportunity' to have a feed and it
seems to work beautifully.

You cruel lot doing a BSL - stop it!!  The WHO recommendations say it is
not
necessary on a well, full term baby unless symptomatic.  Babies do not
become symptomatic if they feed regularly and if necessary by EBM, they
will
always swallow even if they won't suck.  It is suprising how many 'wake
up'
and feed with a few mouthfuls of EBM.
Anne Clarke
Brisbane
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Re: [ozmidwifery] Re: feeds in 24 hours....

[Marilyn Kleidon]

Thanks Tina: you've actually posted that before 
'cause I had copied it and pasted it into my breastfeeding research file!! Found 
it when I went to copy it again!! I have read the whole thing a few times now 
and am somewhat reassured that the baby I referred to with a BSL of 0.6 mmol/L 
may have had a good counterregulatory response going on since he only had "soft" 
signs of hypoglycemia: some jitteryness and slightly increased irritability. 
Still unsure of why his BSL would be so low (even supposing mum had zero 
colostrum) as his intrapartum stress could not be interpreted as 
intrapartum asphyxia in any way.  I now have a high index of suspicion that 
mum may have actually been gestationally diabetic despite her 
reassuring/non-glucose impaired GTT. In which case it would be a transient 
hypoglycemia and the lab results should show  hyperinsulinemia right? I 
hope so. I have been off since so i don't know if the hypoglycemia recurred 
which would be the case if baby had some rare metabolic disorder right? Sorry, 
thinking zebras now (instead of horses, when I hear galloping).
 
regards
 
marilyn

  - Original Message - 
  From: 
  [EMAIL PROTECTED] 
  To: [EMAIL PROTECTED] 
  
  Sent: Thursday, December 16, 2004 2:35 
  AM
  Subject: [ozmidwifery] Re: feeds in 24 
  hours
  Hello everyone,A fantastic resource 
  that provides a wealth of evidence and information on nutrition in the newborn 
  infant is the WHO (1997) literature review  of 'Hypoglycemia in the 
  newborn'.http://www.who.int/reproductive-health/docs/hypoglycaemia_newborn.htmIn 
  particular, the following paragraphs just demonstrates how wonderful mother 
  nature is at providing for the healthy newborn in the first few days post 
  birth with 'suckling hypoglycemia'Great to be back on the 
  list!!!Tina PettigrewMidwife (registration pending)B. 
  Mid.---Metabolic 
  substrates. Data on metabolic substrate concentrations during early 
  postnatal adaptation in the human newborn are relatively few and many date 
  from the era in which early starvation was fashionable and feeding (usually 
  with formula) was postponed for hours or days after birth (Beard et al, 
  1966; Melichar et al, 1967; Persson & Gentz, 1966; Stanley et 
  al, 1979; Anday et al, 1981). Principal findings of these studies 
  were, first, that blood glucose concentration falls with the duration of 
  starvation and, second, that the concentrations of other metabolic substrates 
  (free fatty acids, ketone bodies and glycerol) rise as blood glucose 
  concentration falls. For example, Beard et al (1966) alternately 
  allocated term and preterm infants to an "early feeding" group (fed with 
  formula from 6 hours of age) and a group fasted for 72 hours. Mean blood 
  glucose concentration at 72 hours was 40 mg dl-1 (2.2 mmol l-1) in the fasted 
  term infants, as compared to 68 mg dl-1 (3.8 mmol l-1) in the "early-fed" 
  group. 58% of the fasted premature infants had a blood glucose concentration 
  of <25 mg dl-1 (1.4 mmol l-1) by 72 hours of age, as compared to only 4% (1 
  infant) among the early-fed group; though no complications were noted. The 
  fasted group also showed a reduced increment in blood glucose concentration on 
  injection of glucagon and adrenaline, suggesting a relative reduction in their 
  glycogen stores. Free fatty acid concentrations nevertheless rose in the 
  fasted infants and over 50% of the fasted healthy premature infants showed 
  ketonuria by 48-72 hours of age. Persson & Gentz (1966) similarly noted 
  increases in free fatty acid, glycerol and ketone body levels among fasted 
  term infants. The highest values were noted in babies with the lowest blood 
  glucose concentrations. Increases in the concentration of glucogenic 
  precursors (alanine and lactate) and ketone body concentrations with 
  starvation at this time of life are nevertheless smaller than those in older 
  children with similarly low glucose levels (Stanley et al, 1979; Anday 
  et al, 1981). Moreover it is important to emphasise that the 
  "premature" babies of thirty years ago were probably more mature as a group 
  than preterm infants of today whose adaptive capacity may be even less well 
  developed. More recently Hawdon et al (1992) conducted a 
  cross-sectional study of whole blood glucose concentration among 156 
  healthy term babies. This work is of importance for many reasons. Firstly, 
  infants were demand-fed. Secondly, breastfed babies were studied (46% 
  of the sample). Thirdly, metabolic substrates other than glucose (glycerol, 
  lactate, pyruvate, alanine, non-esterified fatty acids, ketone bodies) were 
  measured. Finally, infants were studied throughout the first week and not only 
  in the first eight hours (Stanley et al, 1979) to three days (Beard 
  et al, 1966; Anday et al, 1981). It was shown convincingly that 
  although healthy term breastfed 

Re: [ozmidwifery] AAIMHI Policy Paper on Controlled Crying

[Pinky McKay]

Hi all,
I have been off line for the past week - looks like an interesting 
discussion.
While I absolutely believe mothers need support and there should be no blame 
placed/ attacks on each other for choices of parenting style, just as for 
any other choices - birth, infant feeding etc, as people working with new 
parents, we do need to encourage INFORMED choice.

While there appear to be no studies of the specific effects of controlled 
crying (this would require longitudinal studies over years) , there are 
studies into the  physiology of infant stress and being left to cry it out 
is included in this in a number of papers by mental health professionals, 
including trauma specialist Bruce Perry who discusses how babies cant react 
to threat with a fight or flight response so react with a "freeze" 
response - ie they "shut down"  (this reference is listed in the AIMHI 
paper). Translated to controlled crying, this is what happens as infants 
become stressed by being left to cry it out - they arent "learning" to 
sleep. There is some compelling evidence that early stress can mess up the 
cortisol release mechanism in the developing brain, predisposing infants to 
stress and anxiety disorders THROUGHOUT life.

Rather than justifying harsh practices by waiting until there is a body of 
evidence to prove harm,  it is worth considering that there can be a  vast 
difference between "no evidence of harm" and "evidence of no harm".

Some babies will inevitably be more "at risk" than others - one of the 
saddest emails I have received was from a mother  whose one year old slept 
after a week of controlled crying but also stopped talking and refusing all 
physical contact from her. A year later he was still not talking and was 
going to an older sibling for comfort. I have since had experience of 
another child who reacted by stopping talking. Many babies become extremely 
clingy and if they start waking again will almost certainly be much more 
difficult to settle, often staying awake for hours rather than just needing 
a quick reassurance or breastfeed as had often been the case prior to 
controlled crying.

Mostly, from my personal observations/ emails/ phone calls from distraught , 
pressured mothers, it seems that sleep training is widely offered as the 
only/sensible option and mothers who respond to night time needs are feeling 
very pressured that they are doing things "wrong"  and "creating bad habits" 
. I feel it is very simplistic  to suggest that controlled crying will solve 
the problem of tired mothers - we shouldnt be pitting babies needs against 
mothers but rather seeking ways to support women to ask for help and develop 
networks for practical support - learning to say "no" to excessive demands 
and nurturing oneself  are life skills whatever teh age of our kids. Most 
people are happy to share the joy of a baby in return for a few errands - ie 
dropping older kids to school, sitting with a baby/ taking it for a walk 
while mum has a nap .

It is also worth noting that there are now at least two mother baby units in 
Melbourne where mothers are supported without controlled crying at all! - 
interestingly staff are reporting less maternal stress and babies are 
developing better sleep patterns as mothers are nurtured - there ARE gentle 
ways to change things that dont compromise babies needs or mothers instincts 
to respond.

Tomorrows (Friday) Herald Sun will have an article re sleep training -I am 
sure I will be quoted on my personal views of "puppy training for babies" 
and there will also be an interview of "the other side".

Meanwhile here are a few articles/ papers that can be accessed online - the 
references at the end of the AIMHI paper also make compelling reading .

Pinky
www.pinky-mychild.com
CONTROLLED CRYING: AAIMHI  POSITION PAPER - includes refs.
http://www.afcca.com.au/Files/Child%20Crying%20AAIMHI.doc

Why love matters - how affection shapes a baby's brain .
http://books.guardian.co.uk/review/story/0,12084,1262302,00.html

Stress in Infancy by Linda Folden Palmer, D.C.
http://www.naturalchild.com/guest/linda_folden_palmer2.html

Emotional Learning in Infants: A Cross-Cultural Examination
Michael Lamport Commons, Ph.D. Harvard Medical School
Patrice Marie Miller, Ph.D. Harvard Medical School and Salem State College

http://www.naturalchild.com/research/emotional_learning_infants.html

- Original Message - 
From: "Graham and Helen" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Monday, December 13, 2004 12:02 PM
Subject: Re: [ozmidwifery] AAIMHI Policy Paper on Controlled Crying


Thanks for posting this Abby - it is a good reference document to have.
At the end of the document it states that the "references ...are not 
specifically to studies on the impact of controlled crying on infants 
because there are no records of such studies".  That surprised me!  Anyone 
know of any that have been done already?!  Anyone interested in doing 
one??!!!

Helen
- Original Messa

RE: [ozmidwifery] feeds in 24 hrs?

[twiggy3]

Thanks Maureen,

I was genuinely interested and am not looking to shoot you down :)  I'm not a 
midwife but a birth/baby junkie so hear lots of stories so thank you for a 
midwive's side of the story.

Jayne

> Ok I expect to get shot down, but here goes. A baby who is hungry, refusing
> the breast , no colostrum apparent, a stressed, crying mother who is
> considering bottle feeding. What's best?  Keep on trying to attach a
> fighting baby, mum in tears or a comp feed, settle both for a sleep,and try
> again next feed? I have seen this, babies wake, eager for a feed, mum's had
> a rest, and is more relaxed. Baby attaches with little fuss. Then there's
> the baby who has lost weight, looks hungry, poor out-put. Mum needs her milk
> supply built-up. This requires good food, rest and a relaxed mum. Expressing
> pc helps, as does a comp to settle baby and eas4e mum's mind. My first 3
> were all comped for the first couple of days, no confusion, no probs with
> attachment. I was more rested and it all went naturally. No allergies. No. 4
> child, different story. I knew so much, this baby was going to be fully B/F.
> Ha. Fed on demand, problem was this baby didn't wake for feeds, I was of the
> "she'll wake when she's hungry" school. Three weeks later below birth
> weight, hardly weeing, no poos. She has dairy milk protein allergy
> I also attended a very interesting talk by a genetic counsellor from the
> NBST people. Certain enzymes require protein and if baby doest feed it can
> die. I forget all the details, but the info was on the net. I'm sure some
> one out there knows a lot more.
> I support BF. I would have loved to have fed for a couple of years. But I do
> feel that the "all or nothing" attitude sets women up to fail.
> I have seen babies who have been chronically under bf. Scrawny, whiney and
> constantly fiddling at the breast. Not sleeping well, tired looking.  I will
> not comp a baby just because it's unsettled, I have read  Maureen Minchin's
> books and attended her lectures and have done the LC course. Original
> Message-
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Behalf Of
> [EMAIL PROTECTED]
> Sent: Thursday, 16 December 2004 10:12 AM
> To: [EMAIL PROTECTED]
> Subject: RE: [ozmidwifery] feeds in 24 hrs?
> 
> 
> >> I will tell her if I believe all is well, but there are times when a baby
> > genuinely needs comping.  Maureen
> 
> 
> Hi Maureen and anyone else who could enlighten me on the above comment about
> there being times when a baby genuinely needs comping,
> 
> Could you please be more specific ie, at what times would a baby genuinely
> need comping?
> 
> Thanks
> 
> Jayne
> 
> 
> 
> 
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> 




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Re: [ozmidwifery] Re: feeds in 24 hours....

[Mary Murphy]

Thanks for the great link, MM

Re: [ozmidwifery] VBAC in SMH Friday 17/12

[Tania Smallwood]

Hello all,

I was sent this the other day by email from a lovely woman I'll be birthing
with in the new year.  Not sure how recent it is, but thought it relevant to
the current conversation.  Will contact her and find out where she sourced
it from, and how long ago.

Tania

BY JONATHAN BOR

Baltimore Sun


Women who attempt normal deliveries after previous Caesarean sections run a
very low risk of uterine tears and other complications, doctors leading a
nationwide study said Tuesday.

The risk is slightly higher than it is among women who have repeat
Caesareans -- but not enough to justify denying women the option of vaginal
deliveries or scaring them away from trying, researchers said.

Mark Landon, an obstetrician with Ohio State University Medical Center and
the study's principal investigator, said exaggerated claims about the
dangers had led to a steep decline in the number of vaginal births after
Caesareans, also known as VBACs.

Last year, 10 percent of pregnant women who had prior Caesareans attempted
to deliver vaginally -- down from 30 percent in 1996. Some doctors have
refused to assist women in VBACs, and some hospitals, particularly in rural
areas, have adopted policies forbidding them.

"I think the risk has been inflated by some, and it may in fact be concealed
in the counseling process in an effort to steer certain women to having
repeat operations," Landon said. "The message is that this option should
remain there for women."

The decline in VBACs has been partly responsible for a continued rise in the
Cesarean section rate in the United States, which last year rose to its
highest level ever. Despite staunch efforts in the 1990s to lower the
C-section rate, more than 27 percent of the 4 million babies born in the
United States last year were born surgically.



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[ozmidwifery] VBAC in SMH Friday 17/12

[Stringybark]

Dear all,
For your info I found out late this evening that  there will be an 
article in tomorrow's Sydney Morning Herald by Julie Roebottom, about 
an article published today in the New England Journal of Medicine.  
I've not seen the article as yet, but Julie's summary of it is that it 
is an American study of 35,000 women (not a randomised trial but a 
retrospective study) which concludes that it is safer for women who 
have had prior CS to have a planned CS for subsequent births rather 
than a VBAC.

In interviews with Andrew Childs (RANZCOG President) and other obs she 
has mainly received comment that this justifies the approach being 
taken in Australia and explains the rising rates of CS.

In an interview with Julie tonight, I emphasized 2 key points:
- CS is more dangerous than vaginal birth - re UK and other evidence of 
increased maternal deaths and infant deaths (Julie says this study also 
found higher rates of maternal death and hysterectomy in the repeat CS 
women) and we have to keep questioning the wisdom of performing CS for 
so many women's first births

- What type of care did the VBAC women receive?  - fragmented care from 
strangers, induction of labour, augmentation of labour, use of epidural 
anesethesia, lack of full information and support to understand the 
reasons surrounding a prior CS, and labels used about women (e.g. trial 
of scar, incompetent cervix, failure to progress)  are all factors 
which impact negatively on women's confidence and success in VBAC.

Depending on which page this article appears on, it is possible it will 
be picked up tomorrow by talk back radio, at least in Sydney.  I'd 
encourage anyone who is able to keep an ear out for such programs and 
take the opportunity to ring in with a midwifery perspective on VBAC if 
at all possible.

best wishes,
Barb Vernon
Executive Officer
Australian College of Midwives.
[EMAIL PROTECTED]
P.S  Please send any replies to this message to my WORK email address 
not this one.  Thanks B

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[ozmidwifery] Re: feeds in 24 hours....

[TinaPettigrew]

Hello everyone,

A fantastic resource that provides a wealth of evidence and information on nutrition in the newborn infant is the WHO (1997) literature review  of 'Hypoglycemia in the newborn'.

http://www.who.int/reproductive-health/docs/hypoglycaemia_newborn.htm

In particular, the following paragraphs just demonstrates how wonderful mother nature is at providing for the healthy newborn in the first few days post birth with 'suckling hypoglycemia'

Great to be back on the list!!!
Tina Pettigrew
Midwife (registration pending)
B. Mid.
---
Metabolic substrates. Data on metabolic substrate concentrations during early postnatal adaptation in the human newborn are relatively few and many date from the era in which early starvation was fashionable and feeding (usually with formula) was postponed for hours or days after birth (Beard et al, 1966; Melichar et al, 1967; Persson & Gentz, 1966; Stanley et al, 1979; Anday et al, 1981). Principal findings of these studies were, first, that blood glucose concentration falls with the duration of starvation and, second, that the concentrations of other metabolic substrates (free fatty acids, ketone bodies and glycerol) rise as blood glucose concentration falls. For example, Beard et al (1966) alternately allocated term and preterm infants to an "early feeding" group (fed with formula from 6 hours of age) and a group fasted for 72 hours. Mean blood glucose concentration at 72 hours was 40 mg dl-1 (2.2 mmol l-1) in the fasted term infants, as compared to 68 mg dl-1 (3.8 mmol l-1) in the "early-fed" group. 58% of the fasted premature infants had a blood glucose concentration of <25 mg dl-1 (1.4 mmol l-1) by 72 hours of age, as compared to only 4% (1 infant) among the early-fed group; though no complications were noted. The fasted group also showed a reduced increment in blood glucose concentration on injection of glucagon and adrenaline, suggesting a relative reduction in their glycogen stores. Free fatty acid concentrations nevertheless rose in the fasted infants and over 50% of the fasted healthy premature infants showed ketonuria by 48-72 hours of age. Persson & Gentz (1966) similarly noted increases in free fatty acid, glycerol and ketone body levels among fasted term infants. The highest values were noted in babies with the lowest blood glucose concentrations. Increases in the concentration of glucogenic precursors (alanine and lactate) and ketone body concentrations with starvation at this time of life are nevertheless smaller than those in older children with similarly low glucose levels (Stanley et al, 1979; Anday et al, 1981). Moreover it is important to emphasise that the "premature" babies of thirty years ago were probably more mature as a group than preterm infants of today whose adaptive capacity may be even less well developed. 

More recently Hawdon et al (1992) conducted a cross-sectional study of whole blood glucose concentration among 156 healthy term babies. This work is of importance for many reasons. Firstly, infants were demand-fed. Secondly, breastfed babies were studied (46% of the sample). Thirdly, metabolic substrates other than glucose (glycerol, lactate, pyruvate, alanine, non-esterified fatty acids, ketone bodies) were measured. Finally, infants were studied throughout the first week and not only in the first eight hours (Stanley et al, 1979) to three days (Beard et al, 1966; Anday et al, 1981). It was shown convincingly that although healthy term breastfed babies had significantly lower blood glucose concentrations than those who were bottle-fed (breastfed: mean 3.6 mmol l-1, range 1.5-5.3 mmol l-1; bottle-fed: mean 4.0 mmol l-1, range 2.5-6.2 mmol l-1), their ketone body concentrations were elevated in response. A statistically significant negative correlation between [log] ketone body and blood glucose concentration was measured at 2-3 days of age, but not within the first 24 hours or after 3 days. Lucas et al (1981) also found breastfed babies to have significantly higher ketone body concentrations than formula-fed babies studied on the sixth day of life. In summary, blood glucose concentration falls in babies who are not fed. But healthy term babies of appropriate weight for gestation (AGA) mobilise alternative metabolic substrates (free fatty acids and ketone bodies) in response. Breastfed babies as a group have lower blood glucose concentrations (referred to later as "suckling hypoglycaemia") and higher ketone body levels than those who are bottle-fed. It is not clear whether this reflects specific promotion of ketogenesis (e.g. by breastmilk fat or another milk component), or whether it is simply the result of differences in blood glucose concentrations and postprandial increments in plasma insulin concentration.

AND

The newborn's capacity to promote ketogenesis in the face of "suckling hypoglycaemia" has been described previously (Section 2.3). Newborn term infants ra

RE: [ozmidwifery] feeds in 24 hrs?

[Ken WArd]

Ok I expect to get shot down, but here goes. A baby who is hungry, refusing
the breast , no colostrum apparent, a stressed, crying mother who is
considering bottle feeding. What's best?  Keep on trying to attach a
fighting baby, mum in tears or a comp feed, settle both for a sleep,and try
again next feed? I have seen this, babies wake, eager for a feed, mum's had
a rest, and is more relaxed. Baby attaches with little fuss. Then there's
the baby who has lost weight, looks hungry, poor out-put. Mum needs her milk
supply built-up. This requires good food, rest and a relaxed mum. Expressing
pc helps, as does a comp to settle baby and eas4e mum's mind. My first 3
were all comped for the first couple of days, no confusion, no probs with
attachment. I was more rested and it all went naturally. No allergies. No. 4
child, different story. I knew so much, this baby was going to be fully B/F.
Ha. Fed on demand, problem was this baby didn't wake for feeds, I was of the
"she'll wake when she's hungry" school. Three weeks later below birth
weight, hardly weeing, no poos. She has dairy milk protein allergy
I also attended a very interesting talk by a genetic counsellor from the
NBST people. Certain enzymes require protein and if baby doest feed it can
die. I forget all the details, but the info was on the net. I'm sure some
one out there knows a lot more.
I support BF. I would have loved to have fed for a couple of years. But I do
feel that the "all or nothing" attitude sets women up to fail.
I have seen babies who have been chronically under bf. Scrawny, whiney and
constantly fiddling at the breast. Not sleeping well, tired looking.  I will
not comp a baby just because it's unsettled, I have read  Maureen Minchin's
books and attended her lectures and have done the LC course. Original
Message-
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of
[EMAIL PROTECTED]
Sent: Thursday, 16 December 2004 10:12 AM
To: [EMAIL PROTECTED]
Subject: RE: [ozmidwifery] feeds in 24 hrs?


>> I will tell her if I believe all is well, but there are times when a baby
> genuinely needs comping.  Maureen


Hi Maureen and anyone else who could enlighten me on the above comment about
there being times when a baby genuinely needs comping,

Could you please be more specific ie, at what times would a baby genuinely
need comping?

Thanks

Jayne




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Re: [ozmidwifery] feeds in 24 hrs?

[Marilyn Kleidon]

Dear Maureen:

For what it is worth I totally agree with all you've said. Very common
scenarios.

regards

marilyn


- Original Message - 
From: "Ken WArd" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, December 15, 2004 11:21 PM
Subject: RE: [ozmidwifery] feeds in 24 hrs?


> Ok I expect to get shot down, but here goes. A baby who is hungry,
refusing
> the breast , no colostrum apparent, a stressed, crying mother who is
> considering bottle feeding. What's best?  Keep on trying to attach a
> fighting baby, mum in tears or a comp feed, settle both for a sleep,and
try
> again next feed? I have seen this, babies wake, eager for a feed, mum's
had
> a rest, and is more relaxed. Baby attaches with little fuss. Then there's
> the baby who has lost weight, looks hungry, poor out-put. Mum needs her
milk
> supply built-up. This requires good food, rest and a relaxed mum.
Expressing
> pc helps, as does a comp to settle baby and eas4e mum's mind. My first 3
> were all comped for the first couple of days, no confusion, no probs with
> attachment. I was more rested and it all went naturally. No allergies. No.
4
> child, different story. I knew so much, this baby was going to be fully
B/F.
> Ha. Fed on demand, problem was this baby didn't wake for feeds, I was of
the
> "she'll wake when she's hungry" school. Three weeks later below birth
> weight, hardly weeing, no poos. She has dairy milk protein allergy
> I also attended a very interesting talk by a genetic counsellor from the
> NBST people. Certain enzymes require protein and if baby doest feed it can
> die. I forget all the details, but the info was on the net. I'm sure some
> one out there knows a lot more.
> I support BF. I would have loved to have fed for a couple of years. But I
do
> feel that the "all or nothing" attitude sets women up to fail.
> I have seen babies who have been chronically under bf. Scrawny, whiney and
> constantly fiddling at the breast. Not sleeping well, tired looking.  I
will
> not comp a baby just because it's unsettled, I have read  Maureen
Minchin's
> books and attended her lectures and have done the LC course. Original
> Message-
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Behalf Of
> [EMAIL PROTECTED]
> Sent: Thursday, 16 December 2004 10:12 AM
> To: [EMAIL PROTECTED]
> Subject: RE: [ozmidwifery] feeds in 24 hrs?
>
>
> >> I will tell her if I believe all is well, but there are times when a
baby
> > genuinely needs comping.  Maureen
>
>
> Hi Maureen and anyone else who could enlighten me on the above comment
about
> there being times when a baby genuinely needs comping,
>
> Could you please be more specific ie, at what times would a baby genuinely
> need comping?
>
> Thanks
>
> Jayne
>
>
>
>
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> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.
>
>
> --
> This mailing list is sponsored by ACE Graphics.
> Visit  to subscribe or unsubscribe.


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