Last year I wrote about a study in Pediatrics which gave credence to the the long-time suspicions of lactation consultants and others who work in labor and delivery: the more fluid a mother gets during labor, the greater the apparent weight loss in the early days of breastfeeding.
The theory is that a mother who has a lot of fluids in labor will have a baby whose birth weight is inflated by excess water, and that the baby will appear to have lost an excessive amount of weight when judging by her 'un-waterlogged' birth weight she might appear to have weight loss that is within normal limits.
Of course, the larger a baby's weight loss the greater the chances that a mom will be told to supplement with formula, possibly starting the downward cycle which leads to early weaning.
A new study out this month adds more fuel to this fire, by observing the weight loss of babies when mothers are given more or less fluids in labor. They found the same result: babies whose mothers had more fluid had greater 'output' and greater weight loss in the early days. In fact, they label this as "iatrogenic weight loss." Iatrogenic means illness caused by medical treatment.
What I particularly appreciate about this study are two of the conclusions. First, "neonates appear to experience diuresis and correct their fluid status in the first 24 hours." This recharacterizes what's happening as normal physiological response rather than as pathology: babies are supposed to be losing more to balance their fluid loads. Smart babies.
Second, the study authors recommend that physicians use a different baseline measurement to determine newborn weight loss: "We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change." They offer a protocol for how physicians can collect information on what's happening in their hospital and form policies on measuring newborn weight loss suited to their setting.
This would be a radical change in practice, and I'm sure that it would be met with a lot of resistance, but I'm excited that the authors have opened the door to the discussion. Those of you who work in childbirth may also feel that there should be a corresponding discussion about how much fluid mothers are given in labor, but that's a topic for another day, I suppose.
Did you have a lot of IV fluids in labor and a baby who had excessive weight loss in the early days?
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