BREASTFEEDING MANAGEMENT INFORMATION

Dr. Jack Newman shares his thoughts about
immediate post partum infant weight loss

10% weight loss is meaningless. So is 7%, and 9.234342%. Percentage weight loss should not be used, as it is now being used, as an indication for automatic supplementation. There is no scientific basis for any such notion. In the first place, scales are different, and there is often a significant difference between scales in delivery, in postpartum and in the doctor's office. Even if there is weight loss, before suggesting supplementation...

Observe a breastfeeding. If the baby is breastfeeding well, there may be an error in the scale. Reassure the mother and follow the baby closely. If the baby is not breastfeeding well, then:

1. Fix the way a baby is latching on. The asymmetric latch (baby's chin is touching breast, but nose is away from the breast) is better than what we have been teaching for some years now (symmetric latch, with baby's nose and chin touching breast).
2. Teach the mothers how to know the baby is getting milk. When a baby is actually getting milk (he is not getting milk merely because he is on the breast and making sucking motions), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide-->pause-->close mouth). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This pause that is visible at the baby's chin while the baby is on the breast, represents a mouthful of milk. The longer the pause, the more milk the baby got. Once you know about the pause you can cut through so much of the nonsense mothers are being told. For example, twenty minutes on each side makes no sense at all. A baby who does the pausing type of suck for twenty minutes straight likely will not take the other side. A baby who nibbles, without drinking, without the pause, for 20 hours will still come off the breast hungry.
3. Once the baby does not drink on his own (nibbles only), teach the mother compression of the breast, to keep the baby drinking, not just sucking.
4. Once the baby is not drinking even with compression, switch sides and repeat the process. Do not tell a mother to feed just one side!
5. Fenugreek and blessed thistle, 3 capsules of each 3 times a day, often help with milk flow.

Often these steps alone will get the baby drinking well and gaining weight well, especially if it is within the first week or so, but often even after. Supplementation should be suggested only if these measures do not work. They often do!

Dr. Jack Newman shares his thoughts about immediate post partum infant weight loss.
Written by Jack Newman, MD, FRCPC ©2004
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.

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