Dehydrated babies
19 February 2009
At long last doctors are launching their first ever investigation to see how many babies are becoming dangerously ill from dehydration, which is caused by babies failing to take in enough breastmilk. Doctors believe that the number of babies put at risk by this condition (hypernatraemic dehydration) is increasing and attribute this to women being put under immense pressure to breastfeed but not being told how to do it properly.
I see babies almost every week who are underfed and under weight, many of whom had been admitted to hospital suffering from the effects of severe dehydration. In almost every case the mother has been assured by her community midwife that her baby was fine and breast-feeding was going well.
I am going to write a blog about some of these mothers to highlight how truly aweful the advice they are getting is. I will never use real names.
CASE HISTORY 1.
Sarah was discharged home from hospital on Day 3, when Sam had already lost 10% of his birth weight. The midwives were concerned but said that breastfeeding was going well & a community midwife would check on the baby the next day. Despite Sam crying endlessly, the community midwife refused to weigh him on her first visit as she said "all babies lose weight in the first few days" When she weighed him a few days later he had lost 15% of his birth weight; her reaction - the scales must be wrong! She assured his anxious mother that he "looked fine" and said that she guessed Sam probably weighed about 4kg - this was 1kg more than her scales said.
Sarah then took Sam to hospital to have his jaundice levels checked at which point his weight was checked again (he was still losing weight) and he was immediately admitted to the neonatal ward where he was given formula milk. When he was well enough to go home a few days later the midwives agreed that Sarah should reduce his formula top-ups as Sarah was so keen to get him fully back to breastfeeding. Once home, he started losing weight again.
When I saw Sam he was 20 days old and still well below his birth weight. Sarah had a very low milk supply and Sam was only being given small top-ups, which were leaving him still hungry and unsettled.
These are my critical observations:
- Why did the hospital midwives think breasfeeding was going well when Sam had already lost so much weight? 10% is widely accepted as being an excessive weight loss.
- Why did the community midwife not weigh Sam on her first visit? Did she not recognise the importance of checking to see whether Sam was still losing weight and if so, how much?
- Does she not realise that the whole point of weighing a baby is to establish a baseline so she can check at the next visit to see whether the baby is doing better or worse?
- Does she not know that a baby can 'look fine' even when he is being underfed - and does she not understand that Sam's constant crying, coupled with a large weight loss was a pretty good indication that he was hungry.
- Why did none of the midwives ask whether the baby was passing urine regularly? Dry nappies = not enough fluid is going into the baby.
- What is the point in weighing a baby at all if you are simply going to assume that 'the scales must be wrong' when a big weight loss is registered.
- Why did the hospital midwives agree that it was OK to reduce the formula top-ups without first checking to see whether Sarah was producing enough milk?
And finally...why was Sarah not told that dry nappies, constant crying and weight loss were all signs that her baby was not getting enough milk?
None of this was Sarah's fault. She was a vulnerable new mother who was badly let-down when she trusted the midwives each time they assured her that everything her baby was doing was normal. After all, how could she be expected to know better than the experts?