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When Every Ounce Counts

By Stephanie Libs, DC

IV fluids in labor can cause excess water weight at birth. This can cause difficulty in assessing baby’s growth.

In my practice, I see so many new parents struggle with breastfeeding. Newborn weight loss is a common issue that often leads to unwanted or unintended use of formula. The use of IV fluids during labor, something we view as simple and benign, can lead to inaccurate weight measurements, which can lead down the path of formula supplementation. An IV not only hydrates the person in labor, it also hydrates the baby. So when the baby is born, she’s full of excess fluid compared to if she had not had an IV.

It’s normal for newborns to lose up to 7 percent of their body weight, as the mother’s milk is coming in during those first few days. Up to 10 percent weight loss is acceptable by some pediatricians, but when more than 10 percent is lost, parents are often told they need to supplement with formula or pumped milk, and, ideally, the child will be back to her birth weight within two weeks. But if a newborn’s weight is being tracked with an artificially higher starting weight at birth, when the baby loses that water weight it will look as though she’s lost more weight than she actually had.

Not only does an IV plump up the baby, it also plumps up breast tissue, and that engorgement can make it harder for the baby to latch. This also can lead to breastfeeding issues and a delay in milk coming in. Engorgement makes for tissue that is not as supple or malleable to fit into a newborn’s mouth and mold to their palate. It can often result in a shallower latch, which is not only painful but also can prevent newborns from transferring as much milk as they could.

If you do have an IV in labor, it’s best to take the baby’s weight at 24 hours old and use that as your baseline, as they will have urinated and released some of the excess fluid during that first day. This will give you a more accurate idea of how much weight they are actually losing, if any.

The amount of fluid administered in labor also has an effect on this. The greater volume of fluid given, the more likely the baby is to experience this artificial excess weight loss. Studies have found that newborns whose mothers have received 2,500 ml or more are at higher risk for excess weight loss. Evidence shows that hydration is essential in labor, but drinking fluids is much more effective than an IV, and it doesn’t have the negative effect of newborn weight loss. Oral fluids have time to process through the digestive tract, as opposed to an IV, which goes directly into the bloodstream.

So what’s the big deal with formula anyway?

After all, fed is best, right? Formula-fed babies are at higher risk of ear infections, asthma, diabetes, eczema, respiratory infections, digestion issues, and SIDS. The CDC reports that in the United States less than 47 percent of babies are exclusively breastfed at 3 months, and nearly 20 percent of infants are given formula in the first two days of life.

So how can you avoid formula? We know that the first latch after birth sets the foundation for the longevity of breastfeeding success. Simple yet instinctual practices like skin-to-skin contact and the breast crawl are key indicators to establishing breastfeeding. Getting a good latch within the first hour leads to a higher milk supply for the first several months. The more your baby is latching directly onto you, the more you will increase your milk supply. Baby’s saliva is picked up by your nipple, and your brain registers exactly what nutrients your baby needs in that very moment. It also increases oxytocin in the mother, which is responsible for your letdown. You can further increase oxytocin by looking at photos or holding something like a hat or blanket that smells like your baby while you pump or hand express. This proves to be helpful if you return to work or are separated from your baby for some reason.

If you are having trouble with latching, make sure to work with a lactation consultant and a pediatric chiropractor. They can help you with positioning, any oral, mechanical, or neurological restrictions, and can troubleshoot many other issues. If your nipples are cracked or damaged, you might need to consider pumping or hand expressing to allow yourself time to heal. Pumping with simultaneous hand expression can significantly increase supply if directly latching the baby is not feasible.

Milk donations from other lactating women are also a great alternative to formula. It also increases the baby’s defense against potential infections, because it exposes the infant to a whole new host of immune cells, antibodies, and so on from the milk donor. Just remember, any time you give a bottle, make sure to replace that feeding with pumping to keep your supply up. The more you empty your breast, the more milk you will make. It’s all about demand and supply.

If your healthcare providers are recommending formula, please take this information into account. Work with a lactation consultant, pediatric chiropractor, or any other provider that will support you. Breastfeeding is hard work. It doesn’t always come naturally, and it’s not always easy. But the support is there. Build your team before you give birth, so you’ll be ready. You’ve got this, mama. And we’ve got your back!