IV Fluids, Infant Weight Loss, and Breastfeeding – A Tricky Situation
As a lactation consultant, my goal is to help new moms have the greatest chance of having breastfeeding success.
While I am an advocate for prenatal lactation support, at the end of the day, I see most new moms after they come home from the hospital – and often, the new mother has started on a path to subpar breastfeeding outcomes.
Don’t get me wrong – I am grateful for the care hospital staff give new mothers. I recognize that their main goal is a healthy mom and a healthy baby. But time and time again, some common hospital practices seem to set new moms back with breastfeeding.
One of the most common situations I see (and have experienced myself) is infant weight loss following birth – and subsequent recommendations for supplementation.
This can be quite a distressing situation for a new mom as she learns to breastfeed, finds things are going well, and then she’s suddenly packed with information about infant weight loss.
It is generally considered acceptable for a baby to lose about 5-7% of his or her birth weight within the first few days of giving birth. Most care providers won’t raise an eyebrow at this, though I’ve personally been told things like “Well, baby is at 5% weight loss today, we need to keep an eye on it.”
Research tends to support 10% weight loss as being normal, though, in my experience, it depends on the pediatrician and the care team at the hospital. Some start to panic once the 7% threshold has been passed.
Over the past decade or so, there has been some research on the impact on early weight loss and breastfeeding outcomes. This study shows that early weight loss (such as in the first 24 hours) is linked to a higher risk of higher than 10% weight loss. This tends to lead to poorer breastfeeding outcomes like due to the early introduction of supplemental feeds, formula, etc.
While it might be easiest to blame the excessive early weight loss on inefficient breastfeeding – which certainly calls for intervention – other research shows a link between maternal IV fluids during labor being linked to newborn weight loss. This study (which is also the most recent) specifically found that when a mother was given 2,500 Mls or more during labor are at a much greater risk for excess weight loss in infants.
Because of this, many professionals (myself included) suggest using the 24-hour weight as the baseline for measuring weight loss – especially in infants who are breastfeeding well and have good diaper output.
This research concluded, “Timing and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change.”
My hope is that more research will be done. The research cited above is pretty good, but it’s minimal in its scope and most isn’t very recently done.
I believe that a more accurate measure of infant weight loss involves taking an official weight at 24 hours when a baby has had the opportunity to shed any extra fluid that may have been introduced into their body during labor. Most new parents don’t want to wait 24 hours to see their baby’s weight, so taking an initial weight is just fine. However, I believe there would be less pressure for care providers to push unnecessary supplementation.
There are situations where an infant’s weight needs to be more carefully monitored – such as in the case of a low or high-birth-weight child. Parents should also be taught how to identify inefficient feeding and signs of dehydration. There are situations where breast milk intake is inadequate, and this should be monitored carefully. With that said, many new moms are pressured to start giving supplemental feeds when it isn’t necessary.
In addition to fluids impacting a baby’s initial weight loss, it may lead to more breast engorgement and edema, which can also lead to increased difficulty with breastfeeding. Teaching mothers about reverse pressure softening would be a good prenatal skill to be taught for these situations in particular.
Here are a few recommendations I have for new moms who may face this situation:
- Request limited fluids during labor if possible and only when necessary
- If fluids are given, have it noted on your chart and let the care team know this child may have extra fluid released (thus more weight loss)
- Initiate breastfeeding as early as possible – focus on frequent nursing in the hospital
- Hand express after nursing and give your baby anything you’ve produced
- Request that a 24-hour weight be used as the baseline
- Work with an IBCLC closely to monitor breastfeeding and help with nursing strategies
- Monitor other signs of wellness – baby’s diaper output, skin tone, and overall temperament. Cluster feeding is normal and doesn’t indicate a problem unless the baby is showing signs of distress
- Advocate for yourself – and talk with your spouse/partner regarding your goals so they can, too.
- If supplementing is necessary, consider cup feeding or syringe feeding. Request a visit with lactation or do a virtual consult with an IBCLC to come up with a plan to continue breastfeeding.
Everyone’s goal is a happy and healthy baby and mom. Clearly, if a baby is struggling to nurse, it’s important to help them. However, if a baby is having extra weight loss, the situation should be carefully monitored to ensure a mom has the best chance at meeting her goals possible.
