#1 There is a misleading post circulating suggesting a newborn's stomach is larger than medical textbooks say it is. It suggests that the volume at 40 weeks could be 33ml rather than approx 7ml. Based on this it incorrectly claims colostrum is not enough and top ups are needed
#2 There are many things wrong with this. These figures are taken from 1 baby during an ultrasound. They measure an emptier stomach and then the stomach 15 mins later when the baby has swallowed amniotic fluid. Scientists do not make decisions based on 1 baby or 1 set of measures
#3 Second, we know that ultrasound measurements can be inaccurate and are a guide only. So many people are told their baby is small / large and have the opposite.
#4 However, lets for a moment say these figures were accurate and scientific and a baby’s stomach could stretch to 33ml. This still does not mean they need 33ml of milk per feed for a number of reasons.
#5 The difference in volume in the before and after photos is because the baby has swallowed amniotic fluid. Amniotic fluid is not food – babies get their nutrition through the placenta. Babies swallow amniotic fluid to practice swallowing and kickstart their kidneys.
#6 Estimates of how much amniotic fluid a baby swallows (and pees back out) per day are around 200 – 250 ml per kg of foetal weight. So a 3kg baby would be swallowing 600 – 750ml. They do not need 600 – 750 ml of milk on day one.
#7 Measuring amniotic fluid intake to estimate necessary milk intake makes no sense - they are completely different processes.
#8 We already know that babies can take in more than 5 – 7 ml per feed. Stomachs can stretch and they grow rapidly in that first week. Lots of studies show that formula intake in the early days is greater than breastmilk.
#9 But that doesn’t mean it is supposed to happen. Just because something is more doesn't make it better. And anyway many a baby given more will protest and present that milk back to you if too much goes in...
#10 At no other age do we estimate how much food someone needs based on potential stomach volume. The adult stomach can hold about 1 litre of food comfortably before you start to feel too full. However it can actually be extended to four litres. I know it’s festive season but ...
#11 Colostrum is not just about food – it is about antibodies, immunity and coating of the new born digestive system. We expect babies to lose a little weight in the days after birth precisely because this process is not just about nutrition.
#12 Protecting that process rather than offering formula, unless medically indicated, is important.
#13 Too much loss e.g. 10+% is a sign that milk transfer is not happening properly, or the mother is not making sufficient colostrum, or that there is a medical issue with the baby. It is NOT that the amount of colostrum produced if breastfeeding is going well is insufficient.
#14 It makes no sense to suggest that over all these years the human body would produce insufficient milk to feed a baby. Yes there will be some cases where this is true, but to suggest that all new mothers are producing too little milk to feed their baby is crazy.
#15 What other mammals give other feeds in the early days? You don’t see gorillas or cats giving their babies other food – you see them attached and feeding frequently.
#16 The focus here should be on supporting breastfeeding women to breastfeed frequently, responsively and keep their babies close. They should be taught to understand the signs of effective milk transfer and hydration in their baby that are not based on volume of milk.
#17 They should receive the care from staff (who have the time to give it) to check all is going well – and if problems arise, a pathway is put in place to make sure that baby gets sufficient milk, whether that is through frequent feeding, expressing or in some cases formula
#18 Most of all we should be caring for our new mothers in a way that supports them in caring responsively for their baby #motherthemother #informedisbest
