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Monday
Oct312011

Newborn Weight Loss and IV Fluids in Labor

Until now, weight loss during the first 3 to 4 days after birth has been considered one indicator of how early breastfeeding is going.  If on Day 4 a newborn’s weight loss is in the average range of 5% to 7%, this usually means breastfeeding is going well.   Nearly all babies lose some weight after birth, because after floating in amniotic fluid for 9 months, they are born waterlogged.  Normal weight loss comes from the shedding of this excess fluid as they adjust to life on the drier outside. 

But when babies lose more than 7% of birth weight during these early days, does this automatically mean they are not getting enough milk?  No, according to a recent study

A greater weight loss may be completely unrelated to breastfeeding and due instead to excess IV fluids mothers receive within the final 2 hours before delivery.  According to this study, these excess IV fluids inflate babies’ birth weight in utero and act as a diuretic after birth.  Babies whose mothers received more IV fluids before birth urinated more during their first 24 hours and as a result lost more weight.  Number of wet diapers during the first 24 hours predicted infant weight loss.  This was true whether the babies were born vaginally or by c-section.  Another study published earlier this year had similar findings.

This weight loss has nothing whatsoever to do with breastfeeding and milk intake.  In fact, the authors suggest that if clinicians want to use weight loss as a gauge of milk intake, they calculate baby’s weight loss not from birth weight, but from their weight at 24 hours.  According to their findings, this could neutralize the effect of the mother’s IV fluids on newborn weight loss.

This is one more reason weight loss alone should not be used to determine when newborns need formula supplements.   The Academy of Breastfeeding Medicine put this well in one of its protocols: “Weight loss in the range of 8-10% may be within normal limits….If all else is going well and the physical exam is normal, it is an indication for careful assessment and possible breastfeeding assistance.”

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Reader Comments (6)

Thank you for this post. I'm wondering whether a high volume of amniotic fluid might have the same effect. My son lost 300 grammes in the first 24 hours of life. He was 4.2 kg at birth and 3.9 the following day. I had no IV during labour, but I did have a very high volume of amniotic fluid throughout the second and third trimester of pregnancy, noted by all doctors. The midwife was slightly worried about my son's high weight loss but we did not supplement and he did fine.

November 1, 2011 | Unregistered CommenterThe Globetrotter Parent

Thank you for posting. I was admitted on a Friday at 9:30am and delivered on 9am on Sunday in active labor the entire time to them get a epidural at hr 45, slept for 4 hrs, pushed for 3 and ended up with a c-section and during this time they gave me petocin 3X. At day 3 my son had a 10% weight loss and they were concerned and they told me that I needed to supplement with formula, which I did not want to do. The dr there said that none of the fluid goes to the baby, but as a doula myself, I didn't agree. In the end we gave my sister in laws breastmilk to my son for 2 days through the supplemental nursing system and once my milk was in he's been doing wonderfully. If I didn't not have the breastfeeding support or knowledge that I do have from working with breastfeeding mothers, I would have been like a lot of other women, who give their babies formula because their dr tells them that they have to.

November 1, 2011 | Unregistered CommenterAmy

Nancy, I am so glad to read this! As you know my baby lost 11% of his weight during the first 3 days and he was put on supplement, which brought all kind of problems to us. Knowing this piece of information I would now probably stick to breast feeding alone for a little longer to see if I can pull it through. Thanks a lot for keeping us updated!

December 2, 2011 | Unregistered CommenterConstanza Ehrenhaus

This is so important for moms to hear! I had a long labor with my daughter, that resulted in a heartbreaking C-section. My daughter lost 11% of her body weight by 3 days of age, and I had been PUSHED with fluids the entire 10 hours I was in the hospital (labored for 2 days with my midwife before then). Every doctor and nurse that came in commented on how amazing she was doing, how well she was latching and eating, that her blood tests were amazing etc. Then without fail they would look at her chart and note the weight loss and tell me she needed supplementation. After JUST telling me how amazing she was and doing so well. I finally asked the pediatrician, who was not going to let me go home with her because of her "severe" weight loss, if he was incapable of trusting his own medical judgement since he had just given her a clean bill of health, complimented me on the feeding gains noted by the lactation consultant and her overall assessment - HIS infant assessment. They kicked me out within an hour of that. My pediatrician didn't bat an eye at the weight loss. She asked me how much fluid I was given, I said at least 6 boluses and she went right about assessing my daughter and saying she was perfect, keep doing what I am doing.

Since being told I was clearly incapable of producing enough for my daughter, I have donated over 3,000 ounces of breastmilk.

March 5, 2012 | Unregistered CommenterAngie Bond

This makes so much sense to me. It's something my doula and Bradley coach brought up but definitely good to read that more studies are being done to establish this! I had a natural delivery with no IV at the hospital, and my son was born at 10 lb 4 oz... He never lost more than a few ounces, and had gained three ounces by the time we left the hospital in 72 hours! People were so astonished, but it really makes sense because his weight didn't get inflated by IV fluid!

June 2, 2013 | Unregistered CommenterMichelle

Another issue to consider is the edema that can occur in breast tissue when large volumes of IV fluids are given. This edema can make it more difficult for the newborn to latch, perhaps delaying an effective latch and milk production. This should always be taken into consideration as an issue to be considered in the breastfeeding relationship.

June 4, 2013 | Unregistered CommenterSuzanne Auger
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