Maternal Intravenous Fluids During Labor and Newborn Weight Loss
by Anne Eglash MD, IBCLC, FABM
After covering SARS-CoV-2 in the last few CQWs, I thought I would take a break and discuss something germane, like weight loss, and then realized that with the changes we are witnessing in newborn care, this an important topic to highlight. Many new dyads are being discharged from the hospital after 24 hours for an uncomplicated vaginal delivery, and 48 hours after a cesarean birth, to reduce exposure of families to COVID-19 and to save on personal protective equipment for health care workers. In some communities it is harder for families to find follow-up care because physician offices are trying to keep people with non-urgent problems out of the office. A new mother recently shared with me that she was advised to supplement with formula at the time of hospital discharge to prevent the need for frequent weight checks.
Many lactation specialists have observed for years that infants born to mothers who have received copious IV fluid during labor appear to lose excessive weight despite breastfeeding well. I personally have seen infants with 10-12% weight loss at 24 hours.
The study for this week’s CQW is a French study that was retrospective, evaluating the relationship between maternal IV fluid and newborn weight loss. The researchers studied 150 records of patients who were low risk and gave birth to a single term healthy breastfeeding infant in 2016. They reviewed the amount of IV fluid given to the mothers, and correlated this with the newborn weights done from birth thru day 4.
The researchers found that when mothers received at least 1500ml of IV fluids, there was a greater likelihood of an 8% newborn weight loss at 72 hours.
Interestingly, they state that the French Society of Anesthesia and Intensive Care does not recommend IV fluids before an epidural to prevent a drop in maternal blood pressure, but 85% of mothers who received an epidural received at least 1500 ml of IV fluid.
I realize that this is not the first study done on this topic, and the results corroborate the findings in similar previous studies.
- Mothers who underwent an emergency cesarean were at higher risk for increased IV fluids.
- Longer labor was associated with more IV fluids.
- Mothers with a higher BMI received more IV fluids.
- Mothers receiving pitocin/oxytocin during labor received more IV fluids.
Lisa Chassagne
Thank you so much for giving me evidence to back something I’ve been saying for a few years to parents. The concern and worry these mothers face when told their baby lost too much weight then fall victim to unnecessary formula supplementation happens all too often. Thank you for a relevant topic for the hospital IBCLC! Unfortunately we are not calculating weight loss after 24 hours at my hospital.
Rebecca
We had a brief time period where we were using the 24 hr wt, but it was difficult for nursing – especially on days- to get weights at the 24 hr time. There was an established system of weights before 0600, and they have reverted to this.
At the same time or close to this we started using the NEWT tool. Entries include the type of delivery and whether the newborn has been supplemented or not. It was my understanding that this tool was supposed to accommodate its wt loss results based on delivery style incorporating fluids into the calculation, but I am not sure that this is so. I am always concerned about the fluids as so many challenges result from excessive fluids, but it doesn’t seem to have changed our practice much unforeseen.
Here is a link to the NEWT tool: https://www.newbornweight.org/
Francine Morrissette
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