by Jack Newman
The fear of low blood sugar of the newborn has become the new "acceptable" reason to separate mothers and babies and give babies supplements of formula in the immediate hours and days after the baby's birth. The reason pediatricians and neonatologists are worried about low blood sugar is that it can cause brain damage, so there truly is a concern.
However, there has developed a sort of "hyper"-concern about low blood sugar that is simply not warranted. As a matter of fact, most of the babies who are tested for low blood sugar do not need to be tested and most of those who receive formula do not need formula. By giving the formula, especially as it almost always is given by bottle, we interfere with breastfeeding and give the impression that formula is good medicine.
1. The best way to prevent low blood sugar is to feed the baby with milk. However, formula and breastmilk (specifically colostrum in these early days) are not equivalent and colostrum is far better to prevent and treat low blood sugar than formula (See point #5 below). A little bit of colostrum maintains the blood sugar better than a lot of formula.1,2,3
2. Having the baby skin to skin with the mother immediately after birth maintains the baby's blood sugar higher than if the baby is separated from her. (See the information sheet The Importance of Skin to Skin Contact).
3. There is no lowest level of blood sugar that is universally accepted as meaning the baby has low blood sugar. Because of this atmosphere of hyper-concern about low blood sugar, the level of sugar keeps being raised to absurd levels. In many hospitals now, 3.4 mmol/L (60 mg %) is now considered the lowest acceptable blood sugar. This is patently aberrant and there is no evidence to back up such a level as the lowest acceptable blood sugar concentration.
4. There is no reliable method of measuring the blood sugar outside the laboratory. The use of paper strips to measure the blood sugar is not reliable. Paper strips tend to underestimate the true value. Only the laboratory gives a reliable measure of plasma glucose or sugar (plasma is the part of the blood which does not contain red blood cells and which is what we are really interested in, but we'll leave this aside).
5. If the baby's blood sugar is low, it does not mean he will be brain damaged. This is due to the fact that other constituents released by the baby's body will protect his brain. These include compounds called ketone bodies, as well as lactic acid and free fatty acids. In fact, babies who are receiving colostrum or breastmilk have much higher levels of ketone bodies, for example, than formula fed babies or even breastfed babies with supplements of formula.1
6. Babies born of a normal pregnancy and normal birth and who are at term and of a good weight do not need to be tested for low blood sugar. Yet, so pervasive is the anxiety about low blood sugar that more and more postpartum units are testing every baby at birth for low blood sugar. This is painful for the baby, anxiety producing for the staff and parents, costly, useless and contrary to evidence.2
7. It is normal for the blood sugar to drop in the first hour or two after birth. Yet many babies are tested first at birth then an hour later and given formula because the blood sugar has dropped. Babies are being tested without reason, then given formula for a normal situation! Incidentally, even if the baby is not fed, the blood sugar will rise after the initial (normal) drop.1,3