The IBLCE Clinical Competencies describe 75 or so activities in which the
IBCLC is able to engage.
http://www.iblce.org/upload/downloads/ClinicalCompetencies.pdf.

Right there, page 2, it says: "3.  The IBCLC has the duty to provide
competent services for mothers and families and will perform a
comprehensive maternal, child and feeding assessment related to lactation,
such as ... Skills to Assist Breastfeeding Dyad ... assess effective milk
transfer [and] assess for adequate milk intake of the child

The part that drives *me* nuts, as a parser of legal language, is that the
loaded term "duty" is used throughout the document.  So ... if I have a
*duty* as an allied healthcare provider to "do" something, and I fail to do
it, is that misfeasance?  But that is for another soapbox, on another day
....

I do not think of test-weighing (as in: Weigh the baby before, and after, a
feed-at-breast, using a scale sensitive to 1/10 ounce, without changing
diapers, clothes, etc.) as an "intervention;" I think of it as
"asssessment."

There are many means of competently assessing milk transfer and intake.
Test weighing is one of them.  It tends to be a regular part of assessment
in some countries, and not-so-much in others.

When I wear my private practitioner hat in the USA, I do a test weigh each
and every time I have a consult with a dyad ... because I usually see them
in the two-week time frame after hospital discharge, and after the expected
milk surge of Lactogenesis II has occured.  Of course, it is just one feed
I am getting a snapshot of, but the baby's outward behaviors have fooled me
enough times that I like to have the data from the weight as well.

When I wear my per diem IBCLC in a large hospital hat, I almost never do
test weights on babies.  I see dyads in the first two days of life, when
colostrum levels are appropriately low.  There is so much sturm-und-drang
right now, in hospital-based practice, about "weight loss" (versus fluid
diuresis ...) in the first few days that I would be loathe to make test
weights a standard practice for otherwise well-feeding happy newborns.  It
has, however, been a useful technique in the hospital when other HCPs are
wanting to supplement with formula for whatever reason ... and the IBCLC is
wanting to show that the baby *is* getting colostrum.

But poor freaked-out mom is the one caught in the middle here, as a
respected HCP proverbially stands on one side of the bed imputing "There is
not enough milk!" and the respected IBCLC is on the other, saying "Yes
there is!"  I don't think these "weight wars" do a stinkin' thing to
enhance maternal self-efficacy.

--
Liz Brooks JD IBCLC FILCA
ILCA President (2012-14)
Wyndmoor, PA, USA
Twitter: @LizBrooksIBCLC
FB: www.facebook.com/LizBrooksIBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome