Laurie wrote: 

>One last thing: A scale is probably not necessary in a truly BF supportive 
facility, culture, country.  [...] I can't begin
to tell some of you how far from the ideal many places are. It seems to me
that the European and Australian LCs are in a more BF supportive place than
the USA. In USA, Birth centers with midwives are very different places than
typical maternity hospitals. I think that's why some of us use scales
because the normal BF behaviors don't happen and then the downward spiral
happens so quickly and then more intense interventions are needed. Also, the
availability of follow-up is not really there. How many LCs get to see a
mother/baby dyad having trouble, repeatedly, say every few days for a few
weeks??? This is what it would take to really follow up and get them going,
without having a scale. This would be great, but it is just not feasible in
lots of settings. Hospital LCs don't usually have a lot of time set aside
for lengthy followups. If the pair goes to the pediatrician for follow-up,
breastfeeding can often get derailed. So, the whole culture has to support
Bf - that's the bottom line.< 

I am not so sure how supportive the UK context is, in fact.  HOwever the 
main thing that troubles me is that the profession of Lactation Consultant 
was developed in the USA, in response to your conditions, yet is being 
rolled out internationally.  If scales and other approaches which, yes, may 
well be needed in your circumstances, become the default way of practicing 
the profession of LC, then what are the implications of INTRODUCING these in 
our differing cultures where we may need different devices and approaches, 
and where the use of these tools may take us some steps, if not backwards, 
at least sidewards?  If LC is to be an influential international profession, 
this worries me. 

Magda Sachs

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