I would have to read the whole article (which I can't do right now), but
after reading it, I think it's a perfect example of how the general understanding
of what test weighing does for the clinician is misunderstood (particularly by
those who don't use it).

To repeat (which has been done ad nauseum):   the scale is a tool.   It's a
tool.   If I were to think a 2 week old baby took in 90 ml during a pre and
post-feeding weight but then really "found out" that it was only 75 ml (using as
this example the greatest edge of the error range, i.e., 15 ml, to give the
most dramatic example possible as a result of this study), then I wouldn't
change a thing that I said to the new mother:   If her baby had been acting hungry
after the feed, then I would have assumed that 90 ml is not enough for him.
If I then found out that he had really only taken in 75 ml, then in my head I
would say, "Well, my inituition about his satiety is even more true."   If he
had taken 90 ml and seemed satisfied, and I found out it was really 105 ml,
then I wouldn't change a thing I said either. In fact, let's exaggerate this
completely: let's say I watched a baby guzzle and gulp at the breast, spit and
sputter, throw up a whole lot after a feeding, hiccup, look around, seem,
satisfied, poop his diaper, etc.   Let's say the moom had round, full, leaking
breasts.   And let's say the scale said he took two-tenths of an ounce.   Would I
believe it and look at numbers only in a vaccuum?   No, I wouldn't.   In fact,
in a case like that, I might even think that there was a chance that I weighed
him wrong or that we had added socks or a hat unwittingly. I could give
example after example, but I think you all get it.

The summary of the study seems to suggest that we who do pre/post weights are
obsessing over ml, scrutinizing the scale to determine if the baby is full
(much like OB's who scrutinize the monitor to see if the mother is in pain!).
My response to the study is:   who cares?  It's no shock that there are
deviations and there are deviations in every instrument that is used.   We've all
seen babies who we think should take about 4 oz and they need 6 oz at that
particular feeding.   What good does a pre/post do in that case if we decide to
obsess over exact measurements and numbers and not look at the human at the other
end?

The way most good scale-using practitioners use the scale is to assess the
*rate* at which the baby is transferring milk and the volume *in relation* to
that weight.   As I've said before, all 3 oz are not created equal.   3 oz after
switch-nursing, breast compressions and sitting around for an hour is not the
same as 3 oz taken predominantly off one breast in a relatively short 25
minutes.   We can use the scale to clinically get at:   1) where supply is,
exactly. 2) how does flow "behave."   3) When does baby start to have trouble
accessing the milk and at what point in the feeding.   Does the baby gulp 1.7 oz
right out of the starting gate and then eek out one-tenth an ounce here, 2-tenths
there, mostly sleeping, over the course of an hour?   What difference would
"errors" in transfer tell me in this scenario?   I'm using the milk-transfers
all together, as part of a larger picture, in order to set up a plan for this
mother.

People who don't use a scale, in my opinion, are the people who don't know
what to do wtih the information they get from it.   But there *is* infromation
we get from it if you know your way around a breast, and how on earth can you
argue with more information???

Heather Kelly, MA, IBCLC

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