To respectfully disagree with Maureen:   one test weight *can* tell you 
"squat" if you consider it as part of a bigger picture.   We often don't have the 
luxury of doing endless or consecutive home visit feedings for private clients. 
  That's why we should always emphasize that this one feeding *is* just a 
snapshot.   But, for example, if you had no scale and came to a visit and saw an 
incredibly sleepy baby who went on to show you a horrible feeding but the 
overall weight gain was great and the diapers were great and the mother was 
claiming that this was very uncharacteristic, you would (I hope) trust your 
instincts and never say that seeing one feeding can't tell you squat.   It clearly 
can, even if it's not a feeding that is reported to be representative of all the 
feedings.   In fact, it might even tell you a lot--you might say, you're doing 
great, keep it up, or you might be a bit more conservative and say, let's get 
more frequent weigh-ins at the doctor for the next three weeks just to make 
sure that you aren't witnessing a downturn or in case the mother is not quite a 
reliable witness.   

The situation you are describing in your post is a clear-cut one--yes, that 
woman probably does have at the very least an acquired low supply but, 
according to what your clinical observations were vis-a-vis breast shape, veining, 
"feel," etc., more likely a pathological low supply.   A test weight there would 
have done not a whole lot in terms of adding to the big picture.   However, in 
more subtle cases (which, let's face it, most of the cases are), the test 
weight can be the very thing that puts a missing puzzle piece in place.   Final 
volume is not really as important in my view as the *rate* at which the baby is 
nursing.   I like to say that not all 3 ounces are created equal (or two 
ounces, or four, for that matter).   It is HOW the baby takes it that is 
clinically important.   

There should be no such notion as overuse of a scale.   If a practitioner can 
basically walk into any situation and feel like she has a general idea of 
what is going on, then the scale should be nothing more than a buttressing of 
what is already suspected (except in those "trick baby" cases where the baby 
gulps but takes nothing, in which case you should thank your lucky stars that you 
have a scale).   If a practitioner only depends on a number and cannot 
extrapolate from other information that is present (in my experience, this is the 
case with some people who are just beginning to use the scale), then the flaw 
lies in the practitioners ability to weigh the whole picture, not necessarily in 
the use of the scale.   The scale should not become the dumping ground for a 
practitioner's poor skills.   

I would think that the earlier a baby is, the more skill is involved in using 
the scale.   Preemies, in particular, could "nurse" well, but it could be the 
mother's supply at that moment that is compensating for a low-stamina baby, 
and the end result, i.e., the number of cc's tranferred, could be perfectly 
acceptable, but yet not be much of an indicator of how well feeding is going.   
This is why lactation management and "insurance pumping" is so important 
(often, that is) with the preemie profile.

And I don't think a scale should bounce around in an SUV for days on end, but 
a car ride to the occasional home visit in a well-insulated bag should not 
affect it at all.   

Heather Kelly, MA, IBCLC, who thinks that *not* using a scale routinely is 
bad practice (there, I said it!), New York City, NY

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