Laurie, in a thoughtful post, writes

> But I don't see the numbers as a
>bad thing necessarily. Lots of stuff in life is measured like blood counts,
>hemoglobin, pregnancy weight gain, fundal height. We use these numbers along
>with other assessors. Some practitioners intervene when the hemoglobin is
>xxx for example, when another would not intervene or do something less.

Haemoglobin is tested *unnecessarily*.  There is no clinical evidence for
routine hb testing in pregnancy or in infancy. In some countries (eg here)
it is not tested for unless there are clinical signs of anaemia or if there
is concern over diet. Most pg women have a baseline hb testing done and
then sometimes they may have it done again at the end of pg - and there is
a lot of controversy about what is normal. Some places don't test - it's
not that we are advanced, BTW, just that the health service is cash-poor :
)

Fewer and fewer places weigh pg women now - the evidence is that routine
weighing doesn't give any useful info.

Fundal height - hmmm....don't know about that. I would like to see good
evidence that routine fundal height measurement is clinically useful.
>
>Now, it IS very hard to say what is a "normal" or "average" intake by a baby
>on a test weight. Yes it is just a guesstimate and yes the test weight is
>just one "snapshot" in time.

I know.....but I am still unconvinced it is a useful snapshot : )

 > If the whole bf picture looks like
>we need to intervene and for example supplement the baby, then I might
>recommend a particular amt of supplement [ebm preferred] based on the baby's
>body weight if the baby took say 6 mls on the test weight. Lets say the baby
>is currently 5 pounds [2270g], it is day 4 with no milk surge. If the baby
>took 20 mls then I might say feed very frequently do breast compression but
>not supps but come back for a reweight tomorrow.

 If the baby is five pounds and is still not feeding well, and the mother
does not yet feel her milk coming in, yes, you want to encourage lots of
feeding and skin-to-skin and no pacifiers....don't know what you gain by
test weighing here, except a comparison test weight for the next day - and
you can tell by all the other factors whether things are going well. Still
don't know why you need those scales!

> For a 5 pound baby they
>need about 13 ounces per day.

Of what?  Breast milk based on an average calorie value? But calorific
value - that is, fat content - of breast milk is the most widely variable
ingredient, especially in the early days.

>If this were a greater than 7 pound [3178 g]
>baby on day 4 then I think less than 30 mls intake would concern me.

Why? He could be feeding again in half an hour - babies in those early days
do not have a typical day.

> I base
>this on my chart which says a 7 pound baby needs about 18-19 ounces of milk
>per 24 hr day. These charts are based on the guidelines of xxx cals/kg
>needed.

Who did the charts? On what evidence? On physiological bf of how many 1000s
of babies - or what?  What happens if the baby doesn't reach his required
calorie intake on  a particular day, but the mother just hangs on in there?
So if I say 30mls x 14 feeds = 15 ounces, this baby would be a
>little behind the amts he needs but lets take into account different amts,
>different calories, milk supply should be increasing etc.

> Again, this is not
>perfection, but making a judgement call. I will be rethinking this every
>day. Thanks.

I know it's art and science, and I know it's judgement.....but I am *still*
unconvinced the judgement is based on anything solid!  Gosh....I know I am
being a hard-nut here ; )  and I appreciate your patience : )

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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