Nina writes: Did the test weigh change anything about the way you managed  
this case or
did it just put a number (of ccs) onto an existing diagnosis of  insufficient
intake?

It helped me to feel confident about my "dx" of low milk supply. There was  
no question that there was poor intake early on but when I saw mom after  
readmission, breasts were "normally" full and breastfeeding looked effective. I  
might have concluded on day 4 and 5 all was well, if I hadn't performed the test 
 wts and the baby could have gone home spiraling down into the same poor 
intake  situation. Or, conversely, I could have had her pumping and supplementing 
for  nothing if the milk transfer and supply had been good. Test weighing 
helped  me, in the context of a full breastfeeding evaluation to sort this out.   
It's a tool I use sometimes to validate what I think I see. I only use it if  
there is a question of milk transfer.  Paula Meier has a study which shows  
the most experienced LC's are not great judges of milk transfer. I think I'm  
pretty good but I've been fooled. This would have been one of those  situations. 
 I agree that it was clear that baby was not getting enough  breast milk 
early on before i met the couplet. But by the time I saw them  breastfeeding 
looked really good. Test weighing disputed what I saw. Without it  I would have 
thought all was well and would have just recommended frequent  breastfeeding on 
cue. 
 
Kathy Boggs, RN, IBCLC

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