In a recent post, Barbara Wilson-Clay said "[Heather Harris] compared this method of scoring with Chris Mulford's The Mother Baby Assessment Tool (MBA) which was previously eval in a similar fashion and found to be reliable." I thank Heather and Barbara for reporting that the MBA was found reliable, but as far as I know that's not the true story. When Jan Riordan tested the MBA for inter-rater-reliability, using nurses as raters and having them score videotaped breastfeeding sessions, the raters had quite wide disagreement on step four of the MBA, in which you assess milk transfer using the mother's symptoms (sleepy feeling, uterine contractions, heavier lochia, breast tingle or pressure) as well as signs like audible swallowing. If there have been other tests for reliability of the MBA, I haven't heard about them. What I was trying to do with the MBA is develop a shorthand that nurses could use in those little tiny blocks on hospital charts where they have to chart feedings. The little blocks, natch, are just the right size to write something like "Sim-45cc" and not big enough to say anything descriptive. (The scoring system from that Jan Barger describes from the new Counselling the Nursing Mother looks like it would fit the same size blocks.) For those who are not familiar with the MBA, it goes like this. Mother and Baby can each get a point on each of five steps in a feeding: Signaling, Positioning, Latch-on, Milk Transfer, and Ending. The funny thing about thinking up the MBA and trying to make it add up to a 10-point scale (so that it would resemble the Apgar and feel familiar for nurses) is that looking for 10 items to rate helped me develop a mental model with five steps and something for mom and baby to do on each step. This led me to the idea that we should start looking at a feeding from the very beginning---the communication between mother and baby that determines whether they are going to HAVE a feeding---and finish at the end---when we see whether the baby looks sated and whether the mom's breasts look and feel OK. Kay Matthews had done this in a way in the IBFAT, when she notes the state of the baby at the beginning of the feeding and asks at the end whether the mother is pleased with the feeding. Whether or not it works as an assessment tool, the MBA works for me as a way of making sure I look at the whole feeding and see what both partners are doing. It is a way of reminding myself that breastfeeding is an interactive process. And it turns out to be a pretty good way to teach people about what happens during breastfeeding. Cheers, Chris Mulford, RN, BSN, IBCLC Swarthmore PA (Eastern USA) *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html