I didn't mean to suggest that Magda's article was specifically about test
weighing.  I used the subject tag of "test weights" because I  was
responding to Karen Clement's request for info about test weighing by
recommending Magda's great article as a nice overview.

 The reference is:  M Sachs, S Oddie:  Breastfeeding -- weighing in the
balance:  reappraising the role of weighing babies in the early days, MIDIRS
Midwifery Digest 2002; 12(3):296-300.


As I read Magda's article, I don't see it coming down against the practice
of weighing at all. Rather it calls for more focused normative research
(desperately needed) on issues relating to early weight loss in bfg infants
and on the practice of weighing.  The article describes the often poor
methodology used in collecting  weight info, the inaccurate scales, and the
lack of research documenting when and how weights might be most effectively
performed.

 Magda makes a statement I agree with completely:  "If babies are weighed,
the results should inform practice."  With an accurate scale, a good reason
for doing a weight check in the first place, and sensitive presentation to
the mother, the information can definately inform management interventions
in my experience.

 Magda also states (with regard to the perception that weighing stresses
parents):  "A Cochrane Collaboration review of growth monitoring discovered
an astonishing lack of evaluation of the effects on parents of weighing
babies...Could the presentation of weighing affect how it is perceived?...We
know from studies on other aspects of midwives communication skills that
these may not always achieve the desired ends."

The review goes on to say that in order to prevent harm associated with
breastfeeding problems, protocols for assessment of intake do need to be in
place -- this would include a method to provide professionals with "what
evidence there is that breastmilk transfer is effective."  Magda
specifically mentions the desireablity of greater use of stool assessments
as markers for adequate feeding.  But she also calls for other ways to
provide "detail on how to assess that the baby is getting milk...Such an
approach might identify cases of severely impaired milk transfer while
enabling assistance to be offered to other mother-infant dyads with
difficulties."

The article concludes by saying that "...weighing requires further
exploration and integration into the breastfeeding assessment toolkit."  I
do not read this as proscribing the use of test weights. Rather it appears
to me to acknowledge that we need more research and better protocols to
enable us to dependably use all the tools available to us.  Direct
observation of breastfeeding is the LEAST effective way to document intake.
This has been verified in several studies.  Most effective (in descending
order) are:  tagging with "heavy" water, weights on accurate scales, looking
and listening to feeding.  Due to the expense of the tagging method and the
not-that-significant difference in accuracy, weights are favored.

Perhaps some of the other researchers will comment, and I'd love it if Magda
cares to comment.  I surely don't want to misrepresent her.



Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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