Perhaps I'm missing something here, but the scenarios that Dr. Gordon put 
forth about how test weighing could go awry seem to me to be really uninformed.   
I don't mean to show disrespect for someone--particularly an MD--who is so 
supportive of breastfeeding and breastmilk feeding.   But anyone who uses a 
scale knows that they are sensitive to a tenth of an ounce and that there is a 
very specific way that you use them.   You NEVER change a diaper mid-feed, not do 
you change outfits, shed clothes, etc.   If you do take off socks, you put 
the socks back on the scale with the baby when you are done.   Test weighs are 
very precise and very precisely done.   I usually get a naked weight first, 
then dress with a dry diaper and get another "pre" weight which I both enter into 
the scale and write down.   No good LC would ever do a pre-feeding naked 
weight, put on a diaper, let the baby urinate and stool, and then take it off and 
expect to get an accurate post-feeding weight!   That's common sense! 

Everyone agrees that these weights must be part of a bigger picture.   I 
think I stated several entries back that it is my opinion that scale use as the 
sine qua non is usually the case with someone whose clinical skills are not that 
great (again, my opinion).   As I said, I've had babies transfer over four 
ounces rather quickly in a feeding and STILL determined that the mother's supply 
(overall) was low, based on lots of other info.   The medical world is rife 
with parallels to this:   before medical imaging was around, surgeons accepted 
a much higher rate of negative appendicitis cases (i.e., cases that seemed to 
be appendicitis but ultimately weren't).   Along comes the CT scan and it is 
used as a piece of a bigger clinical picture, but is not the be all and end all
.   There are cases of appendicitis where the CT scan shows nothing but the 
clinical picture warrants a visit to the OR.   Or, I suppose, there could be 
cases where a scan for something else incidentally shows an enlarged appendix, 
but no clinical sign of anything amiss.   Would a good MD rush this person into 
the OR for an appendectomy?   I would hope not.   What about ultrasounds at 
the site of trauma?   There are situations where an MD would see fluid and would 
go into the OR, but there are also situations where an MD would not 
necessarily see fluid, but might go into the OR anyway, based on other parts of the 
picture.   Would ANYONE claim that these technological interventions are 
"virtually useless?"   I would hope not.   I find 
the statement about undermining a woman's confidence to be--yet 
again---uninformed and, quite frankly, misogynistic.   Since when do real clinical problems 
have to be hidden for the sake of a female's confidence?   If there is a 
problem, women need to know.   If there is not a problem, then women should know 
that, too.   If a baby is nursing well and gaining well and there is not a 
problem, and there is a low-ish 2 oz transfer during a "bad" feeding, a good 
clinician should be able to relay to the woman that it's nothing to worry about and 
that the overall picture is a good one.   There should be not situation in 
which a mother's confidence is needlessly undermined.   Again, that is the fault 
of a not-very-good LC. 

Heather Kelly, MA, IBCLC 

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