To repeat, in my opinion and experience, those who are anti-scale *generally* 
do not know what to do with the information they get from the scale.
 
To ask if we have an evidence base for baseline flow is ridiculous.  I'm not 
going to defend using my intuitions about flow rate just because there isn't 
an evidence base to support it. This field uses non-evidenced-based practices 
all the time.  We are a para-medical profession, to be sure, but we cannot 
argue that there is not an art to being a clinician in this field.  Half the stuff 
we "know" intuitively as breastfeeding professionals just simply hasn't been 
proven in the way we would like to see it.  Breastfeeding medicine and science 
are at least 50 years behind every other branch of medicine.  Should we stop 
practicing, noticing, discussing, or opening our mouths at all until we have a 
huge evidence base?  Come on...

Heather in the UK, you may be "genuinely seeking knowledge," but your tone 
seems disingenuous and you seem to be invested in proving that scale use is 
inaccurate.  I don't buy that you are just "seeking knowledge" when your responses 
are so clearly questioning what I have stated I get out of scale use.  

I feel sorry for you (genuinely) that you do not have the same experience 
that I do when I use the scale for test weighs.  I feel bad that you need to have 
such a tool as a scale be proven to be exact before you feel like it will 
help you in your work. 

As for me and I can speak for my colleagues as well:  I *can* tell at what 
point a baby is beginning to flag based on the scale and based on my skill as an 
LC; I can also tell where supply is at (of course not "exactly"-- I'll 
retract my use of the term for those who are literal) based on milk transfer 
according to the scale (yes, even if it's an ounce off what the "real" transfer is) 
in conjunction with my skill as an LC; and I can also tell how the flow is 
"behaving" (my term...not understood by everyone, but certainly by those who get 
it), even if there hasn't been a double-blind, randomized, large-scale trial 
proving a widely-documented hypothesis about what constitutes the definition of 
normal flow!

If I waited for a documented evidence base to come out defining at what point 
I can call a flow "inadequate," or "not normal," then all the babies I see 
whose mothers need to elevate flow rate in order for their babies to feed well 
would be in big trouble.  Good thing my intuitions aren't half bad in the 
meantime.

The irony that the non-scale users demand that the science be exact before 
scale use can be acceptable is not lost on me...and shouldn't be lost on any of 
you.  Why would someone demand and scrutinize scientific precision while 
practicing with virtually no measurements at all?

Heather in NYC
MA, IBCLC
www.manhattanlactationgroup.com    

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