Thank you to all who responded to my discussion-opener on test
weighing. I got mail off list and on list, and can assure people who
expressed surprise that the debate is still going on that this is a
*live* issue, and why wouldn't it be?
Test weighing and weighing in general touches on a lot of aspects of
our work, and it really is not enough to say (I paraphrase) 'scales?
No big deal. They are a tool, and tools can be used badly or well,
and that's it.'
Obviously, scales are just scales. But it is this 'good' or 'bad'
usage of scales which is subject to examination and discussion. I
can't think that any breastfeeding supporter would want to totally
get rid of scales and weighing - of course they can be useful, but
the question is 'how' and 'when'. I am taking it for granted that
anyone who knows anything at all about lactation, and babies, and
mothers, will not use the scale in isolation from anything else, or
without their own skills, knowledge and experience. Scales/test
weighing used on their own is BAD - we all agree on that!
Having said all that, this recent discussion has allowed me to be
clear that scales and in particular test weighing are affected by:
* the cultural - there are places where the use of the scale before
and after feeds is done routinely, or at least often enough for it
not to seem unusual, and places where to do test weights would be so
unusual that everyone who saw it being done would freak out!!
* the clinical - what can the scales do to help resolve a
breastfeeding problem?
Some people would say 'nothing that I can't do better with other
other skills' and others would say 'they are essential in some
situations'.
* the technical - how crucial is it to have scales accurate to the
nearest gram?
Some people think this is vital and that the right 'AC/PC" scales
need to be used. Others feel accuracy is not important at all, and a
rough idea is all that's needed .
* the 'philosophical-clinical' - this is the best way I can think of
to describe this aspect! This is gonna take longer to explain: I
refer to the area of lactation support where we try to resist the
measuring and assessing and micro-management of each individual
encounter at the breast; where we try to emphasise the part
breastfeeding plays in the relationship of the mother and baby.
For some people, scales and weighing can get in the way of this;
the inevitable focus on 'how many ounces?' that test weighing
produces, can *undermine* the longer-term aim of enabling the mother
to have a wonderful, confidence-boosting, trust in herself and her
breastfeeding.
Others will counter that, saying the measuring and assessing is part
of the confidence-boosting...the mother sees the transfer of milk in
the scales, and becomes more confident. The counter-argument to that
is that happy breastfeeding is hardly ever a matter of 'how many
ounces?' - that comes from the formula feeding 'norm' - and we should
be doing our hardest to get away from that. To which others will
reply ' but we have to start where mothers are' - exemplified in
Diane W's entertaining post where she outlined situations which used
the scales in this way as an educational tool....Diane, there are
others who would have thrown the scales out of the window rather than
use them, in *exactly* those situations :)
The discussion also reminded me of the things we don't know
* how much breastmilk does an individual baby need to survive and
thrive? We have some figures from the 'world' of formula feeding, and
we can do some mathematics with calorie content and growth, but we
simply do not have a precise figure of what breastmilk a healthy baby
needs....and how far an 'unhealthy' baby might differ, and how far a
healthy but non-average baby might differ. And that's before you get
into the differing calorie values of breastmilk - intra-feed and
inter-feed, intra-mother and inter-mother. Maybe we really don't need
to know any of this, except at the end of the unhealthy spectrum.
* how essential is growth compared to, say, transfer of antibodies
and other components of breastmilk? Growth's important, for sure, and
a poorly-growing baby is often a precursor to milk supply-failure, so
it's good to see a baby is growing...and growth charts help us a lot
here. We can be fairly sure when a baby isn't growing as he should
(leaving aside that slow growth might be physiological to that
individual baby) and when his growth would benefit with some extra
calories - but how do we know we are benefitting him (or his mother)
by using the scales to tell us how much supplement (ebm or formula)
he needs at each feed (often a reason for test weighing)? Maybe
leaving things alone and supporting the breastfeeding *overall* would
be better.
In the light of what we don't know, then I suppose the accuracy or
otherwise of the process of test weighing matters less. After all, if
we don't know what to compare our results to, then it doesn't matter
if they are accurate or not.
Seems to me test weighing is boundaried by the culture and
expectations of the practitioner and the mother (a point made by
Diane W in that same post), and the lack of baseline figures for
what we are looking for means I don't think any of us are in a
position to make generalised clinical claims *for* or *against* the
procedure .
Thanks to everyone who took part. I probably haven't finished with
the topic forever, though :)
Heather Welford Neil
NCT bfc, tutor, UK
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