Hi all
I have watched these threads with interest (and been away from the 'puter
for a couple of says, hence the combined post).
RISK FACTORS
Hearing the voices of MOBI mums is really interesting.  These are women who
have spent some time in the MOBI community.  I don't want to discount their
experience or their wishes.  I think that it is really important that we
hear them.  I want to make an observation, though.  These mums now know that
it is possible to overcome or prevent the breastfeeding difficulties that
they encountered.  If they were told today that they had risk factors for
lactation failure they would be empowered to prevent or seek help to
overcome the difficulties early.  However, most primips believe that
breastfeeding is unpredictable, unreliable and that breastfeeding
difficulties are insurmountable ('some women just can't').  There is some
good qualitative research on this. All women need to be adequately supported
in order to breastfeed successfully (hate that word, can anyone think of
another one?).  If these women had adequate primary health care, their
problems with breastfeeding would have been spotted and dealt with before
the train wreck stage.  It is malpractice to say to any mother, 'just pump
and you'll do fine' - and as Karleen points out 30-40% of women will cite
'insufficient milk' as their reason for weaning in the first year so all
mothers need to be supported as women with a greater than 1 in 3 risk of
lactation failure.

HEALTH SYSTEMS
I concur with Rachel and Heather, in their observations that our 'socialised
medicine' - I prefer 'universal health care' to describe it myself - makes
it very rare to see a baby who is in such dire straits at four weeks.
Clearly, if an infant is showing clinical signs of dehydration and severe
malnutrition, refeeding is paramount.  

TEST WEIGHTS
Kathy writes "I would want 24 hour test weights done to see what the intake
really is at the breast. I'd like mom to do a day's worth of weighing before
and after every nursing and writing it down so we can really tell. If baby
is removing milk in proper amounts for growth as outlined in the BAB (both
caloric needs and growth perimeters), then I would look at other physical
issues."
I do not use the BAB (I use other resources) but I do wonder and must ask
again what research any prescription of the 'proper amounts' of human milk
intake are based on.  We simply do not know how many mL of milk will be
enough for any individual infant.  We can tell (from outputs, from
behaviour, skin tone and other indicators) whether a baby is or is not
getting enough. I know this has been discussed before but no one has yet
convinced me that knowing how many mL a baby is taking from a breast is
useful.  The Hartmann team found that some babies thrive on less than 500mLs
of human milk in 24hrs.  Would we supplement this baby?  How much would
give?  Based on what research?  From what I can tell, the formula for
calculating the volume of supplementary feeds is based on a mL per Kg of
bodyweight calculation that applies only to exclusively artificially fed
infants.  The Hartmann research clearly demonstrates that human milk cannot
be substituted mL for mL with modified animal milk.  
I realise that this doesn't answer the question of when or how much to
supplement - or when the risk of supplementation is outweighed by the risks
of not doing so - but I think that it demonstrates that the scale cannot
provide the answer to that question either.
Best regards
Nina Berry BA/Bed(Hons) Dip Arts(Phil)
Breastfeeding Counsellor
PhD Candidate - "Ethical Issues in the marketing of 'Toddler Milks'"

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