It's times like these that I regret not reading Lactnet on the weekends. I only do this at the office. I missed the "test" weighing/pre-and-post-weight thread.

I suspect what I shall do here is to agree with at least some of what everyone has said. All are making valid points and in the end I suspect we all agree that the cart should not be leading the horse.  Two cases of mine come to mind that I think will prove helpful to our conversation. Bear in mind that most of my clients are fairly recent Hispanic immigrants, with a strong penchant for BOTH breastfeeding AND perceived milk insufficiency. Given that:

Case #1: I had a mom who was supplementing (EBM and/or ABM) for the same reason so many do: doubts about their supply. She was more insecure than most, but also more of a doer, more proactive, shall we say. I saw her; the details of the case are not particularly important. She was perfectly capable of making sufficient milk for the baby, who was just as capable of getting it all out.  I do use our scale to reassure doubting moms that in fact the baby IS eating. I don't generally have to worry about them over relying on the technology; as WIC clients, they are usually of fairly low income. The cost of a scale is usually out of the question for them. Well, this mom rented a scale. She didn't tell me ahead of time, she just did it. She decided to weigh that baby before and after each nursing. Like many of you here would have been I was not pleased but it was her choice, which she made on her own. I didn't even mention the possibility to her; she figured that out by herself.

And you know what happened? She weighed that baby before & after each feeding not until I was convinced but until SHE was. (Not that I needed the scale to convince me…you get the point.) Eventually she realized the baby was indeed getting enough breastmilk. She took the scale back, never supplemented that baby again and breastfed him for over a year. So I felt like one thing I'd learned from that little incident was that she knew what she needed, and whether I liked it or not, it turned the case around for HER.

Case #2: I mentioned this baby recently in another thread. It is one of the most complicated cases I've ever dealt with so I shall restrict myself to the part relevant to this thread. 2nd baby, 2nd breastfed. First baby was breastfed for 2.5 years no problem. This second baby had one problem after another so I saw her.  He was 3.5 months old at the time and weighed 11# 6oz, which was 5# 6oz over birth wt. (In grams: birth wt 2727g; wt on that day 5172g) During the consultation he transferred 42g in what his mother deemed a prototypical nursing. He choked on her letdowns, which distressed him, in particular if you leaned his mother back so as to position him on top of her. (Naturally we didn't force that and she sat back up normally.) At the end he let go on his own fully awake and not crying. His mother offered the breast repeatedly; he quietly and steadfastly refused.  Within minutes (or moments, don't recall which) he was crying. But not from hunger - from pain.

To make a long story short he had (among other things) a vascular ring (double aortic arch with left subclavian artery & vascular ring) and cranial synostosis.  Neither of those diagnoses had been made at the time. She had been told that he had a minor heart defect with which he could easily live and the synostosis wasn't even on the doctors' radars.

My point: it would have been all too easy to see that 3.5 month old baby transfer 42g and come to the conclusion that her supply was "low". In fact, her supply was exactly what he wanted it to be, no more and no less. What I wanted to know was why he didn't want more, and why he was in such pain.  I sent her off empowered to find out and that's when the diagnoses started pouring in.

(FYI further testing showed that his choking due to the vascular ring was worse in certain positions - like if she leaned back.)

So, yeah, the scale can very easily be misused or its results misinterpreted. It's not supposed to do our thinking for us, it's just supposed to give us information that we otherwise would not have.

And yes, for some moms one good weighing before & after a feed will be all it takes to finally convince them that their problem isn't their milk supply, it's that they want their breastfed baby on a formula-fed schedule. Over feed him, put him down, he stays put for a minimum of 3 hours. If that is their goal then the scale can be a training tool, and one that you use to move the client past her "I don’t have enough milk" script and on to whatever her actual issue is.  (Put more clearly: "Okay, client, now that we've dispensed with the notion that you're supplementing because you're not making enough milk, why don't you tell me why you REALLY are? I'd love to help you with THAT.") Or at least that's been my experience. 

Most of the time the baby nurses quite well and the mom is very pleasantly surprised. She learns to connect what that feeding looked and felt like with the notion of "enough". She never doubts her milk supply again, and if she does it's because SHE knows she WANTS to. Not for any other more 'acceptable' reason.

That's my $.02. For what it's worth.

Regina Maria Roig-Romero, BS, IBCLC, RLC
Sr. Lactation Consultant
Miami-Dade County Health Dept WIC/Nutrition
Breastfeeding Program

● 7785 NW 48 Street Suite 300 ● Miami, Florida  33166 ● Phone:  (786) 336-1333 x162 ● Breastfeeding Helpline: (786) 336-1336 

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