Dear all:

I have, ever since someone pointed it out to me when I once used it inappropriately, objected to the use of the term Nazi lightly.  I once thoughtlessly used the term to describe the principal at the school I was teaching at when I was a Peace Corps volunteer.  The principal made students kneel for hours in the hot sun as a punishment.  Dreadful treatment.  Nevertheless it was hardly the same thing as murdering millions.  I thoughtlessly called this principal a Nazi in front of two German tourists.  Thankfully, they took the time to explain to me why this was unacceptable given the history of what happened in their country.  So, even were I not a breastfeeding advocate, I always feel that it is entirely inappropriate to use the term Nazi to refer to breastfeeding advocates because it trivializes a dark period in our history.

Similarly, in terms of guns, there are heated and serious discussions about who should carry a gun and who should not in the United States.  The purpose of the gun is to kill something.  Whether in self-defense, hunting, or more malicious intent to kill another human, the sole purpose of the device is to kill.  No so the scale.

The sole purpose of a scale is to weigh something.  We weigh our mail to see how much postage to put on it.  We weigh produce at the grocery store when we are charged on a per weight basis.  Airlines weigh our luggage as a device to charge us more if we stuff too much into one piece of luggage (and now are perhaps moving on to charging us for using the toilet.  Some chefs may even weigh the food they use in cooking.  Often recipes for pies will include the number of pounds of fruit in the pie.  Some of us weigh ourselves to see if a diet or exercise program is working.  Some of us weigh ourselves too frequently when we are obsessed about dieting and exercise. 

First, I'm going to remind everyone that I did provide a huge body of literature on test-weighing and other measurements of intake.  Every single comparison of test-weighing shows that it is more accurate and reliable and precise than any other indicator we can use.   Yet, I firmly believe, as do all the authors of all the studies I read, that those other means of assessing intake are important. Nor have I ever espoused the argument that test weighing is a must do.  I have provided examples of when it may be useful and I do think it is important to be knowledgeable about scales even for those who never will need to or intend to use one, because that knowledge is helpful if one of your clients has had her baby test-weighed ---- because it makes it easier to put the information she received from that test-weigh into perspective.  For instance, if her baby was just fed 2 oz from a bottle and she took her baby into a pediatrician's office, and the baby then took a half ounce from the breast -- you can readily explain the meaning of that half ounce of intake that might otherwise make her anxious.

The reason why I asked for evidence about scales doing harm is because, to date, I have heard lots of anecdotal claims about scales harming breastfeeding.  I've heard many plausible explanations for why this might be so.  And I personally do believe that there are inappropriate uses of the scale that do harm.  Yet, to date, I have not yet seen a single study that confirms this widely held belief (a belief that I myself hold for certain uses of test weighing). 

In fact, Paula Meier's work shows that mothers actually were REASSURED by what I never would have imagined -- 24 hour test weighs and even more unfathomably --- interpreting their own creamtocrit results.  

In essence, I think sometimes even we patronize women thinking that we must PROTECT them from gathering information.  Who are we to decide what information they find useful?  Rather than protecting them from information, should we not instead be  assisting mothers in how to use the information they deem useful in ways that empower their breastfeeding?  And since we deal with women from many different cultures as a group and some of us do as individuals, should we not be looking at the individual's own belief system, taking that into account and working within that structure to nudge feeding towards more normalcy?  Even in Africa, women tie strings around their baby's bellies to monitor growth.  Would you go on a campaign to try to stop that practice even though it has little "accuracy" or equate it with guns?  

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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