About test weights

You bring up a good point Liz. I took the previous post as only for outpaitents. It is important to wait for the breasts to be full (milk fully in) for the test weights to be accurate. So I almost never do test weights with the newborns just born. Although, I occassionally try test weights on the 3rd day post C/section where mom are feeling full, baby is close to or at 10% weight loss to try to document for the Ped so she does not have to supplement with formula. I ALWAYS let the mom know this may not be accurate yet (if the weight gain is low) so they do not feel bad about themselves.
Jane Helgesen RN, IBCLC
Lactation Consultant 
Fairview Ridges Hospital
Burnsville, MN


<The IBLCE Clinical Competencies describe 75 or so activities in which the
IBCLC is able to engage.
http://www.iblce.org/upload/downloads/ClinicalCompetencies.pdf.

Right there, page 2, it says: "3.  The IBCLC has the duty to provide
competent services for mothers and families and will perform a
comprehensive maternal, child and feeding assessment related to lactation,
such as ... Skills to Assist Breastfeeding Dyad ... assess effective milk
transfer [and] assess for adequate milk intake of the child

The part that drives *me* nuts, as a parser of legal language, is that the
loaded term "duty" is used throughout the document.  So ... if I have a
*duty* as an allied healthcare provider to "do" something, and I fail to do
it, is that misfeasance?  But that is for another soapbox, on another day
....

I do not think of test-weighing (as in: Weigh the baby before, and after, a
feed-at-breast, using a scale sensitive to 1/10 ounce, without changing
diapers, clothes, etc.) as an "intervention;" I think of it as
"asssessment."

There are many means of competently assessing milk transfer and intake.
Test weighing is one of them.  It tends to be a regular part of assessment
in some countries, and not-so-much in others.

When I wear my private practitioner hat in the USA, I do a test weigh each
and every time I have a consult with a dyad ... because I usually see them
in the two-week time frame after hospital discharge, and after the expected
milk surge of Lactogenesis II has occured.  Of course, it is just one feed
I am getting a snapshot of, but the baby's outward behaviors have fooled me
enough times that I like to have the data from the weight as well.

When I wear my per diem IBCLC in a large hospital hat, I almost never do
test weights on babies.  I see dyads in the first two days of life, when
colostrum levels are appropriately low.  There is so much sturm-und-drang
right now, in hospital-based practice, about "weight loss" (versus fluid
diuresis ...) in the first few days that I would be loathe to make test
weights a standard practice for otherwise well-feeding happy newborns.  It
has, however, been a useful technique in the hospital when other HCPs are
wanting to supplement with formula for whatever reason ... and the IBCLC is
wanting to show that the baby *is* getting colostrum.

But poor freaked-out mom is the one caught in the middle here, as a
respected HCP proverbially stands on one side of the bed imputing "There is
not enough milk!" and the respected IBCLC is on the other, saying "Yes
there is!"  I don't think these "weight wars" do a stinkin' thing to
enhance maternal self-efficacy.

-- 
Liz Brooks JD IBCLC FILCA
ILCA President (2012-14)
Wyndmoor, PA, USA
Twitter: @LizBrooksIBCLC
FB: www.facebook.com/LizBrooksIBCLC>

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