The cases that several of you have posted which show the value of weighing
babies to see how much milk they consumed in a given feeding have been
impressive and touching.  I see the value of those electronic scales for
the crisis cases that you have shared with us.

I see a similarity in the use of ultrasound or fetal heart monitors or even
heel sticks and epidurals.  Those are valuable tools in certain crisis
cases. The problem arises when those tools begin to be seen as *essential*
in evaluating health status. The use in the unusual case becomes routine.
We all know how these stories have gone in medical care.

Some of you on this list see crisis cases as a majority of your clientele.
And in these cases, exact electronic weighing can be vital, as the recent
reports have shown. The temptation is to use these tools for "everyday
assurances," and to assume that every LC worth her salt will use one
regularly.

Clocks, calendars, and scales and other kinds of measurements can interfere
with a mother's trust in her own and her baby's body to grow toward health.
One of the advantages of breastfeeding is that no one knows how much a
healthy baby is taking in at a given time.  Dr. James Hymes (a perceptive
Ped. of the '60-'70s) said that one of the best things about breastfeeding
is that you can't *see* the milk. (That was before the breast pump
invasion.) A baby's individualized growth and obvious health are the
"measure." It is easy to go from trusting the baby to take what she needs
at the breast, to trusting her to eat solid foods when she is ready and to
eat it in the proper amount for her health. It can be the beginning of a
life-long trust in what is not seen.

It is also easy for a mother to feel insecure in evaluating her baby's well
being without the assistance of external measurements if those have been
the "final word" in her assurance. Then she will have to depend on someone
else to tell her when her child is hungry and what he should eat, when and
where he should sleep, and on and on.

One of the risks of medicalizing breastfeeding is that it is easy to slip
into the "medical care model."  "Some mothers won't know when something is
wrong, so we can't trust any of them. Some women won't be able to go
through a birth without medication, so we medicate all of them. Some women
don't get enough sunlight to have adequate vit. D in their milk so we give
vit. D to all babies. Only a health care professional can truly evaluate
the health of a child." Because we see the worst and sickest, we begin to
see every mother and baby through crisis-colored glasses.

For many of us on this list, much of our work is made up of routine
instruction and corrections to get breastfeeding going well.--OK, maybe a
lot of Yeast!--Instruction on counting wet and soiled diapers (for a while)
is the beginning of letting a mother know that she can, in fact, take care
of her infant. She doesn't have to have credentials. She feeds him when he
is hungry and looks at output and contentment to know that he is doing well.

We have discussed many times here the growth chart misuse.  A healthy,
happy baby/child is to be seen as in no need of intervention regardless of
what the scale says. It is most important to help a mother develop a trust
in herself as her child's care taker and to take responsibility for his
health. Giving over our health to HCPs has not been a "healthful" move.

I have used the electronic scale, having parents rent it when needed. And I
am glad that it is there for those of you who have need of it more often.
But, in my opinion, an exact measurement of how much a baby takes in is not
*routinely* a necessary, or even desirable, evaluation. It can be an
interference in the very important growth of the mother/baby relationship.

The main problem with "test weighing" of the past wasn't with the
inaccuracy of the scales, but in the mindset that only by external proof
can a baby's health be assessed. It took a long time to move toward more
reliable evaluations of health, and I wouldn't want to see us return to
reliance on "specialized" measurement tools.

There are definitely cases in which exact measurement of milk intake is
necessary and life-saving, just as there are cases in which a C-section is
necessary and life-saving. I promote the "judicious" use of technological
interventions.

Patricia Gima, IBCLC
Milwaukee Wisconsin, Upper Midwest, USA

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