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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 13 Jun 2011 07:41:08 -0400
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Dear all:

The argument that you cannot get a sense of the feeding when feeding varies feed to feed assumes that you are not taking a thorough and complete history of the mother.  Mothers usually KNOW if the baby fed differently during the visit and they can tell you how the pattern of feeding evolves.  I don't care what tools you do or do not use when you see a client, but if you assess what is going on at the moment you are there and don't do a history, you may miss very important information.  

Quite frankly, I don't find huge feed to feed differences in most of the babies that I see that are having trouble.  What I find is that it is essential to observe the baby when the baby is ready to feed. I have seen babies nudged to feed where they transfer almost no milk and then when they are ready, it is as if it is a completely different baby.  Very early on, one baby taught me this and I completely changed the way I practice.  I do NOT vigorously try to wake a baby when I see a client.  I wait for cues that the baby is ready.  This takes TIME, but it spares me from thinking a baby is not doing well, when the baby really is doing fine.  I've also had the rare baby who will not eat at a particular time which always corresponds with the time when I see the baby.  There are ALWAYS plenty of other cues that the baby is doing well.  

I repeat, I see that those of us who are posting about using a scale keep repeating these key points about how we should practice whether or not you use a scale.  If you don't take the histories and are not using a scale it is still not a thorough assessment if you don't get a history from the mother about how the feeding you observe compares to other feedings.  

The argument that you can tell nothing during a single feed and therefore you should not use a scale, could really be used to say "why do an assessment at all?" because you can't tell anything about anything you observe during that feeding because the next feeding may be different.  Mothers actually do REMEMBER and actually can TALK or if they can't TALK because they are deaf or mute, they can SIGN and they can really give you a bigger picture regardless of what tools you consider useful for observing a feeding.

And here in Manhattan, the worst train wrecks I have seen are when mother's concerns were dismissed as were prior weight checks which really did show there was a problem.  I hate having to build up a milk supply that was unnecessarily compromised and build up a baby that really didn't get enough when a mother was trying to tell everyone she was concerned --- and she was right about her concern.

Sincerely,  

Susan E. Burger, MHS, PhD, IBCLC

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