Hi Judy,
Nice to get a closer look at your way of practicing. Indeed, very different from mine. I do get a complete picture of how well a baby is doing, how well (or not) he is feeding, how changes in management and positioning change his behavior, his well-being and his moms'. I don't use weighing to reach this. I just use the weight-lists from the well baby-clinic visits (which is used by up to 98% of Dutch moms, I guess, and are pretty accurate mostly) and plot them into the WHO standards. I feel that the weight evolution, the picture one might say, says more (to me at least) than the actual numbers. I ''don't do numbers'' to charge it a bit. I do do a decent mouth evaluation, breast evaluation and feeding evaluation and take an extended history. I think instead of numbers I look at pictures: of what was, what is and what might or ought to be. It works for me and my clients, I guess.
Warmly,
Gonneke, IBCLC in PP, LC lecturer
Twitter @eurolacpuntnet
--- On Sat, 6/4/11, [log in to unmask] <[log in to unmask]> wrote:
From: [log in to unmask] <[log in to unmask]>
Subject: Re: [LACTNET] weighing in
To: [log in to unmask]
Date: Saturday, June 4, 2011, 5:36 AM
Gonneke writes:
Could this have to do with were a LC ''comes from''? I have no health care
background, but a teaching and a BF counselor (LLL) one.In my view
lactation counseling is not health care, but counseling and teaching.
Hi Gonneke and all,
It would seem that where an IBCLC practices does have a lot to do with what
is considered common practice. I mean this both geographically and
philosophically. We still have at least one very busy IBCLC who doesn't bring a
scale to home visits. Most other IBCLCs near me do. I find weight
information helpful as part of a thorough assessment that goes far beyond the
weight alone. Weight tells me a reliable starting point, one which I have
noticed by testing it myself, is often not reliable when coming from the MD
office. I've seen differences of up to 7 ounces (210 g) once in a local
pediatrician's office between my scale( which I check to be well calibrated often)
and the doctor's office scale, within 5 seconds of time. Scales there can
be old, and not very precise, can be used improperly (not zeroing in
between babies), and can be used without reliability, since MD visits are around
the MD's schedule. Baby may be weighed in a full diaper, having just nursed,
at one visit or have been recently changed, and not having eaten for 2-3
hours. Since I rarely see mothers who are not having fairly serious feeding
issues, I want to know how much does the baby weight today, before a
feeding, how much do they weigh after, how long did it take them to get what they
got, and how did they handle it. I also look at the mother's perception
and physical sensation and appearance of the nipple/breast to see how the
feeding went as well. We talk about the baby's behavior and how it "matches"
or doesn't with what the scale is saying and why that might be. Even though
I use the scale, I do not overemphasize its information alone. I help
parents understand what THEY can observe that will give them the information
THEY need to see how things are going as well. For some moms, though, I guess
in a sense, I am providing healthcare information because so often moms
are not getting good information from their pediatrician. The information
from the scale can help me explain why a baby who "nurses all the time" or
"nurses for an hour" can still be losing weight or not getting enough to eat.
It can help me explain why when the MD told the mom to "nurse more", but
did not actually assess if they baby was transferring any milk, it didn't
help the poor baby who couldn't allow himself to sleep he was so hungry. It
helped recently when I wanted to help parents understand that their baby's
"little" tongue tie was actually having a big effect on feeding, when the
little guy fatigued out after removing less than 10g or 0.3 oz. ( and why
this baby's bilirubin was dangerously high the week before, requiring
rehospitalization and all manner of hospital stuff happening to him to get it
down to a safe range again.) This was all the same family, and they "loved"
their doctor because she was so nice. This large and popular pediatric
practice is problematic for me, I admit it. I think if I were helping moms
understand breastfeeding better, checking in and doing anticipatory guidance,
or doing a little finessing to make things more comfortable for the mom and
baby, a weight at that visit wouldn't tell me anything I didn't already
know and might just make the mom anxious or over-reliant on the #s. These,
though, are not the nursing couples I've seen. It sounds like you live
somewhere where someone knowledgeable is following this baby's weight and overall
health that you can rely on. Honestly, that sounds like a dream world...:)
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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