Pat,
I don't doubt that there are LC's out there who can do an amazing job at calculating intake based on observation. It seems similar to the OB unit where I worked with a nurse (who later became a midwife) who was astonishing at being able to calculate a baby's weight, by feeling the baby through the uterine wall. She was better than fetal ultrasound, she was better than anyone else. She had a gift! I didn't have the gift. Nor do I have the gift of beating my scale at calculating intake. I know this because every time I do a test weight I try to guess what the outcome will be before I place the baby on the scale for the post weight. Sometimes I am dead on and sometimes I am far off.

Like Susan, I have been tricked by babies. Not only do I see stealth eaters, I see the opposite, noisy swallowers who sound like a lot is going on, look like a lot is going on when it really  isn't. This is particularly problematic when estimating intake with a nipple shield. With nipple shields it seems very easy to break the "first do no harm rule" if you introduce a gadget that doesn't work and imperils mother's supply along with baby's weight gain. I find my scale very reassuring and it has prevented disasters for me.

While I am willing to grant you that you might have the gift of reliably assessing intake through observation, I am not going to concede the point that it makes mothers anxious to weigh their babies before and after breastfeeding. I have absolutely not found that to be true. What makes mothers anxious is to not understand what is happening with their breastfeeding. Data that helps explain the process to them is almost invariably reassuring if it is approached correctly. In private practice a mother comes to us because she is having a problem with breastfeeding. (Except for the rare mom who is so wealthy that she just wants us to come in and shoot the breeze about breastfeeding) I find what increases these mothers anxiety is lack of information, lack of support, lack of confidence. Not providing information that helps them understand what is happening with their body and their baby. Invariably mothers will say to me at the end of a visit. "Thank you so much. I feel so much better" And this is even if I my scale has indicated that baby did not transfer milk well. Because, if this is the case - The mother already knew it before I arrived. I wouldn't be there if this were not the case. She would have never contacted me or asked for my help!!!! Confirming a mother's instincts is affirming, not alarming. Shutting her down and ignoring those very instincts is to my mind, the most destructive thing you can do to a mother. Confirming that there is a problem and telling her this is how we will work together to solve her problem is reassuring. If the scale shows that there is no problem then that is also reassuring. It is win win.

Kathy Lilleskov RN IBCLC

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