My practice is based in a multiple specialty clinic at a large
New England university. We have five OB/GYNs and five
Pediatricians. I have a "technologically advanced" electronic
baby scales in my office, accurate to within two grams, and
manufactured for test weighing babies before and after feeds.
It is a very handy scales, since it give a weight within
seconds, and it computes from kilos to pounds (and vice
versa) with the flick of a button -- handy for me as I deal with
an international population (and since I am "metric
impaired"). That said, I could count on one hand the number
of times each year I use the scales for test weighing.
Test weighing is so fraught with possible pitfalls that I have to
choose very carefully the times I utilize it. Technology is so
seductive -- be it pumps, scales, etc. I find some parents
wish for a magic cure for whatever doubts they harbor about
their baby. Parents often arrive in my office "lusting" after a
scales to use for test weighing; they want so badly to
quantify the baby's intake. The lure of electric pumps is the
same. (Maybe this phenomenon is exaggerated here, since
this is an engineering college, but I doubt it.) I find I spend
more time talking people out of renting or buying pumps and
scales than I do using this technology.
When do I use my scales for test weights? The **most
common** use I make is as a "reality check" for parents who
have a baby who is doing well, but who want to supplement
because they cannot believe baby is "getting enough."
Despite the fact that the baby has rolls of fat, despite the fact
that the baby is putting out lots of stools, the fact that the
baby sometimes cries after BF translates to some parents --
and grandparents :-( -- that mom doesn't have enough milk.
For these parents, weighing the baby in my office after a few
minutes of BF is often a revelation.
*Rarely* there are some babies who appear to be doing well
-- even appearing to have the open-pause-close jaw actions
of a baby suckling perfectly -- who are just not transferring
milk. A test weight can be instructive in these cases (and, as
I said, these babies are few and far between).
Every few years I have a parent who buys or rents a scales
(not from me, I don't rent or sell scales) to do test weighing
at home. I strongly discourage it. One mother in my practice
weighed her baby before and after EVERY FEED for SIX
MONTHS! She would call and discuss the baby with me, and
she got to the point where she would laugh about her actions
-- but she persisted. We did learn something from her "data."
She saw that her baby would gain weight very unevenly,
coasting along for several days before shooting up. She also
discovered that the baby took the same amounts of milk
each day, even when he changed his schedule around (and
slept longer). She also discovered that he thrived on fewer
ounces per day than would be expected by formula use. She
continued BF for over two years, but gave up weighing after
the sixth month. Now she comes to our BF Moms group and
tells new moms why they shouldn't worry about scales!
I have sent my scales home with parents on a handful of
occasions. These have been for babies where intake was
being monitored carefully (usually premature infants, or for
twins/triplets) and in cases where the parents are caught in
"circular thinking" (also known as "crazy making behavior")--
more often than not generated by the baby's medical
provider. These parents are terrified that the baby won't gain
weight, or might lose weight; they are too ready to
supplement with formula. They are worrying from one feeding
to the next, unable to fight off the sense the baby needs
more (formula) at the end of each feeding. For these parents I
ask them to go ahead and do test weights, but to
supplement ONLY if the 24 hour total is falling off
dramatically. I am careful to let them know that human milk
can't be analyzed by weight, since caloric count varies
(sometimes dramatically) from formula. Most of the time, if
parents can see baby isn't losing weight each day things
calm down. Having a few days data often stops the medical
provider from pushing formula use, as well.
If I didn't have a scales with so many bells and whistles I
don't think my practice would be negatively impacted. Since
the technology is "out there" I find that parents incorporate
these things into their "ways of knowing" about their baby.
We are a society where the fact that generations of babies
have been easily and fully nourished by mothers' milk has
been undermined by several decades of ingeniously crafted
formula marketing. As long as most babies are still fed by
methods that allow the number of ounces ingested to be
measured, I doubt we can divorce doubt from breastfeeding.
[Sigh] [But we keep on trying, right!]
Margery Wilson, IBCLC
Massachusetts Institute of Technology
Cambridge, Massachusetts, USA
where it was 75F today and will be 40F tomorrow!
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