Hi everyone,
I work as an LC in a NICU and I do like to use test weights for our premies
and even sometimes for our full-term babies. Let me give you a few examples:
1. A full term baby is admitted for hypoglycemia and is requiring IV fluids
for a day or so. The baby emerges to eat, mother feeds her. How much to
wean the IV?? The doctors (mostly residents) are unsure and are afraid to mess
with stability. The nurse (she is a genius, as far as I am concerned) uses
test weights to show the MDs that the baby is consuming milk at the breast.
They are then confident that they can wean the IV. Nurses have done this
frequently enough that it's fairly standard to halve the IV rate if the Dstick is
OK and the baby BF well. They are not doing so many test weights for this
indication any more!
2. A preterm baby is getting ready to go home. We do test weights at every
feed (which may only be once or twice a day when the mother is present to
feed) for a week or two (or until mother is comfortable) before DC. The mother
sees how well or poorly the baby does, but more importantly, knows which
signs and behaviors the baby exhibits when he is really well-fed, has not fed
enough, or fed poorly. That helps her at home, and gives her a "guestimate" of
intake. We link the baby's BEHAVIOR to the number of ccs consumed. It is
really used as a teaching tool. Premies can "look" satiated, but can really
just be stressed and have passed out. It takes a very experienced, trained eye
to tell the difference. I believe that that's the leap these moms make in
the Paula Meier/Nancy Hurst studies about test weights at home.
I also do home visits in my area, and don't use test weights.
1. I don't do enough visits to justify the cost of a scale.
2. One test weight doesn't tell you squat. You really should have a series
of them.
3. How accurate is a scale that's been bouncing in the back of my SUV and
used infrequently?
Recently, I went to do a visit for a mother whose baby is not gaining at 10
days out (6#7 down to 5#6!). She told me over the phone that the baby was
swallowing, wetting and stooling fine. Baby is eating "all of the time," no
supplements, no pumping, and the pedi wanted her to "check in" with an LC. She
did not ask me about a scale. I went to her home (20 miles away) and
watched her feed. Great latch, no swallowing (at 10 in the morning), and baby is
frantic.
I then ask her about breast changes--very little--I see pale, non-veiny,
limp, conical breasts with no palpable fullness, with areola shaped like an
Avent bottle nipple (sorry Avent!!). I had her pump--she had the Avent electric
pump, which seemed to be working well, and got three drops. In asking her
about the previous 10 days, I find that she never has felt full or engorged,
hasn't seen any milk drip, can't express more than a drop. She has only "seen"
the baby swallow and doesn't remember hearing any--didn't know she should
hear them. She probably has insufficient glandular tissue. She then asks me
if I have a scale to weigh the baby. Her pediatrician told her that all LCs
have a scale to weigh for pre and post feeds. She was extremely upset because
I didn't have a scale. That was what she wanted me to come to do. I was
flabbergasted. I had spent the good part of two hours assessing, teaching and
explaining the implications of what I saw and was told. She couldn't (and
wouldn't) listen, because I didn't have a scale. For the fee I charge, I
could run around and do pre and post weights! What a fool I am to think the
assessment and teaching I had painstakingly done were valuable. She told me to
leave. She had "gotten all she wanted from me." I stayed for a bit longer,
wrote the plan for her that I was suggesting. I told her I would waive my
fee if she rented a scale to do a series of pre and post weights to help her
see that there was a problem and to rent a hospital-grade pump. I told her I
didn't have enough experience with the Avent pump to believe it was
hospital-grade--and had seen no studies to prove that. I did call her pediatrician's
office and left 3 messages for a return call--no call back. I sent a report
to his office and have never heard back.
I called the hospital that referred her to me and told them what happened.
She had been seen by an LC, but I am sure the visit was rushed, not because
she was a bad LC, but because she was working in a bad situation from
downsizing. That's for another day!
Scales, as with any piece of equipment, can be wonderful and so helpful when
properly used. But sometimes, overuse or dependence on a device is a very
bad thing.
Maureen Allen RN, BSN, IBCLC
Brigham and Women's Hospital
Boston, MA
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