Thank you Laurie Wheeler for pointing out key distinctions between the United States and other 
breastfeeding societies.  I just had a wonderful phone consult that made my day yesterday about a 
mother who needed reinforcement for "natural weaning" as she called it who was one of the few 
women, maybe one in one hundred that I see, who had actually managed to get through the 
breastfeeding experience in what I would call a baby-led feeding process!  My typical ratio of 
clients is about 50 mothers and babies who are out of sync in terms the feeding process for every 
one who might qualify for the more typical situation seen in Australia and Sweden.  

Thank you Rachel Myr for discussing baby watching.  This is absolutely crucial for all of us and 
often in our hospitals at least here in Manhattan, IBCLCs are not provided enough time to baby 
watch.  When I hear complaints from my clients, in depth probing illustrates to me that the IBCLC 
was dealing with a huge overload of patients and had to develop coping strategies and triage 
systems.  The complaints almost always result from the fact that the in hospital staff are simply 
are not given enough time for baby watching. I still remember listening to a talk at an ABM 
meeting where they were discussing the time allotment for consultations and wondering how you 
could possibly observe the full picture in that amount of time.

In countries like Norway, I think the baby scale is more properly used judiciously for breastfeeding 
problems that require "tertiary care", whereas at this point in Manhattan at least it has become 
necessary to use the scale much more frequently for breastfeeding problems that require 
secondary care.  I consider La Leche League and breastfeeding support groups as dealing with the 
far more common problems that require primary care.  I do not consider IBCLCs to be primary care 
practitioners, but the second tier response to problems.  If other support systems are in place and 
problems are minimal, we should not be necessary.

I think the best users of the scale would probably be those who are most critical of the scale 
because they would never allow themselves to get sloppy in theri observational techniques.  
Perhaps this more than any other is the danger in the scale.  You MUST have great observational 
skills and keep them up.  This is why I'm actually happy that I spent a lot of time baby watching 
before beginning to use it and constantly challenge myself to make sure I am not slipping in my 
baby watching skills.  On the other hand, practitioners who don't have the time or don't make the 
time if they have the possibility of doing so, may still be dispensing generalized advice that misses 
the nuances of the mother-baby pair.

Best regards, Susan Burger

PS. Let me make it clear again - I don't see why most of us can spot an oversupply situation 90% 
of the time without a scale.  

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