Dear all:
The quality of advice really has nothing to do with the accuracy, precision, or efficacy of any instruments or methods being used.

I've seen concepts as simple and eloquent as "biological nursing" being misused in ways that have made mothers frustrated.  Yet, I would not fault the concept of biological nursing.  It is how the advice emerging from this concept is being applied by an individual that may have missed the mark.

I've seen mothers being told that they did not make enough milk because their baby is losing weight, only to discover that the baby's intake is well above normal and it is a metabolic disorder that is causing the baby to lose weight.  Weight gain is not a good indicator of milk production.  That does not mean that weight gain cannot help us detect true cases of failure to thrive.  Again, detection of the problem of weight loss is not enough without understanding the cause -- be it infrequent feeds, excessively harsh sleep training, an oral anatomy issue, insulin resistance or the myriad of other iatrogenic and noniatrogenic issues that can throw a baby off her natural pattern of growth.   It is not the scale, but the lack of investigation into what is really going on that is the problem.

I've seen mothers being told that their latch is beautiful based on one five minute, pop your head into the room observation, when had the mother been asked she would have told you she was in excruciating pain.  And, I've tweaked the angle by 1/8 of an inch and had her feel much better.  This doesn't mean that we cannot use a visual assessment to notice that a baby with his bottom lip hanging off the tip of the nipple might not be a source of pain. But visual assessment alone is not enough. 

I've also seen mothers being told their babies just fine because their babies are wetting enough diapers or stooling enough times.  I cannot count the number of times when I have seen babies a pound or more below birth weight, skin hanging in folds, who were still producing enough diapers.  It is not the fault of using a highly visual indicator of diapers, but not informing parents about other indicators that can use along with diapers to assess when to call in help.

Yes, I do jump to conclusions at times before I really look at ALL the evidence in front of my face.  And I constantly try to remind myself not to do it.  This is what I think practitioners must do.

But I have to say, I must really object to the assumption that there is no evidence base for an appropriate uses of test weighing while at the same time reading that those who use test weighing are "starting with the assumption that it must be the mother's 'fault' - not making enough milk - is pretty much guaranteed to end breastfeeding."  Isn't this an assumption about intent on the part of other practitioners?  And isn't it excessive and beyond the evidence to state that a mother who thinks she isn't making enough milk "is pretty much guaranteed to end breastfeeding".  I have countless examples of mothers with insufficient glandular tissue, breast surgeries, insulin resistance, thyroid problems, and any number of challenges who were able to continue to breastfeed despite low supply.  

Anyone who has only had experience with misuse of the scale is welcome to attend my clinics to see how test weighing can be used differently as a back drop to many other ways of assessing mothers and their babies.   And NO, I do NOT care whether or not you ever choose to use the scale yourself.  

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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