Nina writes:

>Equally, if a perfectly healthy dyad - baby gaining well -  presents 
>to someone with a scale with all the usual, culturally determined, 
>anxiety about her baby 'not getting enough milk' and is subjected to 
>what we call here, 'test weighing' the following may ensue.
>Anxious mother, sits down to feed a not very hungry baby.  Mum 
>doesn't let down well to baby.  Test weigh show that bay is 'only 
>transferring X mls'.  Mum freaks out. Exclusive breastfeeding is 
>terminated.
>I hear that the scale is a useful tool for some of us.  What bothers 
>me about it, is that we don't know how much breastmilk is enough in 
>any given feed for any given dyad.  The only research we have tells 
>us that the range of 'normal' is enormous.


Absolutely! That wonderful paper that tells us that a normal range 
for a healthy baby at any one 'episode' is between 0 mls and 250 mls 
is salutory!

Catherine WG used the expression 'episodic feeding' a few days ago on 
Lactnet, and I thought this was a v. useful term indeed. 'Episodic' 
breastfeeding is not of itself physiological, and leads to all sorts 
of stuff like 'feeding every X hours' or 'feeding Y times in 24 
hours' or 'feeds lasting Z minutes'....which can be prescriptive and 
misleading, as we know.

Weighing has been presented on the list as potentially reassuring to 
the mother who thinks/is told her healthy baby is transferring 
enough, and I agree with Nina that it could so easily go the other 
way and end up creating confusion and even confirming anxieties.

We don't ever test weigh healthy babies here, but weighing is 
sometimes regarded as  *the* single test of breastfeeding efficacy. A 
mother who is already worried about her breastfeeding's adequacy may 
be far from wholly reassured by it.

For example, it is normal, as we know for a baby's weekly weight gain 
to fluctuate (one of the reasons why it is useless to way a healthy 
baby too often).  A healthy baby may gain nothing/very little one 
week, and far more the next. I take many calls from mothers who are 
having their healthy, thriving babies weighed once a week [ *four 
times* as often as the current guidance states is necessary or 
helpful for healthy babies, but culturally, this is embedded :( ]. 
They are absolutely not reassured at all in the week the baby gains 
nothing/very little - and this is when supplementation starts.

We *do* have data on how much weight a healthy baby is expected to 
gain over a period of time (it's in the WHO charts). We *don't* have 
data on how much weight a healthy baby is expected to gain after one 
feeding 'episode'. And if we don't have the data, how can we judge 
its adequacy...or communicate this to the mother?

Observing a feed and assessing effectiveness of milk transfer that 
way is indeed crucial to any bf assessment, of course.  My guess is 
that this is what most competent lactation profs on this list are 
doing anyway, alongside the weighing.

Heather Welford Neil
NCT bfc, tutor, UK
-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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