The posts about who should do what, and whether test-weighing is 
appropriate, have been fascinating.  Susan, I hope you can conduct a 
study along the lines you describe, to lay to rest whether weighing 
does or does not assist breastfeeding mothers and their babies.

As an LC in private practice from 1990 - 2003 in Zimbabwe, and who 
yearns to start another PP in UK as soon as possible, I have to 
confess that I have never done a test-weighing, for the simple reason 
that I never owned any digital scales.  However, one of my 
specialties was working with low weight gain or failure to thrive 
babies, and - for me - a baby's weights, from birth, always tell a 
story.  If the primary purpose of breastfeeding is to feed the baby, 
and if a baby fails to gain roughly 30g per day from about Day 3 and 
for the first 3 months of life, then it is a sign that something is 
not quite right with the breastfeeding, that intake is inadequate for 
some reason, and the quicker the cause is discovered, addressed and 
remedied, the easier it is to preserve breastfeeding.  If intake is 
adequate but the baby still fails to gain, or actually loses, then a 
medical reason needs to be found and treated, and I would refer on to 
the baby's paediatrician if he hadn't already referred the 
mother-baby pair to me.

In my experience, the first response of mothers of low-gaining babies 
seeking LC services is relief - they usually "knew" something was 
wrong, and are eager to find out what it was, and do whatever it 
takes to put it right.  The mother's cultural background - whether 
breastfeeding is seen as desirable, or not very important - is what 
makes the difference in whether she goes on to do the very hard and 
time-consuming work of increasing her milk supply, and perhaps 
gradually to replace needed formula supplements.  Or not, as the case may be.

Digital scales would seem like an accurate way of measuring intake at 
a single breastfeed, a super diagnostic tool, saving much time and 
guess-work.  As such, had I owned them, I would have used 
them.  Instead, I had to make do with doing weight checks daily or 
every couple of days to assess gain, or loss, and to work out the 
need for supplements, how much, and when to reduce, as the baby 
achieved a catch-up gain and the mother's milk supply 
increased.  Mothers of previously inadequately gaining babies are 
then fantastically reassured to know that their babies are doing 
well, and often motivated to keep going.   So just as I've observed 
that bottle-feeding per se is not usually the direct cause of a 
breastfeeding difficulty, but rather a last-resort marker of a 
pre-existing problem, so I would anticipate that test-weighing by 
itself would not discourage a sufficiently motivated mother from 
breastfeeding - even if the amount taken per breastfeed was quite 
low.  It would, however, indicate the need for some kind of 
intervention - and quickly.

I guess I may be the first IBCLC in UK to use a digital scale Heather 
..... I'll keep you posted!

Pamela Morrison IBCLC
Rustington, England

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