Several thoughts:

I read the article that Linda cited and it gives us a good idea of the 
variability of normal BF. We can use this to talk to inexperienced moms 
about what they can expect. Haven't we been doing this already? New moms do 
like to have some idea of what to expect, and I think they deserve it. So if 
an exclusively BF baby only BF 4x in 24 hours, this would be red flag.

Similar to the advice about turning the clocks to face the walls, I use this 
analogy when talking with moms who worry about when to feed the baby (some 
may have heard this from me already). I ask them to pretend they are on a 
tropical island with no clocks, calendars, bottles, formula, or pacifiers. 
They have plenty to eat because their partners are bringing them fish, 
shrimp, mangoes, pineapples and the like. I ask them this, "if your baby has 
BF on the right and then the left but seems hungry again in 20 min, what 
will you do? Will you give him the shrimp then?" No, they say they would BF 
again. Right! This is to show they don't have to grab a formula bottle in 
this case. This is sort of a light-hearted discussion of baby watching and 
trusting your body.

Re wrong info with strict feeding times and lengths: I am cynical and think 
maybe this is a concerted effort by some people who do not support BF. Why 
all of a sudden, with much new and evidence-based info about feed 
variability in journal articles and conferences, are we seeing this kind of 
info taught at CLE courses????

About test weights, again. People usually do not check their blood sugars or 
carefully meausre their food intake, however sometimes this is done when 
their is a disease process or something out of the norm. Same applies with 
test weights. They may be useful for preterm infants or non-thriving infants 
to help assess and monitor their feeding effectiveness. The usual thing is 
to NOT be obsessed about these things and to just "feed the baby." Again, as 
in my first paragraph, the moms do need some guidance about what to expect, 
and I think we do a good job with this. They need to know there is going to 
be variability, again the article recently cited showed this: sometimes baby 
will take one breast, sometimes two, and sometimes "switch nurse" or cluster 
feed. Some babies develop a pattern of always taking only one breast, some 
babies always take both, some vary. Aren't we already talking to moms about 
this normal variability?

One last thing: A scale is probably not necessary in a truly BF supportive 
facility, culture, country.  Even for a tiny preemie, he would be kangaroo'd 
and just learn to BF over several weeks. This is just not done in most 
places in the USA. Even "normal" mother/baby dyads are not allowed the 
access and synchronization either in hospital or afterwards. I can't begin 
to tell some of you how far from the ideal many places are. It seems to me 
that the European and Australian LCs are in a more BF supportive place than 
the USA. In USA, Birth centers with midwives are very different places than 
typical maternity hospitals. I think that's why some of us use scales 
because the normal BF behaviors don't happen and then the downward spiral 
happens so quickly and then more intense interventions are needed. Also, the 
availability of follow-up is not really there. How many LCs get to see a 
mother/baby dyad having trouble, repeatedly, say every few days for a few 
weeks??? This is what it would take to really follow up and get them going, 
without having a scale. This would be great, but it is just not feasible in 
lots of settings. Hospital LCs don't usually have a lot of time set aside 
for lengthy followups. If the pair goes to the pediatrician for follow-up, 
breastfeeding can often get derailed. So, the whole culture has to support 
Bf - that's the bottom line.

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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