I have similar experiences as other postings. In the early 80s, the hospital I worked at as an L&D nurse had a true ABC (alternate birth center) concept: labor, deliver, recover, postpartum, early discharge (2-24 hrs postpartum), with a 3rd day home visit (even w/e and holidays) *all* managed by the L&D nurses (ie, nursery, postpartum and Visiting Nurse Association nurses NEVER took care of these patients). It was the golden era in hospital births I think. Parents delivered in a regular kingsized bed, we had wooden cradles instead of infant warmers, labor was minimally medicated, no IVs (so mom had to drink clear liquids including juices, etc). Anyway, the L&D nurses were unique in their (our) influence by midwives (we kept a copy of Spiritual Midwifery on the unit) and by several staff becoming midwives at USC. It was there through Kittie Frantz's lectures that they brought back excellent BF knowledge and we all became experts at initiating THE first feeding and first day BF. Our ABC moms were encouraged to nurse a minimum of 15 minutes per side (total 30 minutes minimum)whenever the baby seemed hungry including *through the night*(!) from birth. For the times, this was radical (still is in many hospitals I work in): locally (in the community and even on our own postpartum floor) the instruction was "5 minutes per breast followed by an ounce of water every 3 hours, and we'll feed the baby in the nursery at night so you can rest. Increase time at breast by 2 minutes a day until you reach 15 minutes per breast." The results should have been a "no-brainer". The "usual" (non-ABC) "BF" babies lost significant weight, struggled with jaundice, and often did not regain birth weight until 3 weeks pp if not already weaned to bottles, and moms became terribly engorged. The ABC babies rarely lost *any* weight at all (at least not that I can remember) and were usually demonstrating an admirable gain by the 3 day visit, never had physiologic jaundice (and the ABO incompatible jaundice was less severe), and as an added bonus: the ABC moms seemed to rarely experienced engorgement when the mature milk came in; if they did , the engorgemnet was minor, lasting 6 hours or less. I came to associate BFing through the night from birth the reason for minimal/no engorgement. I now believe that engorgement is iatrogenic and abnormal, and a clue that BFing didn't start optimally and may still be less than optimal. But I digress. Obviously, this was a select sample of mothers (criteria for ABC delivery was term, no complications of the pregnancy, childbirth preparation, and OB/peds approval). Unfortunately, nobody kept statistics on this. Yet, from this experience and population, I came to believe this scenario (the ABC delivery) represented the "norm." I have since applied this learning of mine to any mother or hospital setting I have worked in with great success. As a registry nurse working wherever I am sent, I am in no position to change policy, but I can change the experience for my patients, one at a time. All of us can do - and do - this much. I think weight checks on BF babies at 2 weeks is too late, for we miss many precious days to correct problems easily before the parents become insane with worry. I do weight checks on all my BF babies, create a weight graph and teach the parents what it means and how to use it. I also immediately communicate to their peds that I am working with the baby and what the weight is on each visit. I do not do pre/post feeding weights in the home and do encourage the parents to let me check the weights on my visits only (ie - they are not to purchase a scale and do their own wts - another crazy-maker for them). Following weights is very concrete information and helps the peds know in an instant what his/her liability is for any baby - whether to "monitor and wait" or intervene. I could live quite happily as an LC without nipple shields or feeding devices, but would not want to go without my scale. By the way, its my dream to own a "real" quality scale (like Medela's) but what I travel with is the nursery spring scale (around $20) sold to parents in baby shops. It is "close enough" and accurate to itself; I do tell parents all scales differ in small amounts. Even within the peds office, there will be different weights from scale to scale, and parents should insist that weight checks always be on the same scale from one visit to the next. Usually the charts are ok, but we must be sure of their appropriateness. I know one project Mrs. Jeffille had been working on was the collection of weight gain data on exclusively BF infants, in order to establish an approproate weight-gain chart for these nurslings. I once worked with a Chinese "slow gainer" below the 10%ile according to the NCHS charts, but was "right on" at the 50%ile on Chinese charts, which fortunately the father had copies of, having been a physican in China prior to immigrating to the USA. I am amazed at the number of Down's babies who are expected to follow the usual weight charts because HCPs are unaware that there are charts specifically for Down's babies/children (in all fairness, many peds do not regularly manage Downs and would not know of this). I help parents obtain these special charts when working with them. (National organizations for special syndromes or diseases can provide information). This is another area of enlightenment whereby we can serve... Katharine West, BSN, MPH, IBCLC(expired and saving money)