Thank you to all who responded to my discussion-opener on test 
weighing. I got mail off list and on list, and can assure people who 
expressed surprise that the debate is still going on that this is a 
*live* issue, and why wouldn't it be?

Test weighing and weighing in general touches on a lot of aspects of 
our work, and it really is not enough to say (I paraphrase) 'scales? 
No big deal.  They are a tool, and tools can be used badly or well, 
and that's it.'

Obviously, scales are just scales.  But it is  this  'good' or 'bad' 
usage of scales which is subject to examination and discussion.  I 
can't think that any breastfeeding supporter would want to totally 
get rid of scales and weighing  - of course they can be useful, but 
the question is 'how' and 'when'. I am taking it for granted that 
anyone who knows anything at all about lactation, and babies, and 
mothers, will not use the scale in isolation from anything else, or 
without their own skills, knowledge and experience.  Scales/test 
weighing used  on their own is BAD - we all agree on that!

Having said all that, this recent discussion has allowed me to be 
clear that scales and in particular test weighing are affected by:

* the cultural  - there are places where the use of the scale before 
and after feeds is done routinely, or at least often enough for it 
not to seem unusual, and places where to do test weights would be so 
unusual that everyone who saw it being done would freak out!!

* the clinical - what can the scales do to help resolve a 
breastfeeding problem?

Some people would say 'nothing that I can't do better with other 
other skills' and others would say 'they are essential in some 
situations'.

* the technical -  how crucial is it to have scales accurate to the 
nearest gram?

Some people think this is vital and that the right  'AC/PC" scales 
need to be used. Others feel accuracy is not important at all, and a 
rough idea is all that's needed .

* the 'philosophical-clinical' - this is the best way I can think of 
to describe this aspect!  This is gonna take longer to explain:  I 
refer to the area of lactation support where  we try to resist the 
measuring and assessing  and micro-management of  each individual 
encounter at the breast; where we try to emphasise the part 
breastfeeding plays in the relationship of the mother and baby.

For some people, scales and weighing can get in the way of this; 
the inevitable focus on 'how many ounces?' that test weighing 
produces, can *undermine* the longer-term aim of enabling the mother 
to have a wonderful, confidence-boosting, trust in herself  and her 
breastfeeding.

Others will counter that, saying the measuring and assessing is part 
of the confidence-boosting...the mother sees the transfer of milk in 
the scales, and becomes more confident.  The counter-argument to that 
is that happy breastfeeding is hardly ever a matter of 'how many 
ounces?' - that comes from the formula feeding 'norm' - and we should 
be doing our hardest to get away from that.  To which others will 
reply ' but we have to start where mothers are' - exemplified in 
Diane W's  entertaining post where she outlined situations which used 
the scales in this way as an educational tool....Diane, there are 
others who would have thrown the scales out of the window rather than 
use them,  in *exactly* those situations :)


The discussion also reminded me of the things we don't know

* how much breastmilk does an individual baby need to survive and 
thrive? We have some figures from the 'world' of formula feeding, and 
we can do some mathematics with calorie content and growth, but we 
simply do not have a precise figure of what breastmilk a healthy baby 
needs....and how far an 'unhealthy' baby might differ, and how far a 
healthy but non-average baby might differ. And that's before you get 
into the differing calorie values of breastmilk - intra-feed and 
inter-feed, intra-mother and inter-mother. Maybe we really don't need 
to know any of  this, except at the end of the unhealthy spectrum.

* how essential is growth compared to, say, transfer of antibodies 
and other components of breastmilk? Growth's important, for sure, and 
a poorly-growing baby is often a precursor to milk supply-failure, so 
it's good to see a baby is growing...and growth charts help us a lot 
here. We can be fairly sure when a baby isn't growing as he should 
(leaving aside that slow growth might be physiological to that 
individual baby) and when his growth would benefit with some extra 
calories - but how do we know we are benefitting him (or his mother) 
by using the scales to tell us how much supplement (ebm or formula) 
he needs at each feed (often a reason for test weighing)?  Maybe 
leaving things alone and supporting the breastfeeding *overall* would 
be better.

In the light of what we don't know, then I suppose the accuracy or 
otherwise of the process of test weighing matters less. After all, if 
we don't know what to compare our results to, then it doesn't matter 
if they are accurate or not.

Seems to me test weighing is boundaried by the culture and 
expectations of the practitioner and the mother (a point made by 
Diane W in that same post), and  the lack of baseline figures for 
what we are looking for means I don't think any of us are in a 
position to make generalised clinical claims *for* or *against* the 
procedure .


Thanks to everyone who took part. I probably haven't finished with 
the topic forever, though :)

Heather Welford Neil

NCT bfc, tutor, UK

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