>Dear Heather and others:
>
>Heather - I have already explained numerous times why ALL measures
>of intake are
>subject to problems of dependability. When you say "that's just
>poor practice" regarding
>examples of people who used a clinical indicator such as observing
>swallowed I would
>heartily disagree.
Susan, I may not have been clear. It's not poor practice to use this
indicator - it's poor practice to send someone home without knowing
the baby is feeding well, and that the mother has the skills to be
aware of this, and what to do if it does not continue, or if she has
other concerns. There are many skills and observations and
communications involved in this....I was not focussing on observed
swallowing, but meaning the whole 'thing' of mothers (and HCPs) not
knowing how to ascertain breastfeeding is going well. Sorry if I did
not make it clear.
>
>Calibration is the way one judges the precision and accurancy of a
>tool and you have
>evidence sent in to Lacnet to show that the precision and accuracy
>of the scale trumps the
>precision and accuracy of syringes.
I understand that. The abstract says the milk was measured by
calibration, but in fact, the paper states the study *weighed* the
milk - it weighed the container *without* the milk, and then *with*
the milk. They did not use calibration alone. However, the study
appears to be poorly- written because it is not clear what they did
with these 2 results (i) calibration and (ii) weight, if they
differed. Did they split the difference, I wonder?
You may well be right about the poor design of the study and other
aspects of it. The authors state there is 'no reliable, simple,
clinically useful' method for assessing breastmilk intake in infants,
and I think they are probably right in that.
Not having a study does not mean there can never be any accurate way
of assessing intake, and practitioners on Lactnet who use test
weighing and are well-practised in it clearly find it useful, and
presumably they feel either i) what they do is accurate or ii) that
accuracy is not important, and that the 'rough idea' is 'good
enough' for outcomes other than wanting to know exactly how much the
baby has taken
I see both outlooks on Lactnet, in fact - the view that accuracy *is*
important and that it *isn't* but test weighing can be useful anyway.
I will compose a post later today discussing both of those.
>
>
>Again, I would argue that THE MOST important use of the scale is to
>prevent unecessary
>bottle feeding by doctors that do not understand that bottle feeding
>and pumping tells us
>nothing about how a baby feeds at the breast.
I can see a use when this (doctor's misunderstanding) is a major
issue - but I can't help wondering that if the doctor says the baby
'must have' (lets say) 70 mls per feed, and the test weigh shows 40
mls, when in fact the baby took 70 mls (because it is up to 30 ml out
either way), where does that leave the mother? Or the test weigh
shows 60 mls and that's thought to be good enough, whereas the baby
actually took 30 mls.....how does this educate the doctor, or the
mother?
The response may be 'but that's not the only way breastfeeding can be
assessed' to which I say 'absolutely!'
More later, probably :)
Heather Welford Neil
NCT bfc, tutor, UK
--
http://www.heatherwelford.co.uk
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