To answer Nina's question about fakers and I have seen MANY fakers over the course of 
time even  though they are the minority.

The fakers become the failure to thrive.  I see at least one baby every month that is at 
birth weight at 3, 4, 5, and sometimes even 6 weeks that started out as a faker.  By then 
it is really difficult to get these sleepy lethargic babies back up to speed and feed them 
purely with breast milk.  In most cases, the milk supply would have been good had mom 
had better drainage early in the process. AND diapers did not provide the necessary 
trigger to pick these cases up.  These babies dropped their activity levels in order to 
survive.  Anyone who has worked in developing countries in the malnutrition wards or 
refugee camps knows the lethargy that can occur and knows full well that it gets to a 
point where it is NOT healthy and there is a HUGE body of evidence about the short and 
long term effects of malnutrition on increased risk of disease and death.  It is the 
underlying cause of 60% of all deaths in the world.  

I do NOT beleive that we should WAIT until a baby has an adverse outcome before we 
intervene.  I do NOT beleive that we should WAIT until mom's milk supply is in the toilet 
and needs to use artificial infant milk before we intervene.

If a baby is taking tenths of ounces versus 1-4 ounces --- there is a big difference.  If you 
keep seeing that baby take tenths of ounces versus 1-4 ounces --- then you have a fuller 
picture.  If you talk to the mother about TYPICAL feedings versus the one that you 
observe you get a fuller picture.

Waiting for a baby to get into serious trouble is like setting up a famine early warning 
system based on rates of starvation.  If people are starving its too late.  Famine early 
warning systems typically use other indicators such as rice prices as an indicator to 
prevent the famine.  The best unknown case is a famine that did not happen was in Kenya 
back in the late 80s or early 90s.  It never hit the news, but it was well documented.

I would rather teach a mother how to gently and actively stimulate her baby to eat more 
and remove more milk from the breast with breast compressions, breast switching, etc.. 
than have her pump or use a bottle at week 2 when she gets bad news at her 
pediatricia''s office.

I would rather teach a mother how to express milk with hand or pump to assertively 
establish a milk supply in the first couple of weeks with a baby that is not driving the 
supply or completing the feedings than have her show up on week 4 with a baby who has 
not gained any weight since week 2 and then have her pediatrician insist on using formula 
and hand hold her through the tedious process of building back her supply.

I would MUCH rather teach a mother to express for her premature baby that is gaining at 
1/2 ounce a day than see her in my group at 4 months when her baby is not meeting 
developmental milestones and then have her try futilely to build her milk supply back up 
with expressing and galactogues only to have it not really improve.

It is because I tend to get the cases that slipped through the cracks and/or have bad 
outcomes that I say this.  I know I see a skewed population.  But these babies need help 
to avoid formula and these mothers need help to avoid feeling like failures when just 
"beleiving" everything is fine isn't enough.

None of this requires the accuracy and precision that were previously argued are 
necessary for a scale to be useful.  Nor does it require clinging to the absolute number.  
Nor is the information from the scale useful if you are not looking at the whole picture.  
Nor would it be useful in all settings --- just some settings, some of the time.

The argument for and against scales is a FALSE DICHOTOMY.  The sort of false dichotomy 
that enables the formula industry to convince every single mothering magazing to have a 
pros and cons for breastfeeding and formula feeding.  This sets up what National Public 
Radio calls a "false equivalency" media situation. 

Lactation consultants are not "impure" if they use the scale or "incompetent" if they do 
not use the scale.  The more important questions is whether and in what settings a scale 
is useful.  Just as any other "unnatural" device one might sometime use such as: 1) 
pilllows, 2) nipple shields, 3) tubes on breasts or fingers, 4) mechanical pumps, 5) 
bottles, 6) creamatocrits, etc.................

Best, Susan

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