>I will repeat again what I've said before, anxiety can be culturally
>influenced. In the United States, the only research on the scale
>that has been done has shown that mothers are NOT more anxious when
>the scale is used. This may be particular to the US where we are
>very much driven by numbers. I have found it to be a relief to most
>mothers either because a) their fears of low intake are alleviated
>or b) their concerns about their baby's hungry behavior are
>validated when everyone else was dismissed.
I'm sure you're right about cultural context, Susan....we should all
(me included!) be careful not to assume mothers react in the same way
everywhere :) I think the UK is pretty similar in context to the US,
because I see the same anxieties and the same number fixation and the
same lack of understanding among mothers and HCPs about the numbers.
>
>
>I feel like those of us who use the scales intelligently are not
>having our posts read. We do not simply judge a single feed based
>on the number alone, PARTICULARLY when it is a first visit or only
>visit. On the other hand, I cannot tell you how many mop up visits I
>have had because someone did a quick assessment (without a scale)
>and saw a "good feed" but didn't listen to the mother's complaints
>about the "bad feeds" and completely dismissed the mother's concerns.
But that's plain ol' vanilla poor care - not because the baby was not
weighed, but because the feed and the situation were not properly
assessed. It's perfectly possible to do a poor assessment with a
scale, and a poor assessment without one. Adding a scale to the poor
assessment doesn't make it a good one.
> Then the baby really gets into trouble because a full and complete
>assessment wasn't made during the ONE visit. When one does a SINGLE
>visit, really careful assessment should be made and you should be
>very careful not to dismiss a mother's concerns. In fact every
>single time when I have had one of those zebra cases -- the abcess,
>the metabolic disorder, the baby coasting on mom's supply that has a
>real suck swallow problem --- the mother KNEW something was wrong
>and no one listened. So, this is not due to the tool or lack
>thereof, it is due to the lack of doing a thorough assessment and
>listening to what a mother tells you.
I agree 100 per cent - and of course observation of a feed includes
many, many aspects of the story, not just what is happening during
the observation, but also the history and what the mother is telling
us (this goes for me as a lay person, too).
The case I posted about yesterday - the baby still under birthweight
at 3 mths - was a prime example of scales being used
*unintelligently* or at least *uninformedly*....in fact the scales
were being used a lot (for here) but no one was paying any attention
to what they said. The mother *was* concerned, not just about the
weight (you can imagine by that stage there were *many* indications
that all was far from well - why the HCPs did not use their eyes and
simply look at the baby I don't know.....by that time, I did not need
to observe a feed or even recall what the mother had told me about
the weight history to know there was a problem).
>
>No TOOL, even if it is your eyes or your ears or your hands, is
>really sufficient to make a complete judgement about a single feed
>if you don't also take a history and have a mechanism for the mother
>to seek follow up if needed. And research has shown that a visual
>assessment of swallows is NOT accurate either.
All true, and in any case, an observation of a feed is far more than
looking for swallows, either number or effectiveness.
My view is that scales are an important part of well-baby and
non-well baby assessment, including feeding assessment - and I need
to ask mothers what the history of weight gain has been, and
sometimes, when I have heard this, to suggest the mother gets the
baby weighed again (happily, easy enough to arrange). I dont do the
weighing myself, 'cos I don't need to - others do it.
I can't speak for others, but that's my position, and I am pretty
sure colleagues who are also NCT breastfeeding counsellors would feel
the same.
Heather Welford Neil
NCT bfc, tutor, UK
--
http://www.heatherwelford.co.uk
http://heatherwelford.posterous.com
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