For me, using a scale gives me control over a vital piece of information. All too many times, pediatricians and home birth midwives scales are inaccurate and decisions to supplement or not supplement are based on bad data. I have even had a mother instructed to formula feed for lack of weight gain when the pediatrician's nurse actually read the scale a whole pound off and told the mother the baby was 7 lbs 2 oz instead of 8 lbs 2 oz. When I saw the baby that very same day, she looked fat and lovely and I could have just insisted that the mother take her back and get her reweighed but was thrilled to have the resources to do it myself. And in the interim the baby would have been supplemented with unnecessary formula.

Another scenario I come across frequently in the US is the partially breastfed baby who is being supplemented with formula who starts gaining weight well. The next step in invariably, the pediatrician telling the mom "Okay, your baby is gaining well now, let's take away the formula and see what happens. Come back in a week or two and we'll check weight gain" Or sometimes they don't even tell the mother to come back for a weight check. So now a baby who potentially has a problem transferring milk is left to sink or swim. Mother's milk supply is at risk, baby's health is at risk and nobody has evaluated how well this baby does at the breast. Yes, I could go in and listen for swallowing, but it is much more efficient to go in and check this baby's ability to transfer milk with the scale. If I have any doubts about the feeding, then I leave my scale behind with the mother and show her how to do test weights herself, unless she finds this overwhelming, in which case I will have her do frequent weight checks on my scale at my house...I do not charge for this service and I would rather be in control of this process than leave it up to a pediatricians office. 

Have I made mistakes as well. I am sure I have. I can in particular remember one instance where the numbers for before and after didn't make sense and thinking back on the visit remembered that the mother had removed the baby's undershirt halfway through the feeding. I called her up and we discussed the fact that I had made this error in measurement and we changed our plan of action. So I fully acknowledge that you can mess this up. But I guess I feel that on the whole my scale does more good than harm.

The degree to which we long for control in our interactions with the moms and babies we work with is variable. I know a lactation consultant in Brooklyn who is longing to learn how to release tongue ties. She does not want to have to rely on the work of others for this, she considers it often subpar and feels that she could do a better job. This is not control that I want. I am glad that I can send babies off to have this procedure done by somebody else. Weight measurement is something I do want to be able to handle myself, because I trust myself. I think that is what the proponents of using scales are saying. We trust ourselves and our skills and know that we will be able to use the scale wisely and well. The argument that scales are fraught with the possibility for error is precisely why we want to use them. It doesn't make me want to use my scale less, it justifies its use!!!!!

Kathy Lilleskov RN IBCLC

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