A word or two about test weights, which I do, and which give me valuable
information on how to manage certain crises.  Test weights are only useful
if done on an accurate (read expensive) scale, which you yourself frequently
calibrate.  They provide a snapshot of a feeding.  If possible, I do more
than one, so I get a sense of how reliable the picture was in the first
snap-shot.  Paula Meier's research documents how inaccurate visual
assessment of intake is with preterms.  I was truly humbled when I began
doing test weights to check my own visual and auditory assessment skills.

Remember, some of us work with very compromised babies.  I need to know what
their feeding abilities are.  Infants with cleft defects, infants with heart
defects, preemies released breastfeeding at 4-5 lbs and not at their due
dates, infants who are self-limiting intake when mom is full of milk.  These
babies often falter.  It is very useful, for instance, to know that in 20
min. such an infant has taken in 16 ml of milk.  That tells me that even
with constant feeding, such an infant may not be able to recover birth
weight, or stimulate full milk production just by nursing.  It helps me know
that I must begin to recommend augmented breast stim. with a good pump and
hand expression.  It helps me understand that pumped milk (esp. post-feed
hind milk) may need to be delivered by alternate feeding method temporarily
while we stabilize baby's growth and milk supply.  Etc.

The scale is a tool.  I have often spoken about the use of tools in our
profession.  There is a certain mentality that tools are inherently evil,
and there is the opposite prejudice that they are sacred.  They are neither.
A good tool is neutral of ideology.  In the hands of a capable practicioner,
it is merely one of many ways that we apply available resources to help a
mother and baby.  Tool use requires judegment and balance, and a good tool
user never relies on any tool to the exclusion of one's own good sense.  But
our senses can fail us (just as our tools sometimes fail us.)  I use tools
to augment my senses, and my senses to augment my tools.

Tool use requires applied counseling skills so that parents aren't alarmed
by the device.  I use tools to move the baby towards normalcy.  Which I
define as exclusive bfg. and which is always my goal.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html