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.  

In the context where almost no one births normally, the normal reflexes of almost all babies have been tampered with.  In the context where almost no mothers have had adequate full exposure to breastfeeding from the time they were little, almost no mothers have had an adequate opportunity to intuitively know how to position a baby comfortably.  In the context where pediatricians can have an opinion letter published in the American Academy of Pediatrics that the indicator of "exclusive breastfeeding" drop the requirement to track formula use in the hospital because this is an "Intervention" which will lead to "pressuring mothers" and that "pressuring mothers" is what causes low breastfeeding rates -- it is understandable that the information on how much formula is used in the early days is underreported.  And in that scenario, the milk supplies of many mothers are compromised right from the start.  By the way, I argued just as vehemently that the indicator of "exclusive breastfeeding" is not an intervention either. Measuring it does not cause mothers to be anxious any more than using a scale does.  It is the person using the scale that can provide reassuring advise or point out concerns that may alarm a mother.  Poorly trained health care workers that weigh babies and use formula at the drop of the hat are a perfect example of how NOT to use a scale.

As for when you would use a weighing scale for test weighing.  What is forgotten is that those of us who work in private practice in Manhattan rarely encounter the mother who has NOT been giving bottles right from the start.  A baby that has been given lots of bottles and very little time on the breast may completely fall apart when they are pushed to overcome the maladapted feeding strategies that enabled them to cope with bottle feeding.  Or the babies that have real suck swallow disorders that were not recognized when they were put on the bottle. Or the babies who have real suck swallow disorders and coast on the mother's milk supply -- who Cathy Genna so eloquently posted.

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.  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.

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.  

Sincerely, 

Susan E. Burger, MHS, PhD, IBCLC

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