>Heather, here in the USA, peer or lay BF helpers do not do test 
>weights. Meaning La Leche League Leaders or WIC BF Peer Counselors. 
>With your explanation of what you do, in the peer support realm (or 
>so I understand it), it is obvious why test weights are not your 
>thing.
>
>As an LLL Leader, I do not do test weights either because Leaders do 
>not ordinarily have a good scale. As an LLL Leader, I also would not 
>get written consent before helping the mother, nor do a written care 
>plan, nor send an HCP report, nor have nipple shields or 
>supplementer devices or special bottles. I am covered by liability 
>insurance through LLLI, as I am for my professional work through my 
>employer.


That's the same for NCT breastfeeding counsellors - our work is a bit 
like an LLL  leader's.   I am not a peer supporter - in the UK at 
least a peer supporter has about 12 hours traning. NCT bfcs train for 
about 3 years (often more) and I have done a lot more training as a 
tutor. I have been a bfc for 25 years, I have trained other bfcs for 
15 years and trained healthcare professionals - paediatricians, 
family doctors, midwives, paediatric nurses, health visitors -  in 
breastfeeding practice for 5 years.  I have to read and assess 
research, and I have to understand the difference between 
research-based practice and all the rest of it - and 'all the rest of 
it' can be wonderful stuff. After all, a lot of what I do is 'all the 
rest of it' :)


>Yet, an IBCLC is supposed to provide a professional service with 
>medical information (not advice or diagnosing medical issues) or 
>guiding the parents to improve feedings of the baby. Test weights go 
>along with being a professional lactation service.


Kathy, I have heard (on list and off list) from a number of IBCLCs 
who  do not do test weights, ever.

They do not believe it is part of their professional lactation service.

This is an area where equally experienced, equally dedicated and 
equally professional people differ - and the ones who don't test 
weigh (or who rarely do it) which would include, I think, all the UK 
IBCLCs (though please, anyone, correct me if I am wrong) will resent 
your implication that they somehow ought to do it,  because it 'goes 
along' with being a professional lactation service. As Karleen points 
out, they may not even use a scale!

>
>And what does it matter if the scale shows 34 ml or 35 ml, this is 
>just splitting hairs.


Ack! You have misunderstood me *totally*!  That was exactly my point 
- what does it matter? I questioned 34ml or 35 ml not because I 
thought it mattered (quite the reverse!) but because I thought it 
strange the weight should be written in this way - a scale showing 
weights to this degree of accuracy must be kidding!

>  The important thing is that in Laurie's case, she was able to see 
>that mother had some milk, but maybe not enough for full 
>breastfeeding. The test weight should have reassured the mother that 
>something came out and ended up in baby's tummy. As Laurie works as 
>a professional, her suggestions must be more precise than for the 
>peer or lay helper.

I am very aware that clinical interventions are different from what I 
do - but my point was that someone quoting 34 ml - 84 ml has to be 
working with a scale that *pretending* precision!

Heather Welford Neil

NCT bfc, tutor, UK

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