>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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