Actually, I rarely see a baby who is doing really well anymore.  The babies
I see now are primarily those having a variety of feeding difficulties
ranging from simple to extremely complicated - thus my wife, Jo, talking
with moms who are stressed out and very worried about their babies weight
gain among other things.  I wish I could see a baby with nothing other than
simple latch and positioning needs...  I have found Jo on more than one
occasion at group or at our home reassuring a new mom that all will be OK -
and that she (mom) has the strength to hang in there while the mom and I
work together to solve the challenges she is facing.

In my 16 yrs of practice I have never once had a mom for whom a test weigh
caused distress when baby was gaining well (but perhaps had other issues).
If the baby was actually fine on weight and the intake at that feed was not
what one would expect, we talked quite a bit about what is normal - the fact
that feeds can in fact vary in amounts - not only from feeding to feeding
but from day to day.  We discuss cues and signs of what is normal with
breastfeeding and what is not.  They know what to look for and know when to
call if something changes - for the better or the worse.   And because I
follow-up, things are monitored until mom and I are both comfortable that
all is in fact going well.  

It all goes back to knowing how to use the tools we have, and how to
interpret the information they give us.  It also speaks to the IBCLC needing
to know the wide range of normal and when there is a problem - and when
there is not.  We also need to remember to trust the mother.  Far too often
moms are not trusted to know their babies and are blown off.  I always
believe my moms when they tell me something doesn't feel right.  It may be
that what isn't right is a true issue with the baby or the feeding, and it
may be that society has filled her head with inaccurate information that is
now causing her to stress more than she needs to.  Either way:  She is
right.

Simply, we must be good enough to know how to use the tools we have (or who
we can go to to learn), and to know when there is or is not a problem and if
at all possible, how to fix it - or to know who can fix it.  

Jaye

Jaye Simpson, IBCLC, CIIM
Breastfeeding Network
Sacramento, CA
www.breastfeedingnetwork.net

-----Original Message-----
From: Tania Archbold [mailto:[log in to unmask]] 
Sent: Sunday, June 12, 2011 6:59 PM
Subject: Re: A Lay persons point of view on scales

But why would you do a test weigh on a healthy gaining baby?

I will often do a naked weight to have for my records. Here babies are not
usually seen by their doctor between discharge and one month of age. 

If I have a mother of a 2 week old baby call me with damaged nipples I will
take a full history, watch a feed, observe the baby's oral anatomy, discuss
what I observed and weigh the baby naked. 

Guiding the mother to improve the latch, note any tongue tie, give info on
that, and then using the weight decide if baby needs supplimentation with
expressed milk or if baby is transferring adequately despite poor
positioning is usually how these types of calls go. 

On the rare occasion I do a pre and post feed weigh I make it very  clear to
the mother that this is one snapshot of a feed that is out of the baby's
normal routine and may not give us a clear picture of what is going on. If
the mother insists she feels this would be helpful we will do one and book a
follow up to see her again within a day or two to see how things are going. 

Clear communication with the mothers we work with can avoid a lot of the
misunderstandings. I know that being in private practice I have the luxury
of being with a client for 2+ hours if necessary to cover all of this at a
pace that is comfortable for the mother. 

Tania Archbold BSc IBCLC. LLLL
Www.mothersnectar.ca
Ontario Canada 

On 2011-06-12, at 21:34, Nina Berry <[log in to unmask]> wrote:

> Equally, if a perfectly healthy dyad - baby gaining well -  presents to
someone with a scale with all the usual, culturally determined, anxiety
about her baby 'not getting enough milk' and is subjected to what we call
here, 'test weighing' the following may ensue.
> Anxious mother, sits down to feed a not very hungry baby.  Mum doesn't let
down well to baby.  Test weigh show that bay is 'only transferring X mls'.
Mum freaks out. Exclusive breastfeeding is terminated.
> I hear that the scale is a useful tool for some of us.  What bothers me
about it, is that we don't know how much breastmilk is enough in any given
feed for any given dyad.  The only research we have tells us that the range
of 'normal' is enormous.
> Nina Berry
> Australia 

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