At the risk of  really beating a dead horse, here's a real life test wt. 
situation I've been  involved in over the last couple of days. Baby, full term, 
birth wt. 7-12,  first baby, born by vaginal delivery at a different hospital 
than the one  where I work. Readmitted to our hospital on day 3 with 10% wt. 
loss and  bilirubin of 17. Mother had been exclusively breastfeeding since birth. 
 Baby 0+, Coombs negative, no bruising, no other risk factors for  jaundice. 
Baby admitted late Saturday and not seen by LC until Monday. Infant  breastfed 
every three hours in hospital and then supplemented with formula per  MD 
order. Mom and baby were never separated. The baby was readmitted to pedi  and mom 
stayed in room with him. No one started mom pumping until she was seen  by LC 
on Monday.

Baby 5 days old when I first saw couplet on  Monday AM.  It had been three 
hours since baby had fed. Breasts  moderately full, everted, elastic nipples. 
Baby latched readily and latch  looked good. Sustained rhythmic suck with bursts 
of deep jaw excursions and  intermittent audible swallowing. Each time baby 
became sleepy, I helped mom  with breast compression to enhance flow. Test wt. 
after 35 minutes (baby now  sleeping and unwilling to bf any more) showed 12 
ml intake.  Test wt. was  done on Baby Weigh Scale with conditions the same 
before and after feed, e.g.  no diaper or clothing change.  Breasts somewhat 
softened at this point. I  advised mom to pump to supply supplement--she did so 
with hospital grade pump  and got just enough milk to cover the bottom of the 
bottle. Plan:  Breastfeed on cue, but at least every three hours. Use 
compression and  massage to stimulate flow. Pump after to fully empty to stimulate 
supply.  Oh, and by the way I would have guessed from the way the baby nursed  that 
he got much more than 12 ml.  

Today, end of day 6.  Bili down, baby ready to go home. Three hr. since last 
feeding again. Nobody  was limiting this baby to 3 hr. feeds but that is when 
he woke up. Same  scenario, only this feed baby took 15 ml. and mom pumped 
about 15 ml right  after.  Estimated milk supply at this point is 8 oz. per 
day--low and not  enough for this baby at this point. Mom has no risk factors for 
low supply.  Milk is in but quantity is low.  It very likely will increase over 
next  week or so. Meanwhile baby will need supplement with pumped milk and or 
 formula until supply is sufficient. She has no hx of infertility, has normal 
 shaped breasts, good breast growth during pg., no health issues, normal post 
 partum bleeding.  Baby has strong coordinated suck on digital exam and no  
evidence of oral abnormalities.. My guess is there was poor milk transfer  
early on  for whatever reason and this contributed to low supply. And  when bili 
was so high baby probably did not breastfeed effectively and no one  started 
mom pumping. But it can be difficult to determine what came first the  chicken 
or the egg--low supply or poor transfer. And it's still very early.  
None-the-less, test weighing certainly helped me to analyze baby's intake and  to 
determine mom's supply is somewhat low.  I would not have done a test  wt. on a 
normal thriving baby. But--this baby had lost 10% of wt. and had  pathological 
jaundice--most likely lack of breastmilk jaundice. Test weighing  did not 
discourage this mom. She already knew things were not going well. She  just wanted to 
know how to fix it. And importantly for me, test weighing  disputed what I 
thought I saw--adequate intake at breast. It also caused me to  explore further 
to determine that mom has low supply at this point. Test  weighing and pumping 
after helped me to determine that baby is taking most of  what is in the 
breast.  

So-- sorry for the long discourse,  but I am definitely a fan of judicious 
test weighing in the context of a full  breastfeeding evaluation.

Kathy Boggs, RN, IBCLC
Mountain  View, CA




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