In a recent post, Barbara Wilson-Clay said  "[Heather Harris] compared this
method of scoring with Chris
Mulford's The Mother Baby Assessment Tool (MBA) which was previously eval in
a similar fashion and found to be reliable."

I thank Heather and Barbara for reporting that the MBA was found reliable,
but as far as I know that's not the true story.  When Jan Riordan tested the
MBA for inter-rater-reliability, using nurses as raters and having them score
videotaped breastfeeding sessions, the raters had quite wide disagreement on
step four of the MBA, in which you assess milk transfer using the mother's
symptoms (sleepy feeling, uterine contractions, heavier lochia, breast tingle
or pressure) as well as signs like audible swallowing.  If there have been
other tests for reliability of the MBA, I haven't heard about them.

What I was trying to do with the MBA is develop a shorthand that nurses could
use in those little tiny blocks on hospital charts where they have to chart
feedings.  The little blocks, natch, are just the right size to write
something like "Sim-45cc"
and not big enough to say anything descriptive.  (The scoring system from
that Jan Barger describes from the new Counselling the Nursing Mother looks
like it would fit the same size blocks.)

For those who are not familiar with the MBA, it goes like this.  Mother and
Baby can each get a point on each of five steps in a feeding:
Signaling, Positioning, Latch-on, Milk Transfer, and Ending.

The funny thing about thinking up the MBA and trying to make it add up to a
10-point scale (so that it would resemble the Apgar and feel familiar for
nurses) is that looking for 10 items to rate helped me develop a mental model
with five steps and something for mom and baby to do on each step.  This led
me to the idea that we should start looking at a feeding from the very
beginning---the communication between mother and baby that determines whether
they are going to HAVE a feeding---and finish at the end---when we see
whether the baby looks sated and whether the mom's breasts look and feel OK.
Kay Matthews had done this in a way in the IBFAT, when she notes the state of
the baby at the beginning of the feeding and asks at the end whether the
mother is pleased with the feeding.

Whether or not it works as an assessment tool, the MBA works for me as a way
of making sure I look at the whole feeding and see what both partners are
doing.  It is a way of reminding myself that breastfeeding is an interactive
process.  And it turns out to be a pretty good way to teach people about what
happens during breastfeeding.

Cheers,
Chris Mulford, RN, BSN, IBCLC
Swarthmore  PA  (Eastern USA)

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