Several of you have commented already and I will re-emphasize certain
points. I write from a USA perspective and I am currently employed 3 days a
week as a hospital based IBCLC / RN.
I totally agree that IBCLCs are needed throughout the health care system
(not just in hospitals) and should be helping mothers and children over
several years.
I do want to say, that in my role as hospital LC, I do assist mothers/babies
that are older. Most of my work is with newborns and premies, however
mothers do call and come for consults with older babies, up to about 1 yr.
Many mothers have told me that I've kept them going.

Hospital employment generally pays well, and has the option of health
insurance benefits, which are really a necessity in the USA. The LC
typically pays for this option, but at a better price than if he/she were
buying this insurance privately. I hope this next comment doesnt' sound
snobbish, but since many LCs are RNs, they are highly educated and perhaps
used to a relatively higher rate of pay. I have a master's degree in
nursing, for example. I changed careers from RN to IBCLC. Another point is
that sometimes the hospital employer will pay for some continuing education
for the LC (this is becoming less common due to economic constraints) and
occasionally even re-certification. I believe that if not for the efforts of
many LCs in hospitals (where the VAST majority of USA births occur), there
would be far fewer mothers breastfeeding, and so this would have a big
impact on all other healthcare venues.

The LC services are mostly free to hospital pts, included in their OB fees,
and the followup care is often also free. At my facility, any level of
followup is free.
I have been a private practice LC and I had a very meager income, even
supplemented with pump rental, which many LCs really don't want to do.
Because healthcare in USA is funded via private healthcare insurance or
Medicaid (welfare/indigent coverage), and PPLCs are typically not reimbursed
via these systems, many mothers do not choose/are not able to utilize PPLC
services.

As long as these situations exist, I think IBCLCs will continue to choose
hospital practice more often. I commend ILCA and all the LCs working with
them,  for all their efforts towards remediating these issues.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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