Dear all:

One of my colleagues always jokes about our profession being about pain and starvation.  And Susan defined the difference between peer-support drop in groups and professionally-facilitated drop-in clinics as "problem-based" clinics.  So, I would like to redefine the negative terminology to our profession being about moving towards satisfaction and comfort and the clinics as "solution-based" (which always means you must recruit mom into the process of defining her own solutions).

More simply, one can distinguish between drop-in clinics and drop-in support groups.  In essence, however, there is probably lots of overlap in what goes on in these drop in settings.

Anyway -- since we have lots of IBCLCs and some CLCs and LLLL doing groups in Manhattan, here are my impressions of what really goes on:

Volunteer peer support:
LLLL facilitate groups to provide peer support with sharing and discussion among mothers and do not charge a fee.  
Some IBCLCs  facilitate their groups AS LLLL and they stick to that model and do not charge a fee

Fee based peer support
Some IBCLCs facilitate their groups to provide peer support similar to LLL and charge a fee
Some IBCLCs facilitate their groups to provide peer support, have a weighing scale and allow mothers to use it (but don't interpret the results for mom) and charge a fee

Fee based minimum to moderate hands on (This appears to be the predominant style)
Some IBCLCs facilitate their groups by offering tips to resolve problems in a discussion format, allow women to weigh and measure their babies, and may provide some minimal hands on assistance and will refer mothers to home, office or semi-private groups if the problems are extensive (and of course charge a fee

Fee based moderate to extensive hands on
Some IBCLCs facilitate their groups by offering tips to resolve problems, assist women to weigh their babies and measure intake, offer tips, and assist with positioning and attachment.  Some of these charge a SLIGHTLY higher fee.

This was the model when I worked for Elizabeth Seton.  I found that this was almost impossible with the once a week groups at Elizabeth Seton because there would be 25 women in the group.  So at Elizabeth Seton, the clients who had MediCare could get coverage for office visits at the same site and others would pay a reduced fee. Since Elizabeth Seton provided the space, it eliminated the overhead for office space.  I don't remember if anyone documented the weights.  I definitely documented the weights and actually tracked babies over time (which was exhausting).  I had a huge computer program. This obssessive compulsive behavior on my part enabled me to conclude that I no longer believed in nipple confusion because the women who bottle fed and kept up their milk supply did better than the women who used a tube on the breast and didn't keep up their milk supply.  This is when I decided SOME babies developed a "flow preference".   
 
At Realbirth, there were always two groups a week, initially with two different lactation consultants so we talked a lot.  This worked much better with the IBCLC who communicated.  It did not work with the IBCLC who did not and her group died out.  She blamed it on the day of the week, but it took off once she quite and I ended up doing twice a week myself (which was exhausting by the way).  I later went on to once a week in one location and sharing in the other location.  We had no formal sharing system.  We just called each other about challenging cases.  I found that mothers really did not remember what suggested as tips from week to week.  So, in addition to the weight log, I also started writing tips on cards with a big disclaimer that they should contact their other HCPs for medical advice.  The center also started logging in a contact sheet for the pediatricians after there were a few of those cases of severe failure to thrive with mothers who were in denial.

Realbirth met its demise and most of the staff were incorporated into a new parenting center run by the pediatric practice that tells moms to sleep train their babies at six weeks of age and most recently one mom reported that they said "you're not doing it right if your baby isn't crying heartily before you allow your baby to feed".  So, I am just doing one clinic a week at the Pilates studio where I ended up paying the fees to the studio that Realbirth owed them (Realbirth still has not declared bankruptcy but owes a lot of people including myself) and I now pay a modest rent.  I love being in a space that concentrates on "health".  So now, I have added in HIPAA release forms and a consent to consult form for all mothers coming into the group.  I still do the cards with tips.  I track weights on a one page form.  I have not moved on to additional paperwork yet.  I raised my fees and the clinics that are now run by the pediatric practice (where they  do not provide written cards) raised their fees too.  The new "Parenting Center" was recently were "shocked" when they wanted to move another IBCLC into the Pilates studio to do a clinic on a different and I said "no".  

In this clinic, I will sometimes suggest a home visit for very complicated cases, but I have actually been able to manage even tubes on the breast in this setting.  It took me a long time to get to this level.  It really is a complicated dance and when it gets very busy, I always emphasize that I put my phone number and email address on the cards.  Sometimes I will call mothers if I feel that they are shy and slip away during the group.

Upon request I also provide insurance forms for the groups, but I don't do it on a routine basis because the fee is low and the time cost to me is high.

While I have worked with others who are training to be IBCLCs who are very competent, I find it really makes no difference to my energy or ability if I have an assistant or not.

Semiprivate group clinics:
There are two of these that I know of in Manhattan.  Both of us limit the numbers.  We charge a little under the third the cost of a home visit.  I don't know about the other group.  I provide ALL  the paperwork that I provide for a home visit.  I find this very manageable even with complex cases.

Hospital clinics:
I know hospitals do run clinics, some use a scale, some do hands on. I don't know a lot of details about these clinics.


Hope that helps.

Best regards,

Susan Burger, MHS, PhD, IBCLC

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