Dear Barbara,
   You never cease to amaze me with your insight and tact.  If we all keep in mind that as James Dobson recently said: "Rules without developing a relationship and Respect leads to Rebellion" (may not be the exact quote).  So often we want to have the "authority as the expert" to make the diagnosis and set the plan without regard to the patient, the staff nurses or the doctors.  If we would all place ourselves in the other persons shoes and try to anticipate their feelings, we would approach things differently.  We truly are not enemies with these people.  For years, like so many other seasoned Lactation consultants, we had no position or say.  We had the credentials but not the position.  I had to share information, mentor quietly and praise when they tried and the outcome was much improved.  It was a quiet working behind the scenes.  The results for me have been wonderful.  This year at my evaluation, I shared with my supervisor (non nurse, non lactation consultant) that the staff has grown so much, I feel that is the greatest contribution I could have made. Probably more important than a huge physical project that could stand up and say look at me which often is the only thing that justifies the big raises.  Our nurses are good at working with moms and breastfeeding.  We do not see all of our breastfeeding moms and I don't want to do that. We see the problems, patients requests and the Dr.'s ordered consults.  Any other place I have seen who sees all the breastfeeding patients has staff nurses who pass the buck and don't try to be good.  What happens on the other 14 hours when we are not here?  The patients get less than they deserve with breastfeeding help.  I am thrilled with the difference we have at our hospital.  Other entities who consult here and go to some of the other hospitals as well, always comment on the difference they see at our hospital.  The nurses are reasonable and work well with breastfeeding.  The atmosphere is relaxed and confident.  Other lactation consultants who have come to our hospital from other settings are amazed at the level of breastfeeding expertise with our nurses.  I often hear, "I often only have to come in and tweak a few things because so much has already been done right to help get that baby onto the breast."  This is so good to hear after spending years of tears feeling like I was getting nowhere.  So hang in there with whatever situation you have.  Continue the gentle sharing of information, respect the opinions of others and work with people rather than demand they do it your way.  And yes, sometimes you have to look the other way and just work with what you have.  We will always have the "bottle challenges", supplementation issues and poor advise to try to overcome but as so may others have shared, this can be worked with.  We have been so successful with positive changes, almost no one gets bottles and most moms and babies are not forced at the breast anymore.  We do a lot of skin to skin (the absolute miracle worker) and wait our babies out before any supplementation, usually 24 hours (without any other problems).  I have been working with breastfeeding moms for over 27 years.  I have only had the full time position as LC at our hospital the last 4 ½ years.  The staff is very complementary and really appreciate me,  I get frequent thank yous and my boss sees the survey results which frequently have my name with positive thanks for a job well done.  Could anyone ask for more?  I feel truly blessed after so many years of frustration.
   As far as working with the doctors,  I usually share the information by way of written data/articles.  I don't always get a response at the time but often they refer their patients for Out patient visits.  They see the results of my work with their patients and develop trust enough to listen.  And often give me what I ask for. Nothing is 100% but I feel we all have a pretty good working relationship because of the ground work that has been laid.
    Thanks for letting me share my story
     Jane Lowe, RN, IBCLC

Babara writes:
"Several have posted me privately to ask about how we accomplished the
changes in Austin, and one person praised me for leadership.  I have to say
again, this was truly a team effort.  I don't have the power or position to
drive that kind of change.  The change in terms of the NICUs came from
committed neonatologists and the nurses/LCs in the hospt, and was driven by
awareness of evidence-based research.  I'm just priviledged to be able to
participate at the level of the milk bank and other coalitions.  One of the
points I'm trying to make by sharing this information is to remind my
colleagues that the doctors and nurses are our natural allies; aggressive
formula marketing is our enemy.  Our experience here tells me that we can
participate in wonderful changes if we approach our natural allies with
cordiality, sharing ideas, stategies, and information.  But we must also be
open to receiving information about the institutional challenges our allies
are struggling with.  This allows us to come up with mutual solutions that
ultimately benefit the mothers and the babies.  And if we don't keep the
focus that that is the aim of all our work, then we aren't going to be
effective change agents.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html