Hi Cheryl,
We have about the same deliveries per month but less BF initiation (around
50%). We cover Mon-Fri, one LC, usually me.
Sometimes I think it is even harder in low BF initiation and duration
regions, because the culture and mindset are so BF-unfriendly.

I have a few thoughts on how to carry out your LC duties.

What I do is make rounds and moms have a way to call me when/if they need
help. I usually pop in 3 times in 8 hrs, if possible. Some of these
visits take just a minute for mom to say they are feeding well, and have no
needs. Some take longer if mom or baby are having trouble. They call my
office or ring the nurse's light if they need me. Often I place them STS and
they ring when baby cues.

I have an 8 page packet of info that I've put together with all the relevant
issues, latching, common questions (diet, meds, illness, use of bottle),
milk storage, back to work issues (virtually all moms return to outside
employment within 6 wks) etc. The first page, front and back, is penned by
yours truly. The other pages are from ILCA, the major pump companies (sorry,
this is not ideal) and we purchase the Diaper Diary with the photos of wet,
dirty diapers and the log to keep track of feeds and output for 1 wk. For
premies, I purchase a premie pumping handout and log with photos. I briefly
show mom what is in the packet and ask that she keep it handy at her bedside
while in hosp. We can refer and I can show her the written info is there
when she asks those inevitable questions. (Of course, answer the questions
first, then show the hard copy is there).
You are right, they are in a fog. I mostly focus on skin to skin and her
getting comfortable with a position and good latch. Encouraging rooming in
and unrestricted bf. Taking the bottles and pacifiers out of the crib.

What I find helps is a followup "clinic." Even though this sounds difficult
to manage, it may actually save time because phone calls are sometimes
difficult to accomplish and get enough info to know if they are doing ok or
not. Then when you have an outpatient, it is a mom with a problem, and the
visit takes longer than a routine followup. At a routine followup visit,
moms are more receptive to info and have been bf for a couple days and
usually their milk is in too.
With our f/u visits, it is geared to primips or moms with premies or other
bf challenges. Most experienced multips who leave bf well, don't have to
come back, but of course can come if needed or if baby leaves hosp with
jaundice, for example, as that is one of the things we check with a handheld
bilichek machine.

With staff teaching, staff could be assigned to shadow the LC and that way
you are doing your job and they are learning as you go. They should also
have a couple days in with followups.
I would be happy to share my packet with you, just email me at work
[log in to unmask]

Laurie Wheeler RN MN IBCLC
Mississippi USA

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