I apologize in advance for the long email.  I am one of two IBCLC's at a 
hospital with 90-120 deliveries a month, about 80% breastfeeding initiation 
rate.  We have one LC here at a time for Mon-Sat coverage, 9-5.  Currently, 
we see all breastfeeding moms every day of their stay (except delivery day), 
do dischage follow up calls for all moms, occasional outpatient visits, phone 
and email consults and a weekly support group that usually takes 2 hours.  I 
also do a monthly newsletter for staff and staff education on breastfeeding.  
We also have a NICU that we provide LC assistance to. The problem I need 
advice about has to do with the visits to breastfeeding moms and the lack of 
time to do good outpatient follow up calls.  When we see a breastfeeding mom 
in the hospital we have a standard teaching plan.  The topics covered include 
expected # of wet/stool diapers for each day of the first week, infant initial 
weight loss and gain, caution with pacifiers and bottles, frequency of feeds in 
early days/weeks, engorgment tx, pumping/storing EBM, cleaning pump, sore 
nipples and working and breastfeeding, caffeine and medications with 
breastfeeding.  We cover this info regardless of if the nipples are sore or if 
they are asking questions about any of this.  If I'm talking to a multip that 
breastfed over 6 months with a previous child, then I don't go over all of the 
info.  I've been in this role now for about 1.5 years and I LOVE my job but 
covering all of this info is getting quite tedious.  I do think it is important for 
them to know all of this, however, I wonder how much they actually remember 
during this time.  Some of the mothers are barely listening to me.  I would like 
to change our LC focus to more of a problem solving and question and answer 
approach.  I still want to visit all of the moms, regardles of if they are multip or 
primip to ensure that they are confident with how things are going.  How do 
those of you that are hospital LC's approach this and what do you think?

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