I am a hospital based LC at a pvt not-for-profit hosp.  We don't keep our stats the same way that you do.  We keep only initiation rate.  Twice a year we survey 6 month continuation rates.  Our initiation rate is about 48% and about 50% still BF at 6 months.  It seems like all of the time you spend on chart review could be better spent on nurse education.  I'm sure that you have pitched that to a higher up at some point in time.  To start off there is an excellent article by Marsha Walker on the website, www.health-e-learning.com.  It is called "Just one bottle won't hurt"--or will it?  and describes the changes to the GI tract that just one bottle of formula can cause.  My favorite "shock fact" is that the introduction of formula causes the gut flora to become "indistinguishable from adult flora within 24 hours," and that if breastmilk were reintroduced exclusively "it would take 2-4 weeks to return again to a state favoring gram positive flora."Go to the articles section from the home page.    It sounds like your neo would like to see exclusive BF rates rise.  I've seen hospitals where mom has to actually sign an informed consent before her BF baby is supplemented.  Maybe the neo would be agreeable to something like that.  Unfortunately sometimes someone other than the LC has to spearhead this movement.  Good luck!
Amy Stallings RNC, IBCLC

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