I am hoping for some input from all of you wise Lactnetters.  I am looking
for ways to help increase our breastfeeding rates.  I recently began work at
a local hospital as a Breastfeeding Educator.  (I do rounds with the new
moms and teach an occasional breastfeeding class).  I am not (yet) IBCLC.  I
will be sitting the exam in July.  The rounds are primarily handled by
another breastfeeding educator (also sitting the exam in July) and myself,
with an RN IBCLC doing rounds one day per week.  (The "program" is over-seen
by an IBCLC who runs the Perinatal Outreach program.)  Between the three of
us we now have coverage 6 days per week between 9am-2pm.  We also have a
volunteer WIC peer counselor that comes in two afternoons per week.  It is
not enough, but it is better than it was.  It is a smallish hospital with
approx 250-300 births per month.  It is far from being breastfeeding
friendly but we are ready to start working on it.  I know that a lot of
policies need to change (i.e. babies must remain in nursery for 4hrs after
delivery before being "released" to mom, formula routinely given "just in
case", no alternative feeding methods allowed other than bottle and I could
go on and on) to help increase rates.  I'm just not sure where to start.
Right now our breastfeeding initiation rates are at a dismal 55% (approx)
and very few of those are exclusively breastfeeding and many give up
breastfeeding altogether before they ever leave the hospital.  It has been
even worse than that for the last few weeks.  Out of the 13 moms on the
floor today, 3 were breastfeeding and only one of those 3 was exclusively
breastfeeding.  It was the same yesterday.  Our population is predominantly
lower income African American and Hispanic.  Very few of the moms take the
breastfeeding classes.  How can we reach these moms to encourage
breastfeeding?  It seems that the decision to breast or formula feed is made
before they even reach us.  We don't see the moms until they come up from
recovery, and then we are very restricted on what we can say to moms who
have chosen formula feeding.  We don't want to make anyone feel guilty, of
course! Until recently we were discouraged from even visiting the FF moms.
If you have 10-15min to spend with a mom, how do you encourage her to change
her mind about breastfeeding?  I now understand so much more why I would see
moms who insisted that the hospital LC didn't help her.  There is a good
chance that the LC was severely restricted in what she *could* say or do.  I
have so much respect now for those of you who work in the hospital
environment day in and day out.  It is extremely frustrating to always feel
like you have to be on the defensive.  Hopefully those of you that have been
able to successfully make changes can give us some advice on a starting
point and a plan of action.  Keep in mind that the hospital environment is
foreign to me.  I am learning more every day, but it is a whole different
world from the private practice setting I came from.

 (I know many of you are probably wondering what I am doing in the hospital
environment without a health care background or my IBLCE certification.
There are many days that I find myself wondering that as well!  The hospital
wanted to hire non-RN's because they need all of their RN's in a nursing
capacity.  I worked for 3 years with the head of the Perinatal program in a
private practice setting.  She knew my background and knew I was sitting the
exam soon and was willing to give me a chance.  From the hospital's POV, in
a few months they will be able to say they have 4 IBCLC's on staff.)

Thanks so much for any advice you can give!

Mellanie Sheppard, CBE,  IBCLC Hopeful 2004
Arlington, TX USA

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