Renee has mentioned the problem regarding the lack of a recommendation for  
LC to patient ratios in hospitals. Since ILCA is the standard setting body for  
IBCLCs, I would suggest that ILCA should be the entity that establishes the  
evidence-based LC to patient ratio. The book Breastfeeding and Human Lactation 
 by Jan Riordan has always mentioned 1 LC per 1000 births as a minimum 
criteria.  Here in Massachusetts our new perinatal regulations state that an IBCLC 
(or  equivalent - there is no equivalent but the phrase remained) must be 
provided to  breastfeeding mothers who require advanced lactation support. The 
hospitals are  left to determine how many to have on staff. Some of our hospitals 
have fired  the LCs to save money, rather than bill for their services or take 
the time  to learn the evidence-based reasons why LCs on staff are crucial 
for improving  breastfeeding durations. Hospitals, administrators, physicians, 
and nurses are  all responsible for and accountable to the mother and baby for 
breastfeeding  outcomes. Allowing hospitals to dodge their responsibility by 
pleading poverty  should be addressed. Three relatively new articles verify the 
importance of LC  services in the hospital.
 
Rishel PEN, Sweeney P. Comparison of breastfeeding rates among women  
delivering infants in military treatment facilities with and without lactation  
consultants. Military Medicine 2005; 170:435-438
 
Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings  
from the pregnancy risk assessment and monitoring system. Pediatrics 2005;  
116:1408-1412
 
Bonuck KA, Trombley M, Freeman K, McKee D. Randomized, controlled trial of  a 
prenatal and postnatal lactation consultant intervention on duration and  
intensity of breastfeeding up to 12 months. Pediatrics 2005; 116:1413-1426
 
Hospitals in Massachusetts are now required to have lactation services  
because the perinatal regulations state the requirement. Consider approaching  your 
state department of public health to begin the process of holding hospitals  
accountable for their patient care (or lack thereof). You can check the  
Massachusetts Breastfeeding Coalition website at _www.massbfc.org_ 
(http://www.massbfc.org)  for a summary of the new  breastfeeding language and news release. 
The NABA website at _www.naba-breastfeeding.org_ 
(http://www.naba-breastfeeding.org)  also has  information on this in the News and Alerts section.
 
Marsha Walker, RN, IBCLC
Weston, MA

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