I tried sending this response from another email address but it didn't work, so I am trying again. My apologies if somehow it shows up on the list twice. I'm actually kind of glad it didn't go through, as this gives me another chance to edit myself, especially in light of other responses to the list since I wrote it :-)
Anonymous said,
<<As an IBCLC who has spent more than 6 years working at several WIC offices, its been my personal observation that pumps are issued to almost every woman who declares herself to be breastfeeding, even if she only latched the baby once, in the hospital.>>
I have been an IBCLC for 13 years, all of that with WIC, but only in Miami - for what that's worth. What you describe is not our policy nor has it ever been - rather the opposite. The Miami-Dade County WIC program has a very large caseload; we will never have enough pumps for "almost every woman who declares herself to be breastfeeding". That this has been *your* experience I do not doubt however; what stands out to me is the lack of consistency between WIC programs, even from one county to another.
<< WIC includes pumps and BF gadgets, such as nipple shields, in their BF budget, and it is my strongly held opinion that such gadgets, including pumps, are dispersed all too freely, and at almost every occurence of a BF "problem", in lieu of offering professional (read IBCLC) observation and assistance. >>
See now in Miami, such gagdets are only given out by breastfeeding staff, all of whom are either IBCLCs or PCs. Our nipple shields and such are issued only by IBCLCs; PCs will sometimes issue manual pumps, and our pump coordinator is a PC/CLC.
Our pump policy is similar to those already stated by others on the list. The priority of our pump program is A) sick hospitalized babies, or otherwise chronically ill such as congenital heart disease, etc B) exclusively breastfeeding working (or going to school) moms. When they get the pump depends on when they'll need it.
<<I am suggesting that WIC is using their BF budget to supply women with pumps and gadgets rather than actually hiring an IBCLC. Once a woman is issued a pump, the milk has to be delivered by some other means than the breast, or the purpose of pumping is negated, of course. This is so detrimental to direct breastfeeding that the entire practice astounds me, especially considering the vast percentage of women participating in the WIC program and the fact that formula is the highest cost of the entire system. Why, oh why, does WIC not employ an IBCLC at every office? >>
Excellent question. This statistic no longer seems to be on the IBLCE website but in the summer of last year, IBLCE had on their site what I found to be an astonishing statistic: only 320 IBCLCs in the US (out of a total of over 9,500) work for WIC. Do the math - that's only 3.3%! Given that nearly half of all the infants in the United States are on WIC, one can only feel appalled. I do not believe it possible to make a significant dent in the breastfeeding duration rates of the United States without making dramatic changes to that statistic. WIC simply must hire more IBCLCs, in my personal opinion.
But now the issue gets complicated. Briefly:
A) There seems to be a lack of consistency between WIC programs as to how breastfeeding is promoted - the nitty gritty of staffing, salaries, gadgets, etc. There needs to be better guidance from above, at the federal level IMO, as to how individual WIC programs support and staff breastfeeding. Not that I want some federal dweeb telling me when to issue a nipple shield, mind you. Heavens, no. But the vast differences between differing WIC programs with respect to breastfeeding staffing and support needs to change, IMO. There is a difference between variety and confusion.
B) WIC usually pays less than the typical U.S. hospital-based IBCLC earns. That has to be addressed, as it will be difficult to recruit IBCLCs when there is a significant discrepancy in pay.
C) Is there such a thing - i.e., an official job position - as a "WIC IBCLC"? Most, unlike myself, are also their breastfeeding program coordinator so the answer to that question IMO is no. That has to be corrected. Some WIC programs will need more than one IBCLC, especially if the one they have, as the coordinator, is not free to spend enough time actually counseling moms one-on-one.
Now, Linda tells us that WIC at the federal level would love to hire an IBCLC for every WIC program. That comes as welcome news to me. I know that breastfeeding is genuinely a priority for WIC at the federal level, but it has been my impression, perhaps erroneously, that they do not yet "get" the importance of IBCLCs. It is as if they think that breastfeeding support, for WIC moms, begins and ends with Peer Counselors. It does not. It may well begin with them, but if you want to seal the deal many WIC clients will need an IBCLC, period. I know, I see it all here: diseases and syndromes I've never heard of before, bleeding nipples, breast reductions, premies and LBW babies galore, tongue-ties, you name it.
Sometimes I actually get angry about this subject because there seems to be a subtle bias out there, one that says, "WIC clients only need PCs." No one makes that claim about middle- or upper-class moms; the option of seeing an IBCLC is presumed. But if you're on WIC then somehow you're supposed to make do with one underpaid PC. I'm sorry, but no; just because you're poor doesn't mean you won't need an IBCLC.
I do NOT mean that every mother needs an IBCLC. What I'm saying is that (in the U.S.) only the poor are told they don't/won't/shouldn't ever need one. Peer support alone is somehow always supposed to be enough for them. But a woman, rich or poor, that *does* need an IBCLC, NEEDS ONE or she will not continue breastfeeding.
Remember: nearly half of all infants in the U.S. are on WIC.
Nikki said in another post, <<One doesn't use a LC for breastfeeding support, at least not in my community. Women hire LCs for problems.>>
"HIRE" being the operative word. Most of my clients are too poor to hire one. That is the problem. And even if IBCLCs were covered by health insurance plans, a very great many of my clients have no health insurance. Perhaps someday all that will change, but for now hiring an LC is not an option for many of these women. Hence WIC must hire them.
So, Anonymous, when you say that gadgets are being handed out willy-nilly, I believe you, even though nothing could be further from the truth here in Miami. People are expensive - they require health care and pension plans, vacation time and sick leave. Gadgets are cheaper. Handing them out makes you feel like you're "supporting" breastfeeding. And actually supporting women takes TIME, human contact. This is analogous to what is happening to birth in this country. Same problem. Different body part.
I give full credit to our local WIC managers, who have put their money, their time and their priorities into breastfeeding. And we have no more money than any other WIC program in the country, so if we can do it, so can yours! What you need is support from your state and local WIC staff, especially your local ones....
Regina Maria Roig-Romero, BS, IBCLC, RLC
Sr. Lactation Consultant
Miami-Dade County Health Dept WIC/Nutrition
Breastfeeding Program
● 7785 NW 48 Street Suite 300 ● Miami, Florida 33166 ● Phone: (786) 336-1333 x16219 ● Breastfeeding Helpline: (786) 336-1336 ● Fax (786) 336-1302
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