I know that there has been some dicussion on here about hospital based RN/IBCLC's but it didn't bother me because i know that i am a great IBCLC but here is a little tid bit on the RN. This RN probably had a list of home visits that she had to do that day and she may have only been granted 15-20 minutes if that to each family visit. So in that amount of time with probably limited breastfeeding skills this is what she saw:
pale skin - no jaundice (beacuse doesn't every baby who isn't feeding well become jaundiced)
'good latch' which meant at the visit infant was feeding
'good latch' also probably meant the infant was alert and sucking actively.
3-4 hours of eating is normal ( I mean i know it isn't normal for a breastfeed baby but if you have attended many formula presentations 3-4 hours of eating is normal)
Probably during the visit since the infant had eaten the mother also changed the diaper and there was urine in the diaper.
Recipe to increase milk production (hmm, maybe that came out of a breastfeeding phamlet from enfamil)
And don't forget that some of this visit has to go to the mother as well. How is bleeding, movement and the oh so famous - you need to drink lots of water to get a good milk production. 

But when you came in - you had lots of time and was able to look at everything - top, bottom, in and out. 
This is the difference that we do.

I think that this would be a great time to do a patient safety review and present it to the home visitor agency and offer some teaching to the staff. 

Jessica Callahan RN, IBCLC
USA, NC

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