To Edy and Sue Jacoby,

RIGHT ON about caseloads and burnout.  I did a key informant survey in June
1992 to try and estimate how much and what kind of help was needed to help
WIC moms make the decision to breastfeed and continue to 3 months.  This is
what I estimated is needed:

2-5 hours of prenatal contact over 4 sessions.  At least one contact should
be a class or group; at least 2 sessions should be 1:1.  10 hours of contacts
are needed postbirth, starting 24-48 hours after birth. At least 6 of these
hours must be in the first 6 weeks; at least 2 hours of 1:1 are needed, and
observation of feedings is mandatory.

One Full-Time Equivalent (FTE) LC can support 10-15 FTE peer counselors.  One
Full-time LC is needed for every 1000 births.  Fewer that 2% of prenatal
contacts require a LC. 10-25% of peer-supported women will need referral to
an LC for backup or more extensive work.  Most peer counselor should work
part-time because of the intensity of the work and their own babies' needs.

Peer counselor caseloads should be no higher than 1:10 for routine education
with no more than half of these post-partum women.  For intensive work,
caseloads should be no higher than 1:2.  LC caseloads should be based on 2-3
hours for initial consults, which includes time for documentation and
administrative support. Phone referrals from PCs are about 30 minutes long.

Putting some numbers to all this: assuming 5 hours prenatal contact and 10
hours postpartum; 5 mothers per peer counselor, 10% referral rate from PC to
LC, PC compensation of $5/hour and LC compensation of $25/hour, this comes
out to a total cost of about $11.25 per mother.  Costs not
included/calculated are overhead, program set-up, equipment, administration
other than client records, and training.

As I observed in clinics, I was stunned at the lack of time for helping solve
crises.  Even if the clinician knew what to do and the mother wanted help,
both were staring into a waiting room full of other clients waiting patiently
(?) to be seen.  Adequate support of breastfeeding requires skilled people
and TIME, and a little equipment.

I've found no published studies to either corroborate or refute these
estimates.  Anyone want to comment?  Let's tinker with these numbers a bit
and see what the bottom line is.


Linda Smith, former breastfeeding counselor for the state health dept.