I've been following these two threads with interest, and I have a few
comments.

Re the pumps, we do give each mother a M--- manual pump to take home, if she
wants it.  It is a charge item, but our billing office agreed to charge only
$25, since that was the going rate in the community (occasionally they will
do this), so I don't feel we're "gouging" anyone, as the pump is better than
most of the inexpensive manual and battery pumps available over the counter.
 Our booklet of information states that using a pump is a learned skill, that
most women get better with practice, and we advise exclusive feeding at
breast for at least three or four weeks.  Occasionally a mother will say that
she doesn't have any milk because she couldn't pump any in the first few
days, but quite a few more moms have been able to use the pumps to relieve
temporary engorgement, or perhaps for sore nipples, until they can get in to
see one of us.

Many working women can't afford to buy an electric pump like the Nurture III
or the Pump in Style, so at least they'll have a decent hand pump when they
do go back to work.

I've found that most mothers find hand expression difficult initially, even
when they're taught how, and I think they're just as apt to think they have
no milk after trying hand expression the first time.

The final reason is the one I find hardest to justify--it's a sad commentary
on our materialistic society.  Our policy states that no formula packs will
be given to nursing moms at discharge, but the nurses think bf mothers are
being "deprived" by not getting this wonderful free gift, especially if their
formula-feeding roommate gets a nice little diaper bag. The pump makes the
staff a little happier about not giving formula gifts. I don't like it--I
think in black and white--but it's a compromise I can live with, at least for
now.

Re the posters who say they didn't study much for the LC exam. I'd bet those
people are the ones who have a *lot* of practice hours in addition to having
stayed current with breastfeeding info over the years.  I don't think most
people could pass the exam without a solid background in a clinical setting
of some sort.  I think the slides might do them in. ( On the other hand, I
doubt that someone with years of clinical experience as a nurse, for
instance, but no particular interest in breastfeeding, could come close to
passing, either.)

Judy Dunlap, RNC, BA, IBCLC