Recently I posted (vented!) my frustration that a large local hospital is
requiring IBCLC *plus* RN (*and* 3 years OB experience) in their recent
job postings. I received a thoughtful reply which I am here posting to the
entire list. I received permission to do so from the author, and I am
actually melding two letters from her into one post.  While I don't agree
that RN should be required, I do think there are important issues raised
here that I'd like to see discussed in this forum.
~~~Margery Wilson, IBCLC

"I work as an RN LC (I am an IBCLC) and there is a good reason.  Let me
try to explain.   We work with babies within the first 24-48 hours after
birth. We are working with much more than feeding issues.  We are able
to assess babies' respiratory status, their general well being, and
because of our OB experience, we are able to get a feel whether the
problem is *just* a feeding problem or more serious.  Babies will develop
sepsis during the first few days, and they often don't feed well.  They
may have a broken clavicle (collarbone) and it may hurt to be positioned.
They may have been deep suctioned and have a sore throat.  These
ailments are not always picked up in the first medical exam.  The
assessment skills of an OB RN are uniquely suited to detecting these and
other non lactation issues.  While being an RN does not necessarily make
a good lactation specialist, neither does an IBCLC necessarily make a
good detective of these medical issues. The blending of RN/LC combines
them both and gives the mother baby pair the best chance of success.
        I hope that this all makes sense and gives you a better
understanding of the need for the best combination of skills.

     One more thought that has not been mentioned yet.  The RN's on the
floor have minimal direct contact with mothers and babies.  We have
nurses aides who do much of the duties once performed by the RNs.
That gives us RN/IBCLC's  concentrated time with the mothers and
babies and better opportunity to pick up on incidental  conditions that
might adversely affect breastfeeding.  We can then then work on fixing
them!!
        I hope that you see where an RN/IBCLC might be a benefit."