Laurie and All:  I echo your sentiments, Laurie.  Yes, breastfeeding is normal 
and natural, but we do not live in a normal, natural world.  And not everyone 
thinks like most of us.  I was initially quite taken aback at a comment made by 
our unit secretary this morning:  "Breastfeeding is normal?  I thought 
bottlefeeding was the normal way to feed a baby!  When I had my babies 36 
years ago, I was told that formula was just as good as mama's milk (she hails 
from the Deep South) by my doctor, so I didn't even think about 
breastfeeding!"  She was not being defensive or argumentive - she was 
honestly surprised at my statements.  She was also shocked that many of the 
daily recalls posted on the FDA's (US Food and Drug Administration) website 
are for contaminated formula.  I think we both learned something valuable 
today.
We all come to breastfeeding management from a wide variety of 
backgrounds - I think we all need to remember that we need to practice at a 
level within our comfort/education zone.  I could not even imagine stepping 
foot into the hospital setting to practice lactation without my medical 
background.  I approach hospital breastfeeding management from the point of 
view of:  How do I help a mother achieve her breastfeeding goals within the 
framework of a medical diagnosis (hers or her baby's)?  And, sadly, I have to 
agree with Laurie in that here in the US there is no such thing anymore as 
a "natural normal" birth.  My practice setting is about as different as you can 
get from Laurie's.  I work with primarily upper-middle and upper class white 
married women - LLLI's definition of the ideal breastfeeding population.  My 
breastfeeding initiation rates are 93% - one of the highest in the Chicago 
area.  My dilemma is how to increase duration beyond the 1st few months - 
many of my moms are stay-at-home and in an ideal position to go for 
extended nursing.  My population is also very well educated and informed and 
has a large disposable income.  They are ripe for the product manufacturers' 
picking.  If an item is out there, they buy it whether they need it or not.  I 
struggle to help them understand that breastfeeding is a normal, natural 
process, not something that is medically or economically driven.
One of the reasons I feel that UCLA's Lactation Training Programs were never 
widely copied by other colleges/universities (which was the original intent) is 
that the 2nd part of the program is restricted to licensed health care 
providers.  One of the requirements of this course is to see/work with a 
minimum of 100 babies with a variety of medical diagnoses (many quite serious 
and uncommon), which means the LC needs to be closely working with other 
members of the medical team and, honestly, we are not there yet as a 
profession.  It is expected that one would also be managing breastfeeding 
within the scope of practice of one's license.  The UCLA faculty feels that 
when the student is seeing one of these babies, one is in the medical setting 
and needs to be practicing under a license.  Nursing and medical students, 
when in school obtaining their degree, legally practice under their clinical 
instructor's license.  I recently received a phone call from a prospective IBLCE 
candidate who wants to pursue Pathway F.  She is having difficulty finding a 
mentor and asked if I could mentor her.  I'm having some difficulty with the 
hospital with this because she is not a licensed health care provider.  If I am 
able to mentor her, she will be practicing under my license while doing her 
clinical time with me.  This is a very gray area legally and one that not many 
hospitals are willing to go to.
One of the fun aspects of my job is that I DO get to do the LLLI stuff too.  
One of the most valuable services we offer is a weekly moms support group - I 
call it Baby Bistro.  It is totally run by the mothers themselves - my function 
at the group is to hold someone's baby if they have to go to the bathroom or 
to take one of the twins, when we have mothers with twins in the group.  But, 
the managers do not see this as a necessary service and I have to struggle to 
keep the group in place from year to year.  This is nothing new to LLL leaders.  
The consistent feedback from moms is:  "If not for this group, I would not 
have nursed as long as I have."  And, "I live for Fridays and group!"
Sorry for the length, but I'm trying to survive the attempt by new managers to 
take giant steps backward, instead of forward!

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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