Alice asks for a way of helping staff determine if and when to refer to a
lactation consultant.
I am a hospital based LC. Our staff use a risk factor list. We identified
maternal and infant factors that would put them at risk for lactation failure.
Infant factors: SGA, IUGR, < 37 weeks gestation, cleft lip/palate,
consistently poor nurser, difficulty with latchon, down's syndrome,
jaundice, oral defect, multiple birth, NICU babies, and those who have lost
excessive weight by dismissal.
Maternal factors: abnormally appearing breasts/nipples, flat/inverted
nipple, previous breast surgery, previous breasfeeding difficulties,sore
nipples, first time to breastfeed ( either primips or multips that did not
breastfeed previous baby), teen moms, moms whose other kids are older,
history of infertility,
  PIH, diabetes, and chronic hypertension.
The nurses are instructed on this list at orientation and it is included in
our careplans. Our nurses are really good at letting us know who they are
concerned about now that they are use to the risk factor list. Hope this helps.

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