In Lactnet, Janice said: 

"Even a PHN with an 18 hour breastfeeding course behind her, in my mind, has
NO BUSINESS dealing directly with issues that centre aroun breastfeeding.
  
Why?  Because by the time the mother presents to her, it's too late.  If
that mother has already added a supplement, what is the PHN to do?  I'll
tell what I hear her do in my community:  "Oh...okay."  What other choice
does she have?"

I have to respectfully disagree with this statement.  In our county
(Northern California, USA) we have Public Health Nurses that do a LOT more
than say: "oh...Okay."
 
* they teach moms how to use nipple shields or SNS or if necessary paced
bottle feeding techniques to help baby eat(#1 FEED the baby)
* they arrange for a WIC breast pump - often going to WIC, picking it up and
taking it to the mom (#2 PROTECT the milk supply)
* they provide education on how to pump(#2 PROTECT the milk supply)
* they help the mother improve latch, utilizing tools such as nipple shields
or Starter SNS if needed (#3 FIX the breastfeeding)
* they arrange for me to make a home visit WITH them so that they can
continue to learn and improve their skills

YES, at times they get to moms too late - we're working on addressing those
issues...  BUT they do their best to prioritize the breastfeeding moms and
get to them as soon as possible.

There are not enough PHNs to do the job, and other breastfeeding support
systems need to be developed.  BUT to say that Public Health Nurses don't
want to or can't provide the first-line of interventions in relation to
breastfeeding is to diminish the great service they can and do provide when
given the tools with which to accomplish it!

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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