All the varied replies about doing hospital consults have been quite an
eye-opener and some of you work under almost unbelievably hostile
conditions! I have been offering hospital visits for nearly 8 years, mostly
at one private hospital, but with increasing frequency at another new one,
and rarely at two more.  Before I opened my doors, so to speak, the first
thing I did was to go around and introduce myself to the doctors (GPs)
paediatricians and obstetricians most frequently used by the LLL moms I had
been in contact with. One of the OBs said that I would need "right of entry"
(hospital privileges?) to visit in the hospital, promptly phoned the matron
of the private hospital, set up an appointment for me and advised sternly
that I would have to "sell" myself. The interview was nerve-racking to say
the least. This lady clearly does not believe that mothers need help to do
what should come naturally, but she agreed that I could visit in her
hospital so long as I did not upset her staff who were, after all, midwives.
I followed the same procedure for the other hospitals as they opened.

Referrals are received via the OBs, the paeds, ante-natal classes, and often
from the hospital staff themselves (nearly always the "last-resort" ones).
I make maybe 4 - 5 hospital visits per week, and sometimes go in to see one
mother and end up seeing 3 because I just happen to be handy.  Sometimes the
mom phones to make the appointment, but frequently the staff phone.  I try
and respond *very* promptly.  In the last couple of years I have been
invited to write in the patient notes so that there can be no
misunderstanding about observations/recommendations.  I am *very* careful
not to upset the staff! while at the same time being very careful to be the
mom/baby advocate.  It helps that we're all working towards babies being
breastfed, but occasionally methodology differs and mothers continue to
receive conflicting advice.

Although there is plenty of scope for conflict and/or professional jealousy
I think I can safely say that there is almost none.  Maybe it helps that I
am not a nurse - this makes me very respectful of all that training and
knowledge that I don't have!  But, having satisfied the protocol in terms of
being let in to the hospital, I feel relatively welcomed when I go in
whereas I know that when an occasional LLLL goes in (at visiting hours) and
the staff become aware of it, there is always resentment.  I can visit out
of ordinary visiting hours and not have to compete with friends or relations
and other interruptions.  I can also visit when the doctors do their rounds,
and discuss with them how they want things managed etc. and this seems to be
a good form of PR too.  Hospital staff see the value of being able to shift
responsibility for the success of breastfeeding on to someone else, or being
able to call me when they are busier than usual.  I *always* try to obtain
the opinion of the nurse looking after the mom/baby couple before I see
them, and report what I found/did/recommended on my way out.  Often we share
the same exasperation at first and the same enthusiasm when things come
right. I find that coming from the position, "we are part of a team" is
helpful. Sometimes I make special requests, "Mrs XX might need a bit of
*extra* help with latching, would you be able to help her?" sort of thing. I
am sure to pass on complementary remarks, "Thank you for helping Mrs YY, she
was so grateful". The staff also know that I do the home follow-ups too. It
works.

So to anyone planning to offer consults in the hospital - IMHO it would be
best to go through the "usual" channels, and yes, even pay for the
privilege.  I couldn't imagine how stressful and demoralising it would be to
pretend to be just another visitor.  This is a wonderful job and one of the
great things about it is acting (and being acknowledged) as a professional,
part of the team!  Just my .O2.  Best wishes.

Pamela Morrison IBCLC, Zimbabwe
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