Diane and all:

As a home health LC/RN I felt I had to comment.  What you describe is quite
common, which prompted me to approach a local agency and offer my services
as an LC.  In support of my ob/ped staff, I must say the have been just
wonderful with respect to lactation.  What has helped (in addition to a
supportive administration!) was taking the BFHI 10 steps and mildly revising
them to suit home health for a starting point.  Additionally a general
policy was written which includes both of Marsha Walker's (Thank you!!)
_hazards..._ articles, the WHO code for marketing br milk substitutes, and
it basically elaborates on each of the 10 steps.  My staff is in the process
of completing the 18 hr course - we are doing it in bits - we can't afford
to take them out of the field for 3 days!  They also do one-on-one with me
for consults for a period of time.  Another OB consultant and myself are
snailing our ways through the referral sources - providing education to each
group's staff about bfing and our services.  One other little, but I feel
important, aspect of the program is my informal award - The Bosom Buddy
Award - given monthly to the nurse who's contribution to a mom's/baby's
bfing experience was exceptional.  The nurses love it!  (I haven't thought
of an appropriate token for this award yet!)

Is anyone else out there in the home health arena as an LC?  What have you
found to be helpful?  I would appreciate the input - this field really is a
growing one!  Don't give up on home health ob nurses - mine are wonderful -
they just needed a bit of education!

Debbie Shinskie RN CES IBCLC
Private practice, home health, education