Marie sadly asks:

<< 1.  Did these VERY overworked and understaffed nurses get lazy because the
LCs
 are around?>>

Partly -- and partly because bottle feeding is so easy and doesn't take "any"
time, these nurses feel (I suspect), that bf isn't all that important.  It is
just something the mom wants to do.  If everyone taught bottle feeding the way
it should be taught, it would take as much or more time to teach it right than
it takes to teach breastfeeding.

<< 2.  Do you suspect breastfeeding isn't the real issue?>>

I sense a lot of anger here -- the LCs have a "cushy" job...while they are
REALLY working -- and it sounds as though they ARE overworked.  So in your
analogy of kick the dog, you are being the victim.  It's so easy to push bf
off to someone else that can do it while they do something else.  Include have
a cup of coffee....

<< 3.  Assuming staffing levels is the real issue what can an LC do?>>

Short of sitting down with the staff and administration and putting all the
concerns on the table and getting input from the "breastfeeding committee",
not much.  I'm afraid LCs are still looked at as the cream in a tight system.
While it is admirable that hospitals want to get "market share" the idea of
doing appealing things to get the market share doesn't mean much any more
since it is managed care that is driving who gets what patients.  "Luxuries"
such as LCs don't cut it in this cost containment environment.  Hospitals
want, of course, Cadillac service on a Chevy budget -- and is evident from
your post, don't want to pay you what you are worth.  I can't believe you are
making LESS than a staff nurse.  That's unconscionable!!!  Managed care
companies shoo their patients to the cheapest facility....

<< 4.  Does every mom need a lactation consultant?  (I remember an article
title
 like this somewhere.  If you know the reference please share it.  I need it
 for ammo).>>

Absolutely NOT.  The vast majority of what we do as LCs, any good nurse should
be able to do and teach.  The basics, such as latch on should be done by
anyone, and done correctly.  Why is it that breastfeeding is the one area that
is taught/managed "a la experience and opinion" rather than being evidence
based and tailored to meet the needs of the nursing dyad?  And of course, all
the interventions in birth -- but that's another story.  And what about the
"just one bottle" or "we're using the X, Y, or Z bottle for this baby, and it
doesn't interfere with bf, so don't worry about it.  (See my lead article on
this in the next edition of Clinical Issues....also read gnashing of teeth
here....)

<< 5.  Where should we concentrate our efforts: administration, staff,
specific
 individuals, moms, epidurals?>>

All the above??

<< 6.  Is this a common problem-- some sort of a life cycle in breastfeeding
 support?>>

I do think it is part of the cycle.  I find myself mopping up after lots of
dumb advice given to moms  by lots of well meaning HCPs.  Yesterday's mom
whose baby was a slow weight gain (16 ounces in 35 days) was put on the pill
at 28 days with assurances that it wouldn't affect her milk supply.  AND she
was following BabyWise.  The combo of the two was lethal, in her case.  She's
off the pill, and we worked through the BW #$%^.

<< 7. What would you do?>>

Open that bookstore, Marie.  Shall we do it in CA or IL?


 Any suggestions are greatly needed and warmly appreciated.
 TIA
 Teary eyed and ready to retire (Jan still what to open a book store?)
 Marie Davis, RN, IBCLC

Jan Barger, RN, MA, IBCLC -- in Wheaton....
  >>