I would agree with Gail Hertz that the first place to start educating would
be the Emergency Department.  My experience in both working in the ER as an
Army Nurse and in having consultations in the ED is that the staff are more
than willing to learn about breastfeeding problems.  At times, they don't
know where to begin.  Some folks don't know that breastmilk and formula are
not equal.  Keep in mind that these are the HCPs that can move at the speed
of sound with an OB patient in a wheelchair so they aren't birthing babies
in the ED.  Obstetrics and, in some places pediatrics, simply aren't their
forte.  They are generalists.  The education they have received in cases
like this is about as much as we received in nursing school on OB, maybe 2
or 3 days of clinical experience.  Be sure they know what resources are
available in the community.  Figure out what diagnoses they see most often
in the ED.

For our area the most common diagnoses seen in the ED were dehydration,
hyperbilirubinemia, mastitis and failure to thrive.  At the time, the
closest IBCLC was many miles away so we did our best with the resources we
had (myself and another CBE along with help from our local LLLI chapter).
I inserviced the nursing staff about the nursing process when dealing with
these particular diagnoses and they were forever grateful.  If they learned
nothing else, they knew who to call if they needed help or had someone that
needed follow-up upon discharge (which all of these patients do!).  Even
the ED doctors listened with curious ears!

How do you approach the subject?  Talk with the manager of the ED, explain
the concerns you have, offer to do some training for them.  Your enthusiasm
and time invested may go further than you expected.

Good luck,

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources  http://www.childbirth.org/bbfr
Manhattan, KS  USA
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