Yesterday I attended our Fall Women's Health Update at our regional office (
North Carolina Dept of Health and Human Services).  The first speaker was
discussing contraceptive news when someone asked if Depo was being given by
all home visiting nurses. Some depts are doing this and others not, depending
on whether the hospital gives it before discharge. I asked for an
explaination and the consultant said that home visitng nurses now  could give
the Depo shot at the first postpartum home visit if the mom didn't get it in
the hospital. When I  expressed concerns about the effect on Breast milk
production,  she said that American College of OBstetrics/gynocology and all
the other professional organizations had approved it's use in breastfeeeding
women because there is no scientific research supporting any effects on milk
production. And the  health risk  of a mother getting pregnant 2-3 weeks
postpartum is getter then the risk of a decreased milk supply. So postpartum
women on Medcaid in NC are getting Depo either in the hospital or at the
first home visit. And they wonder why bfing rates are so low here.
I did a presentation (2 and 1/2 hrs) on Supporting and Encouraging Our
Clients to BF. This meeting was for health dept nurses and mid-wifes.  I
think it was well received. Lots of input and questions. I started by asking
who had received formal bfing education in nursing school-no one had. I asked
who had attended any bfing  workshop or continuing education programs and  5
had ( out of 20) and 3 of those were from my health dept where I have done 3
inservices in the past 5 yrs!
I went over the county's stats across NC and compared those to the 1994
stats. Not much improvement. I also discussed certifications--what IBCLC
means,  and what is a Lactation Specialist ( the title the hospital uses )
and also the difference between a LC and IBCLC. One hospital in our region
has a nurse /lactation consultant title who is not IBCLC.
We discussed the 10 Steps to Supporting a Parents Choice to BF ( AAP packet
-very good) and watched the Loving Support PSAs with those adorable babies.
We discussed how to be a supportive health dept without having to spend a
dime
( start with smiles and praise from staff, a seating arrangement in the lobby
which is convenient  to nursing ( even just small U shaped grouping of
chairs, not long rows), and posters and handouts illustrating bfing).
I ended with a role playing of counseling situations, including one with five
people working on developing a bfing policy for a small health clinic with a
very enthusiastic health director who supports bfing wholehardedly and a
reluctant nursing director who doesn't want naked mothers flopping out boops
in the lobby. That one played very well and illustrated the point that it
doesn't matter what our personal beliefs and practices are, we need to
implement a bfing friendly policy because that's what is best.
When my computer crashed this spring, I lost all my bfing presentations. I
had paper copies but no back up disks ( I know, I know, My husband told me
about that one!). So I am redoing all my presentations which is taking alot
of time but they are turning out good, with totally current and up to date
info and new formats. So many of you have taught me new ideas, and gave me
good references--I feel your presense when I am teaching.
Last week, I gave a 2 and 1/2 hr program at our Area Health Education Center
On Postpartum Assessments for  Home Visiting  Nurses. I was sandwiched in
between baby assessments and maternal assessments, with a lunchbreak  in the
middle. I agonized over whether or not to use powerpoint and decided not to
use it because I like to have audience participation. I used videos and
lectures and demonstrations as my teaching tools. At lunch  3 people  came up
and said they were so glad I wasn't using Powerpoint because that is so
boring. And they said they enjoyed hearing what the others in the audience
had to say. There were 45 in this audience so we could easily talk.

Barbara Whitehead, IBCLC
Eastern NC

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