I agree that many US LCs are only able to use a bandaid approach. I'll give 
some very sad examples. I have a good friend IBCLC, who has excellent 
clinical, listening, observational, and counseling skills. She works in a 
hospital setting with other good IBCLCs. The way they operate is to get a 
list of all BF dyads and see the ones with a 10% weight loss first. If BF 
support was really in place (it's not) there would probably be no 10% 
losses. Her caseload is very large, and includes many premature infants. My 
work setting is less intense, and fortunately, I can't remember having a 10% 
loss prior to hospital discharge. She runs around trying to put out fires 
and catch the moms who are going home.  My friend is allowed so many hours, 
but often clocks out and stays on her own time to continue helping moms.  
All the LCs are trying to change the system, and have been for years.

I often get moms who are ready to go home, but the baby is not BF well or 
even not at all.  If the baby is taking 15-20ml from the bottle, everyone 
seems happy and feels like all will be ok. If I can catch the situation and 
get to the doctor before the discharge, I can usually get the pair an extra 
day, but often the parents want to go home right then. Often, they have 
traveled an hour or more to get to our rural hospital and state they cannot 
come back in. They sometimes have another pediatrician in another town or 
city that they are planning to followup with in 2 wks! What can you do in 
this situation besides a bandaid approach? Try to get them to stay and 
observe/assist and give them a plan and follow-up if they'll come. 
Typically, USA hospital LCs function as primary, secondary, and tertiary 
providers of BF care and they function within a larger culture of 
non-support. Don't even try to get a tongue-tie evaluated, much less 
clipped.

I've just finished making some folllow-up calls on BF duration at approx the 
3-4 month mark. The vast majority had weaned between 2 and 4 weeks. One 
mother was still BF. This is so very frustrating.

Laurie Wheeler, IBCLC, MN, RN
Rural Mississippi, s.e. USA

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