Mardrey

I appreciate your concerns re trying to 'assign' a pt a particular
complexity category. In my experience, doing this in nicu as an RN, the
levels changed shift to shift. What I believe we are going to be doing with
breastfeeding dyads is more of an 'after the fact' assigned level.

Like Mrs. J needed basic bf review, she's a multipara who has bf 2 previous
infants. I generally do not spend a whole lot of time w/ these moms but
review and bring them up to date on medication issues, resources, support
groups etc. This type of pt would be a level one. This is not to say that
she could have a tongue-tied infant and that would certainly put her in a
higher level or her infant could be preterm. Certainly one experienced
multip may take more of my time than another exp. multip, but you get the
picture. In general, a primip or a multip who has never bf an infant before
would be a higher level than Mrs J.

A mom w/ a premie, a mom w/ breast reduction surgery would be higher level.
Today I had a mom who is planning to bf her second baby. She did not bf her
first 11 yr ago. She had postpartum hemorrhage, DIC, and is in ICU. Her
nurse pumped her breasts for only a few minutes one time today. She is very
very weak and has recieved many many units of blood. This is a very high
level of complexity, I would be thinking level 4 here - requires a lot of
support, instruction, and followup.

My low level pts get a routine f/u call or some I even have 'call me prn'
(as needed) - I give them the option of a f/u call or they can call me. Most
exp. multips will elect to call me if they need to.
Hope this clarifies what I think we are going to develop. Thanks for any
replies. [3rd post, goodnite.]

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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