OK, on my soapbox!!!
I spent several years ( a number of years ago, before there were
readily-available 1-wk courses) as the hospital's designated Lactation
Specialist; my position was designated "Patient Education and Discharge
Coordinator", and I was an RN whose only credential for the job was that I
was a natural-born teacher-type, interested enough in BF concerns to take
the time to follow through with new moms, and vocal enough to make a little
noise about harmful and antiquated BF practices. I had no particular
education or training in lactation (other than my own & that which I gained
on the job as staff OB nurse), and not only was I repeatedly refused funding
to become accredited as an IBCLC, I was actively discouraged from doing it
"on my own". (Why? What were they afraid of?) New York State requires every
hospital to "designate" a lact. specialist, but they don't (or at least
didn't - has this changed?) require any particular training or standard of
certification. In other words, the Flying Fickle Finger of management could
land on anybody and say "you're it". I ask you, does this make a nurse a
Breastfeeding Specialist? (I won't even go into the horror stories here - we
all have heard them, I'm sure!)

So I was "it" for BF concerns; my job was to deal with ALL the BF problems
(most of which, not surprisingly, were new-mom problems), teach the little
"infant care and feeding" class all moms were required to attend before DC,
be sure all moms were taking babies home to nice, safe, happy families and
arrange social service consults for those who weren't, coordinate
post-discharge follow-up with community agencies, be sure that all babies
went home in an approved car seat, write care plans on all moms/babies
appropriate to their needs, provide continuing ed for staff, etc., etc. -
PLUS carry, at the same time, a regular "patient load" (as we call it in the
biz). Often including being in charge of the "unit", being the
"narcotics/med nurse", doing admissions and pre- and post-ops, and right
down to picking up laundry & emptying waste baskets at the end of my shift.
I was required, on the one hand, to serve as educator and resource for BF
moms, a full-time job in itself, and at the same time carry out every single
duty of a "regular" OB nurse (another full-time job).

Does this make sense to anyone? Do we see why hospital LC's don't always do
the job the way we all know it should be done? By the way, the hospital's
ultimate resolution of my concerns about this was to eliminate the "Pt. Ed.
&DC Coord." position; I had done such a good job of peer education with the
staff that an "expert" was no longer required, as all the nurses were now
equally capable of ensuring that BF would proceed smoothly for one & all.
Well, of course I quit, and would not go back into hospital nursing, let
alone hospital LC'ing, for anything, but what I want people to understand
out there in Lactnet-Land is how incredibly poorly-defined the job of LC can
be in a hospital setting. I am hoping that things have changed since then,
but this wasn't all that long ago (I left in '93). I know that that same
hospital has not significantly changed its way of doing things (although
there are 2 self-motivated IBCLC's on staff now, there still is no official
plan or position in place for BF), and even in these days of 24-hr. DC has
no follow-up plan for its new moms - no DC nurse, nothing except a reliance
on the public health nurses to make phone calls. Since the public health
department is where I went after I left the hosp., I know exactly how
haphazard that can be despite the best intentions and some of the best
nurses I've ever seen anywhere...

What's my point? Just that any individual could be the Mother Mary of all
Holy Milk, IBCLC, RN, BSN, PhD herself, but that if her employing hospital
doesn't support an appropriate staff position it will remain a hazardous
hit-or-miss affair for the women and babies the hospital "serves". Maybe the
"lactation nurse" will be off on any given day (or God, forbid, even on
vacation), or maybe she will be unable to care for a given woman who needs
her desperately because she's tied up taking care of another woman's
postpartum hemorrhage or other crisis, or perhaps she's been "floated" to
the endoscopy unit (I'm not kidding!) where she's "a pair of hands" (and,
trust me, all you who have never worked in a hospital, this happens all the
time - I know about as much about doing colonoscopies as most proctologists
know about breastfeeding!!) Hospitals must be held to a better standard of
accountability than this, and until they are, the best set of credentials in
the world won't do a thing for our moms & babies.

Cathy Bargar, RN, IBCLC (thankful to be out of there!!!)