I carry a scale, and in the trunk keep a box with SNS, a few Haberman
feeders, and a lot of nipple shields.  I have non-latex, non-powder gloves
and periodontal syringes in my bag, and some freq. used hand-outs on my clip
board.  I actually find that carrying my copy of The Breastfeeding Atlas
helps me teach positioning and latch, and it often reassures moms to see a
picture of someone else with their problem.  That's about it.  I don't carry
gv or APNO, but direct moms to store to obtain.  I don't feel comfortable
applying it as I am not an RN or MD.  Not having an office anymore has
really made me realize that most of the "equipment" I need is in my head and
my hands.

I realize that renting and selling pumps has traditionally been the way most
LCs (including me) have supported their work of counseling mothers.  I've
had some concerns for years about our profession linking itself too closely
to retail.  Unless the retail is the part one especially enjoys, I think it
places our emphasis in the wrong direction, and doesn't entirely look
professional.  Plus  I've come to believe it's stratigically a bad idea in
terms of business planning, because the pump companies have more concern
with their own bottom line than with the fate of our businesses.  With the
advent of the Pump in Style and Purely Yours, the rental business went sour,
and now those pumps are going into discount stores.  So the LCs who have
depended upon those sources of income are facing losses.  While it is nice
for working mothers to access that equipment directly, it is a problem when
the mother needs a clinical grade pump and thinks one of the commercial ones
will do the same thing.  Plus, they get shared all over the place.  There
are prob. 2-3 users for most of the Pump in Styles I encounter in people's
homes.  Women share them with neighbors, co-workers, and family members, and
that problem  can only get worse when the pumps become widely available in
more stores with no counseling provided on their use. I had a mom two weeks
ago who bought a PNS over the internet and her husband had the tubing
plugged in on the wrong ends (he had the LOOSE ends  of the tubing jammed
into the holes in the back of the breast shield!)  There was virtually no
suction even on high, and she had been using it to try to manage engorgement
and get milk to feed a 37 weeker who was so scrawny by the time I got there
it was scary!  He was a lawyer -- hardly an idiot.  They just didn't know
the difference.

 Consequently, unless the LC lives someplace where there are no retail
outlets that currently supply slings, pillows, etc, I think we are smarter
to emphasize the service and consulting aspects of what we do.  It's
ultimately the niche we could really control, and that's where I've chosen
to stake my claim.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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