Have been lurking for some time--first post.  I am Barbara Carter, BSN,
IBCLC since 1989.  Was working OB for 2 years after being certified and
trying to convince our hosp. that an LC was needed.  Finally landed the
position in 1991.  We have expanded as of 18 mo. ago and now have 3 FTE's for
6500 deliveries/yr.  Want to address Jennifer's post on supplementation.  We
instituted a protocol about a year ago to reduce the number of readmits to
NICU and therefore, reduce costs and separations of mom and baby.  When a
baby reaches 7% loss, we encourage q 2 hr. feeds while awake.  If baby
refuses to BF, we have her pump and syringe or cup feed any colostrum.  At
discharge, we recommend a pediatric follow up appt. within 48 hrs.  If a baby
reaches 10%, we have her supplement with 15cc colostrum (if available), or 15
cc formula after every BF, again using cup, syringe, or finger feeding.
Bottle is last choice.  We do not use banked milk.  Pediatric f/u appt. for
weight check should be in 24 hrs. after discharge.  A mom can refuse our
protocol and we do not insist on it especially if she feels breast changes:
fullness of milk coming in.  We tell her to do this until milk in and she
knows baby is able to transfer it.  This has greatly reduced NICU readmits
for dehydration, jaundice.                  Hope this helps--let me know if
you need more info.
        Barb in NC

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