Hi..I am a first- time poster.  I apologize in advance for the length of my
post.  I attempted to respond privately without success.

Judith, I work in an inner city hospital with approximately 2500 births per
year.  Barring illness, maternity leave or vacations, we have 24 hour, 7 day
a week coverage. As you know, night time is when most babies want to cluster
feed and when moms are most vulnerable to supplementing; so, even though,
the night shift can not be as productive in number of patients helped; we
find them to be very much needed and appreciated. Our goal is to see every
breastfeeding mom on a daily basis, and moms and babies experiencing
difficulties multiple times. This allow us to personalize our care, to limit
new info given during a visit and to reinforcement previously given
information.
     We had a much-needed second LC for 4-6 hours on weekdays, but budget
constraints eliminated this position several months ago.  We are going to
reinstate those hours by October 1.  Honestly, we could easily use a second
person 8-12 hours most days.
  Even though, we are covered by the mother-infant unit budget, we respond
to any need for breastfeeding assistance.  We have gone to ER, outpatient
surgery, ICU and the trauma unit.  We have facilitated babies spending the
night with moms on other units who are hospitalized for surgery,  accidents
etc. to continue nursing.
       An order is never required..it is an expectation on our unit. For
nonmaternity units, either staff or the resident calls us and we respond.
Sometimes, we find out because a relative of the admitted patient comes to
maternity asking for diapers and we just follow up.  We would then see that
patient on a daily basis as well.
       What has helped us a lot is the staff and patient appreciation for
lactation support they receive.  We have had patients say they chose our
hospital because of the availabilty of lactation support.
     We still have a long way to go to remove breastfeeding barriers for our
moms.
     In conclusion, what has worked for us is to just respond to any
breastfeeding situation in which we think we can be of value.  Because of
that, our role in the hospital has evolved into a necessary part of the
healthcare te

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