In a message dated 5/7/03 4:12:45 PM Eastern Daylight Time,
[log in to unmask] writes:

> There are three of us IBCLCs who work in a hospital setting. We have about
> 1000 births a year and about a 60+ % breastfeeding rate--and growing. We
> see the mother-baby dyads in the hospital as "inpatients", and then again
> two days after discharge as "outpatients" for a breastfeeding assessment.
> All was going well.....parents reassured and delighted, physicians
> madeknowledgable about the baby's condition and any interventions
> necessary..

If it ain't broke, it is so sad they have to mess with it!


> Now, it turns out that our boss has been told that the hospital will no
> longer receive insurance reimbursement for the majority of
> those "outpatient" visits. In fact, it seems that all of the breastfeeding
> moms will first receive an in-the-home VNA visit. If there are any
> breastfeeding problems, then they will be referred to us.
> These VNA nurses are great, but they are not IBCLCs and will only receive a
> short training session on breastfeeding from us before this program is
> launched.

On the bright side, this is better than nothing. I'd really hit hard on s/s
of "ineffective" BF during the training session with the VNAs. Perhaps
they'll have better identification of problems and refer more.

> Our boss did suggest that we might be able to do the initial outpatient
> assesment of mothers with "breastfeeding issues" She could not define that
> very vague term and asked us to.

Is your boss a nursing manager/director; is her background in nursing? If so,
she should be familiar with NANDA definitions of "effective," "ineffective,"
and "interrupted breastfeeding, as well as that for "infant feeding
difficulty." She also should be familiar with NIC/NOC (related to
interventions/outcomes) for breastfeeding. If you want some of this
stuff/criteria on PP slides, send me a personal email.

Really and truly is there even ONE newborn we could confident may be labeled
re: Effective BF at discharge? Although all the positive behaviors may be
present, all the outcomes generally cannot be. The best we can usually call
it is "Potential for Effective BF" = maybe, but can't rule out problem at
this point. Therefore, many others are "At Risk for Ineffective BF" or
actually should be "labeled" as "Ineffective BF" = high risk for problem or
actual problem. So how many newborns in today's USA hospital goes home and we
can SAFELY say is without a BF problem?


> What I am asking you, is what would you consider an "issue" that merits a
> real, genuine bonafide IBCLC?? To me, just about anything can so easily
> become "an issue" : sore nipples, poor latch, engorgement, weight loss,
> twins, etc. etc. etc. Does anyone else have a similar program that does
> receive reimbursement? Can anyone give me some research articles that might
> help to support or present services? I worry that the moms will not get
> enough support; that they will give up breastfeeding; that babies might
> have to wait to be seen by one of us--when there is already some trouble
> brewing...

I may also have a ref list related to those slides mentioned. Email
personally and I'll send.

> And why the urgency?? Because our deadline is in two days: come up with a
> definiton of "breastfeeding issues"!
>

Did they really drop this on you with two days to "deliver"? Even if the two
days are up before you get all you need, I'd keep plugging away on this. Why
can't you get a doc to sign off for the outpatient visits?

Karen G

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