Diane H.: I am so sorry to hear about your mom.

I have been thinking about the issue of working as an LC for some time.
I had a small pump rental station, and was working as a OB RN in our
local hospital.  There is no active LLL here or other type support group.
I live in a rural area and geography is a major issue (people are really
spread out).  For a time, I was doing okay with pump rentals and even
getting paid for some lactation consults privately.  My work in the
hospital was considered part of my nursing job and I never could persuade
them to bill for it. I saw mostly inpatients. I could see outpatients but
the hospital was not interested in charging for or promoting this
service.  Since my income was mainly from my job, at least, the financial
aspect was not overwhelming. Though I do lots of phone support and stuff
now, I had to close my pump rental business as I went to grad school and
got too overwhelmed.

 I am wondering for Diane, and maybe
some others who are independent and looking for ways to expand, have you
considered hooking up with a midwifery practice if one exists in your
area?

 I am also wondering if there are other nurse-midwives lurking out there
who combine or integrate LC services into their practice.  I am presently
in limbo. I just passed my comps and am now a graduate of CNEP (the
Community-based Nurse Midwifery Education Program thru the Frontier
School of Midwifery and Family Nursing, Hyden, KY), and am in the process
of completing the last class needed to attain my MSN so I can practice in
WA State.  I am not sure the shape or form that my practice will take as
of yet but always assumed lactation consulting would certainly be
something that I would continue to offer as part of my service.  It
seems like such a natural extention of nurse-midwifery.  However, it
has occured to me of late that it might be nice to have another person to
work with who could make breastfeeding support their primary focus as
this can be a time consuming activity and nice to be able to share once a
practice becomes busy and successful (my preceptor has an extremely
busy practice and loved that I was an LC
-- she could refer all the bf'ing stuff to me which helped lighten her
load  while I was at her site).

However, I have some concerns about my ability to get reimbursed for
lactation stuff. We have a high percentage of Medicaid clients in the
area but was one of the early counties on "managed care". The insurance
co. doing the managed care for Medicaid considers electric breast pumps
rentals for moms with hospitalized sick or premie infants "a luxury" and
won't pay for those, and certainly won't even acknowledge lactation
consulting.  It has been a real hassle. If someone has specific how-to's
or thoughts about billing and actually getting paid, I would be most
appreciative as this area always frustrates me and overwhelms me. You
could email me this info privately ([log in to unmask]).  TIA.

Ione Sims, GNM, IBCLC