Mary,
In response to your message, I agree that ethically we, as a profession, need
to service the poor.  Again, I restate that I do have respect for the
volunteers.  In fact, I'm presenting to my local group in June for
leaders-to-be.  But, since my role is that as a private practitioner, I do
charge for my services.  However, the point I wanted to make is that many of
us who do charge for services will indeed make exceptions and use a sliding
scale payment fee for women who cannot afford our services.  Ethically, I
feel I have an obligation as a professional to either provide the service or
refer her to another affordable resource (ie. free services at the area
hospital or LaLeche).  I have done all types of offerings....paid services,
complimentary (free) services, referral to the area hospital, and LaLeche.
I'm lucky because I reside in a fairly affluent community, so many women can
afford my services.  But, a few weeks back, for example, I serviced a woman
with latch-on difficulties and unresolved, severe engorgement as a
complimentary service because her husband had been laid off from Arthur
Andersen in St. Charles, Il as a result of the Enron stuff.  So, I just
wanted to clarify that though many of us charge a fee for services, it is
indeed done compassionately, and allowances for need can be made.  Perhaps
the payment thing merely stems from our market analysis of our service area
just like any other business...
Sincerely,
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
Geneva, Il

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