I've been mulling over the concern others have of connecting our profession
with products.  It seems to me that each profession has products that are
connected with it.  Teachers recommend computer programs that will help
students just as they told me long ago about books and literature that
would help my kids.  Doctors use different equipment, ophthalmologists not
only prescribe but also have glasses and contact lenses to order.  

I am afraid that if I tried to be a "pure" professional I would  in effect
be reducing my effectiveness.  

When I began to work in a hospital in 1995 I found that Moms in the
hospital had no ability to go out and get the equipment they need if they
have a baby who is too sleepy to nurse (very often here in my hospital) or
is in NICU.  Dad or a friend was called to bring a pump, but the pump
usually arrived they day she was leaving.   Most were going home without
the equipment they needed to maintain a milk supply, I could not teach them
how to use it, and babies were getting lots of bottles " until the milk
comes in". 

I finally went _begging_ to the executive director who "found" enough money
for me to have some double pump kits and a Lactina for the floor.  Since
then the  process is as follows.  If baby is unable to nurse for whatever
reason, she is informed of the need to express her milk.  We offer
information on hand expression and  pumping - and of the availability of
equipment on the floor.  If she wishes to have her husband or a friend
bring a pump, that's fine.  Lactinas and one classic are on the floor on
wheels and I have found them to be effective for the needs of our
population.  We have the double pump kits for sale but the use of the pumps
is free.   Moms see milk coming out and get more persistent with their
babies.  Yes, we try to teach them how to deal with a sleepy baby and how
to feed their baby until they wake up - but better to feed them expressed
colostrum than glucose water or formula.  

In my prenatal classes I show them some pumps - good and bad - and
recommend they wait until they have their baby to buy one.  This way they
won't say I sold them a mini-electric and then told them later they needed
a Lactina due to  a baby in NICU.

Products on the floor?  Yes, I have everything from Pure Lan,  to nipple
shields - and even hobbit shells which I find can be helpful with the large
number of inverted nipples we have in Puerto Rico - especially when they
use them inside their bras during day 3-4 for engorgement.  Yes, hand
expression would work - if they would let me touch them!  

(Not that it matters, but the profits of the sales goes to a non-profit
corporation, not to my salary or to the hospital, though the corporation
gives 10% of sales back to the hospital - a small amount considering they
provide a suite of offices and telephone service.  I get paid a set fee per
hour by the hospital when I am seeing moms, whether I sell them equipment
or not...) 

I would just ask that I not be judged except by those who "walk in my
moccasins".  Each hospital, each city and each culture has its own problems
and the solutions may not seem logical to those not actually there.  Just
as there are a million ways of raising lovely children or having a great
marriage, there are many ways of being a professional lactation consultant.


I truly enjoy reading and hearing of solutions you have all found for
different problems.  Perhaps I will not use them today, but I will file
them in my head for possible later use.  The creativity of those LC's who
came in 1985 and had to run without any of the new products has to be
commended (I started then, also, and was running by the seat of my pants
for many years).  However, as new products and ideas come up, I want to try
them, and just like LLL said to me as a mother: use what you can and leave
the rest...

Jeanette Panchula, BSW, RN, IBCLC
Puerto Rico
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