Hello LACTNET,
I understand that I should first introduce myself: (BUT please don't miss my question which follows!) I am
Mary Kroeger, CNM, MPH, currently working in a fullscope midwifery/OB/GYN practice on Kauai, Hawaii. I only
recently returned from 14 months in Central Java, Indonesia, where I worked on contract with the provicial MOH
assisting with their "Safe Motherhood" and MCH activities. I was a member of Wellstart International's (San
Diego) clinical faculty 1991-1992 as the only regular obstetrically-based faculty they've had to date. At
Wellstart I was, among other things, very active in the development of the international (WHO/UNICEF)
critieria for "Baby-Friendly Hospital Initiative (BFHI)" as well as assisting with initial development of a
draft training course for BFHI. Then I worked as a staff nurse-midwife at the Birth Place, in San Diego, (the
largest free-standing birth center in the USA )from 1992-1995. In 1993-4 I represented NACC on the
Breastfeeding Expert Work Group in Washington, which was assisting the DHHS in the development of "United
States-based" criteria for BFH's.  I've also worked longterm overseas doing MCH, family planning and lactation
promotion in Belize, Swaziland, Kazahkstan, Somalia and shortterm in Uganda, Nigeria, Zambia, Indonesia and
several other Central Asian repulics. My particular area of interest and expertise is what I call the
"Eleventh Step" to successful breastfeeding: namely labor and delivery practices themselves. That's perhaps
enough. I am glad to join LACTNET!
Okay, now my question to which  I need an answer soon: I need examples of places where formal Hospital
Privileges (the privilege  to chart and to bill) have been granted tor RN/IBCLC's. The RN/IBCLC who works with
our practice does do rounds on all of our breastfeeding  patients, but she was just refused the right to chart
and have privileges. The reason given by the administration may be valid: which is that she is an employee of
our practice, but not on the nursing staff of the hospital. We suspect that this is a technicality, however,
and that basically the hospital doesn't want to set a precident with giving her privileges as a lactation
consultant. Send cases or comments to me privately at <[log in to unmask]> or publically through LACTNET .
Thanks and I am looking forward to participating. *** Mary Kroeger