Hi Melissa:

You ask:
>I'm wondering how some of the rest of
>you work within hospitals as a private practice LC? How are you paid? Do you
>see every mom or just problem moms? (Moms with problems, that is.... :-) )
> How do you handle differences of opinion with hospital policy

I realize my situation differs totally from that which you face in the U.S.
due to differences in the structure of the medical community AND the
insurance/malpractice customs. Nevertheless, I will share with you the way
I have been surviving here:

1) At this time, no hospital would actually hire an LC 'cause they don't
know what one is, what we do, etc. LC-ism is, in Mexico, where it was 10
yrs. ago in the U.S. when ILCA, IBLCE, and all the rest got off the ground.

2) I have permission from the directors of several private hospitals to
"cruise the halls" <smile> and visit the new moms, offering my support (and
services, hint). My usual routine is:"Good morning, Mrs. X, I'm the
Lactation Consultant. Will you be bfding your baby?" (Usual answer is yes,
or..yes, but I have no milk yet...blah,blah,blah)  I may show her via
hand-expression that the calostrum is lurking , much to her surprise.
Inform her that I visit all the moms, and if she would like an orientation
bed-side that takes approx. 45 min. we can schedule a time...either that or
if necessary, I do house calls once she is at home. At this point she, or
her hubby usually inquires about the cost of my services.

2) Fees: I charge the patients directly, in cash. My fee never comes
through the hospital or from a ped....but directly from the patient.

3) I also get occasional referrals from peds or ob's (gradually increasing,
Thank the Lord). I charge the patient directly in these cases, too.

4) At this time, there is no need for Consent forms (Malpractice is almost
non-existence here in Mexico), nor for referral reports back to the
doctors.
In fact, the Docs. would be blown away if I did this.

5) I DO phone the referring meds. re: the patient, what I saw, recommended,
etc. and they seem duly impressed (and even surprised) by this attention.
In the near future I plan to design myself a simple report form to give the
doc. It won't kill me to do this, and will certainly make a positive
statement about how seriously I take my work. Plus, I'll be educating them
on problem-solving techniques which will eventually benefit their patients,
right?

Note:  You are all an inspiration to me...You make me want to be more and
more professional in my activities.  I feel like I am your Mexican
representative or emmisary...an ILCA-member on the frontier. I don't want
to let you down.

VIVA LACTNET! , my continuing-education night school.

(We Lactnetters ought to get CERPs for all the hours we put in! After all,
we learn so much while Lactnetting, don't we?  What do you say, IBLCE
Board?)

NEW VOCABULARY: Noun = Lactnet  or Lactnetter (He/she who lactnets...)
                Noun(plural)= Lactnetters
                Verb = to Lactnet
                Gerund = Lactnetting
                Past-participle = Lactnetted
                Adverb = Lactnettingly   (or is this an adjective?)
                Past-tense = Lactnetted
                Noun = Lactnetation
                Adjective = over-lactnetted   (that's ME!)

CHALLENGE: I'll give a free tour to the maya ruins of Uxmal to anyone who
can use at least 3 of the above words in one sentence.  The clock's running
!