In a message dated 2/10/99 10:22:26 AM Central Standard Time,
[log in to unmask] writes:

<< Feb 1999 09:46:53 -0600
 From:    "Maurenne Griese, RNC" <[log in to unmask]>
 Subject: Breastfeeding care for inpatients
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 Molly M, Bryant RNC,IBCLC Sacred Heart Medical Center NICU-level 3 Eugene,
 Oregon wrote a long post asking several questions about lactation education
 and support in the hospital setting, with particular interest in what NICUs
 do.

 Well, here's another long post regarding what we do at our hospital that
 averages 750 births per year.

 We have one full-time RN,IBCLC on our staff.  She does all of our
 postpartum follow-up phone calls (BF and ABM), outpatient and inpatient
 consults.  She does not consult with every breastfeeding mother.

 According to Riordan and Auerbach (1999, pg 714), many hospitals are
 staffing based on a 1 LC to 1000 birth ratio, which still provides only
 part-time service and which was quoted by same as "woefully inadequate" (I
 agree).  We have no one (IBCLC or CBE) "on-call" for evenings, nights or
 weekends and we all know that the need for BF assistance extends beyond 9
 to 5!  I can't tel you how many phone calls I've received at home in the
 evenings or weekends for breastfeeding assistance!

 It is expected that any nurse that cares for a BF mom/baby in our hospital
 be competent in assisting with normal breastfeeding situations and routine
 problems we see in healthy moms/babies -sore nipples, poor latch,
 engorgement, etc.  That expectation comes from management, peer pressure
 and patient input.  Approx. 1/3 of our RN staff are also CBEs-Certified
 Breastfeeding Educators.  They are very skilled in assisting with normal
 breastfeeding and common breastfeeding problems and provide great care MOST
 of the time.

 If our nursing staff can't solve the problem, they discuss it with our
 IBCLC, who may offer additional suggestions or may see the patient herself.
 If a patient needs an in-depth individual consultation due to special or
 complex circumstances (and I would regard a NICU admission a special
 circumstance), then our IBCLC is consulted.  For inpatients, a physicians
 order is not required since this is considered a routine service offered by
 the hospital, such as a dietitics or social services consult.

 We are not a part of a bargaining unit with a union.  That's an issue that
 I'm not willing or able to discuss further as I am a manager at my
 institution.
 We offer at least one local BF conference each year and we also send 2 or 3
 nurses to become CBEs each year.  Each nurse completes a breastfeeding
 competency upon hire and every 2 years.

 In my opinion, I do not think you have to be an IBCLC to provide good
 nursing care to the families we serve.  It may be necessary in some cases
 to receive third party reimbursement, but not in the inpatient setting.
 Those of you who are IBCLCs may be able to comment on third party
 reimbursement better than I can.

 Quality care for breastfeeding families takes a comprehensive team approach
 and involves many disciplines-prenatal care providers, childbirth and
 breastfeeding educators, La Leche League Leaders, IBCLCs, physicians,
 pharmacists and public health providers (did I forget anyone?).  In a Level
 Three Perinatal Care setting, you really need to develop a comprehensive
 breastfeeding program if you haven't already.  We have the only hospital
 based IBCLC for 60 miles to the east and 200 miles to the west.  She gets a
 number of outpatient referrals and we are only a level 2.

 Many administrators (and sometimes managers!)confuse an IBCLC and a
 CBE/CLE, thinking they are one and the same.  I think it is because they
 are new professions.  They need to be made aware of the differences between
 the two types of breastfeeding assistance providers so they avoid
 misrepresenting services provided in their institutions.

 Staff education  has been the KEY to our success.  It can't be a one time
 deal.  It has to be ongoing and it involves a vested interest from everyone
 involved-nursing staff, physicians, management and administrators but most
 importantly-the patients!

 Hope you find this information helpful.

 Maurenne Griese, RNC, BSN, CCE, CBE
 Director, Educational Services
 Mercy Health Center of Manhattan, KS USA

 --------------------
 Date:    Wed, 10 Feb 1999 09:52:33 -0600
 From:    "Jane D. Squires" <[log in to unmask]>
 Subject: Good new subject
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 On the same subject of good news.  In November our local newspaper changed
 the cribside logo from a stork carrying a baby (not great) to a bottle and
 pacifier (I could not believe it).  I wrote a very nice letter telling them
 how the bottle and pacifier showed no human touch, in fact it depicted the
 opposite in my mind >>