Laurie,  an interesting and revealing picture of what you have to tackle.

>Breastfeeding rates are
>quite low, especially bf continuation, and moms usually return to full time
>employment at 6 wks.


That *in itself* is just awful. Full time? At 6 weeks?

>  Yesterday my case load was thus:
>1. 35 wk infant feeding fairly well, experienced mom -- going home on day 2,
>should do well -- will get early followup visit.
>2. 35 wk infant, primip, not eating well at all; going home anyway on day 2.
>will need followup - pumping - etc


Can't believe these mothers would be going home on day 2 - with a 35 
weeker?? Here, there would be no question of mother and baby spending 
anything less than 1 or even 2 or even more weeks in the hospital 
with a baby born as early as this. And then at home, they would get 
regular follow up from the community midwife and possibly visits from 
liaison staff from the hospital, esp if the baby still has problems. 
These visits from the midwife might be daily (though not in places 
like London where there is a shortage - but they  wd still get phone 
calls and visits maybe every other day).

>3. infant with respiratory distress and probable sepsis, in special care
>nursery on oxygen, IV, antibiotics
>4. infant born at 34 wks gestation, mother with insulin dependent diabetes
>and PCOS, skin tags, hirsutism
>5. 34 wk infant not gaining, came in for 48 hr followup, ineffective,
>lenghty feeds - yes pumping too but mom decided to do more bf.
>6. antenatal visit with mom with infertility x 6 yrs; PCOS


All of these are way beyond the scope of a volunteer - but the 
volunteer can still be involved as a listening, supportive friend, 
and does something *different* from the specialist.

>
>Would peer counselors or LLL Leaders be comfortable totally "managing" these
>mothers and babies? Without a physician conferring? I am truly curious
>because I realize every country and culture is different and healthcare
>systems are vastly different.


I think you are right to note this difference, Laurie. We get a lot 
of stuff  wrong in the UK with regard to birth and aftercare, but the 
system is in place to have routine medical/midwifery care at the 
point of need,  and mostly, women are encuraged and supported to bf, 
though the knowledge and skills to make this  a reality are sometimes 
lacking. However,  even the mothers and babies on your list 3, 4, 5 
and 6 are still having their medical care managed - and the role of 
the LC would be to liaise with the carers to ensure bf is still 
supported. These mothers will still benefit from peer or volunteer 
suppport, alongside the medical and clinical knowledge you bring to 
their care.

>  Or do you think an LC with didactic and
>clinical experience with sick moms/babies would be useful.


Very!! It's not an 'either or' but a 'both'.

Heather Welford Neil
NCT bfc, tutor, UK

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