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