Several thoughts in one post, briefly:

I am not opposed to a second credential, but feel strongly that said provider should work under the direction of an IBCLC. In USA, this would be similar to the RN/LPN supervision and delegation roles, the OT/COTA (occupational therapist/certified OT assistant), MD/nurse practitioner, or MD/physician assistant roles. This might mean an IBCLC on the premises, or on call, or some other stipulation that an IBCLC oversees the second credentialed person.

Polysporin or other antibacterial ointments: I recommend that the mother gently clean or rinse with a clean cotton ball moistened with water prior to bf. In my experience, mothers just don't feel right about leaving it on for the baby to ingest.

Discharge planning: I am proud to report that I started a bf center in my hospital that offers all bf moms/babies a free followup appointment approximately 48 hrs after hospital discharge, sooner if needed. Additional visits as needed and weight checks as needed. Mothers who had their babies elsewhere can come in too. If the mother indicates she cannot come back (transportation issues in a rural area) then I will try to arrange followup with another IBCLC at a sister hospital in another city, with a pediatrician, or with the health department/US WIC lactation specialist. Some experienced mothers decline the appointment, but it is offered and encouraged to all. All mothers get a phone followup if they don't make the visit. I coordinate my appointment with the baby's doctor visits as indicated by the baby's health and history and discussion with the doctor.

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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