Fran,
I am a unit-based LC in the NICU.  Before five years ago, there was almost no
LC coverage in our NICU.  Kathy Howard and I were staff nurses in the NICU
for a very long time, and took the LC exam in 1997, actually in hopes of leaving
the NICU to work closer to our homes.  After we took the exam and passed,
many of the nurses started asking us to see their breastfeeding patients, while
they looked after our babies on vents, drips, etc.  Anything not to deal with
"the breasts"!!!!
Early in 1998, we had the pleasure of hearing Barbara Ackerman speak in
Florida.  While hot tubbing with Barbara, we realized that this was something we
could do for our unit.    When we came back, we met with managers who were
supportive, wrote a proposal and about 18 months later, finally got one FTE which
we split between us.  One of the things we did was to keep track of our
breastfeeding rates.  Our rate was 50% when we first wrote the proposal, went to 60%
while we were waiting and now hovers in the high 80-mid 90's percentile.
Nearly all of our mothers initiate pumping--the nurses in the NICU encourage them,
as well as do the high-risk antenatal and postpartum staff. Kathy has moved
on to another position, and I now work 36 hours--3 12 hour shifts, from 10am to
10pm.  I try to see mothers prenatally as much as possible--we have a class
once every two weeks for mothers who need to learn about pumping and
breastfeeding premies.  That gets them hooked--and those mothers are asking for a pump
when they come up to postpartum!!  It used to be that mothers started "in a day
or two, when they felt better".  Along with quicker recognition of low milk
supply (so we can jump on it sooner) and making sure each mother gets a
hospital grade pump to go home with, this has led to better milk supplies than we saw
previously.  The nurses have learned quite a bit of troubleshooting, so that
when I am not there, they have at least reminded mothers to start pumping more
frequently and more completely, so that when I'm there, we can discuss Reglan
or Domperidone (I ask that the mothers increase pumping frequency for a day
or two before starting meds if they have begun to slack off a bit--it usually
works).  More of the nurses will initiate breastfeeding and nipple shields when
necessary--I just ask that they let me know that the mother has a shield, so
I can follow up with teaching.
Last fall, our department was cut by 1/3.  For 10,000 deliveries a year, we
had had about 4.5 FTEs and now have about 3, including me.  The decision was
supposedly not financial, according to our director.  Our NICU has a census
which ranges from 30 to 70 babies, mostly in the 50's.  Thankfully, the NICU
nurses have taken on more and more breastfeeding teaching (they do a great job!!),
since at some point I imagine I will be mandated to work on postpartum as
well.  Right now, I help out as much as I can without interfering with LC coverage
in the NICU.
Having a NICU background and being unit-based, I believe, has been essential
to the success of this program.  I am familiar to MDs and nurses, and they
trust me not to push the premies too hard.  Another important thing to consider
is to make sure your practice is evidence-based.  Sometimes what you do will be
questioned--I never had any problems after I showed the person the research
or the reference.
Feel free to contact me if you have any questions.  Good luck!!
Maureen Allen RN, BSN, IBCLC
Lactation Consultant
Neonatal Intensive Care Unit
Brigham and Women's Hospital
Boston, MA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html