I just wanted to add a little to what Pam said and reiterate that the job of 
hospital based LC is, indeed, far different than the community based LC. I 
have the benefit of having BOTH these positions and I have to say that 
beause of this, I have developed a different perspective.

In the hospital, for the most part, we are dealing with well, term babies. Each 
baby comes into this world is a different way and has had a different birth 
experience. This baby's mother may have had no meds, IV's, epidurals, or Mom 
may have had the whole 9 yards. I have seen babies from both scenarios be 
poor nursers and others be fantastic from the get-go. I know the evidence 
points out otherwise, but I am going from what I see here (and I have been 
doing this a long time).

The point is that in the hospital we are dealing with a brand new scenario for 
both mother and baby. Sure, breastfeeding is natural, but by the same token 
it is a "learned art" and we are dealing with mothers who have not developed 
the "art" as yet. Everything is new, scary, and overwhelming. Those of you 
who do not work in the hospital have no idea what it is like to have to help 
Mom and baby pack in a lot of knowledge when Mom is not even past 
the "taking in" phase of her recovery (by the time she is supposed to go 
home). The Mom we have in the hospital is a totally different mother than the 
same one I might encounter in the community days or weeks after her 
delivery. After she is home, Mom has the benefit of familiar surroundings, the 
benefit of time and the ability to develop the "art" of nursing and she has 
hopefully also had some sleep. In other words she can think and act more 
clearly.

When I see a mother in the community (and it is most often because the 
pediatrician has referred the case to me as a "feeding problem" and on 
occasion it is a self referral which still has to be okayed by the pedi for 
reimbursement), she is a totally different mother than I might have seen in the 
hospital.  She is past that takking in phase and cab hopefully think and act 
more clearly. At that point, I can deal with just the problem at hand. I don't 
ahve to deal as well with all the post partum teaching as well as feeding 
issues.

So, yes, I have to deal with a lot MORE issues in the hospital: especially with 
the more stringent jaundice guidelines and with peds who don't always trust 
the process, and all the other woes that some have pointed out. But you 
know what? That's just the way it is. When I find a teachable moment (for the 
pedis) I take it. Just a couple of weeks ago, the pediatrician who was on was 
talking with me about a patient and the breastfeeding problems she was 
having. When she asked if I was going to go in and see her, she said,"Can I 
come with you and watch?" I didn't do anything out of the ordinary but she 
complimented me after. By the same token, I defer to her when we are dealing 
with something out of my comfprt zone and  when there is a need to 
supplement (or whatever) I am more than willing to work WITH the doctor and 
work around the problem because the bottom line is that I am more likely to 
be able to preserve the breastfeeding experience that way.

Another time, right in front of another pediatrician, I pointed out a prominant 
tongue tie. Now I know (because I know this doc) that this would have been 
blown off completely had I not said something. The next day, the frenulum 
was clipped by one of our ENT's. I know the family learned something and I 
hope the doc did as well. Because I have pointed out several tight ties to 
another of the docs, she now is far MORE careful about looking for them and 
having the ENT evaluate. 

So the combination of skills has been (for the most part) a positive for 
everyone concerned. That's the way it should be: a collaborative team 
approach. Sometimes, the teams area good mix of "players" and sometimes 
they are not. There is absolutely NOTHING any of us can do about that 
exccept to nurture the good ones and step away from the toxic ones.

Pam also mentioned parental responsibility in her last post. You know, 
everyone, there comes a time when we as LC's have to step back and let the 
parent take the responsibility to speak with the physician, get a second 
opinion, etc. Most of what we might give as phone information is stuff that is 
readily available online just about everywhere. So I have to agree with Pam 
about when to f/u with the doc and when it is Mom and Dad who have to take 
the lead and do so.

Personally, I am very pleased that there is so much new, indeepth information 
on breastfeeding on the AAP website. I have been printing it out and giving it 
to our pediatricians and showing them where it is on the site, etc,. If you 
have not taken the opportunity to really look at the AAP breastfeeding 
information in depth, take the time to do so. There is a ton of good stuff there.

All we can do is take every teachable moment we can and go from there. We 
cannot fix the world and it will never be as we like to think it should be. That's 
life. Things are different now than they were when I was nursing my children 
and they will be different again years from now.

As far as bashing goes, there is a big difference between sharing a frustrating 
situation when a doc may have given poor advice or undercut a mother, but it 
is a whole different thing to generalize and criticize an entire profession 
(doctor, nurse, hospitals,etc). So much has to do with the presentation and 
how the person (doc, nurse, lawyer, LC,etc) comes across.

Betsy Riedel RNC, IBCLC

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