I want to be entirely scrupulous in the matter of my public comments.  I
stated that the mother with whom I'm working on a relactation (after the
infant was dx with profound allergy to formula) had only seen peer
counselors.  That remark was made  without fully questioning the mother.  I
made an un-charged follow-up visit today, and got more facts which I will
now share:

The mother does not know who she saw.  3 different youngish women wearing
white coats made 3 separate visits to the NICU to speak with her.  She is
unclear who they were, only that they represented themselves as people who
were to help her with breastfeeding.  She assumed they were lactation
consultants.  I learned that there were no written instructions given to her
(with the exception of a pamphlet.)  One of the women described a
feeding-tube device to her, but none was provided, and no hands-on
instruction given in its use.  The mother was not given a verbal or written
follow-up discharge plan, nor was any follow-up provided in the form of any
phone contact after discharge, even though she left the hospt. with a
non-nursing infant.  There wasn't any post-discharge instructions on pumping
provided.  The woman was given some very supportive encouragement, and some
positioning advice which she describes as "different from what you have
shown me"  Her comment was that everyone was very nice, but her plan is to
be much more assertive if her second child is born pre-term.

 I phoned the pediatrician this afternoon to see if there were any notes
from the hospt. which made it into the mom's  chart to alert the doctor to
the need for early post-discharge follow-up. There were none.  As it
happened, this mom had a delay seeing the reg. pedi. who is pretty good
about asking how bfg is going, and saw someone who seemed less informed.
Since there were no notes, the alternate doctor had no reason to ask and no
habitual routine which made sure that question got asked.

My colleague's point is well taken that I should have been really sure of
the facts before I cast blame on peer counselors.  I cannot say for certain
whether the scenerio above was the result of the actions of peer counselors.

My colleague also wondered whether I ever communicated with the hosptital
personnel who previously support any of my clients.  It has not been my
habit to do so in the past.  I have decided that while it will be more work
for me, from now on, copies of my reports will also go to the lactation
departments.  Hopefully this will open up more dialog.

I understand from Linda Smith that the state of Ohio has mandated some sort
of guidelines (scope of practice) for peer counselors. I hope she will come
on-line to describe this.  Perhaps another way of looking at the larger
issue of who is delivering care to lactating women would be to begin to
lobby for some sort of standardized entry level education/training with a
minimum number of hours, establish some standards of practice, and request
that some sort of entity be created which could accept reports of adverse
outcomes.  Aside from the specific facts of the case I'm involved with,
accountability is an issue if the de facto situation in institutions  is
that non-licensed, non-certified individuals are acting as lactation
consultants.  Consumers have a right to know who is delivering service they
are paying for.  It is my understanding that institutions are now hiring
"lactation educators" for $8-9 per hour, and asking that they "act in the
capacity" of lactation consultants.  Health care is a tiered system, and
there must be protocols built into this sort of practice which assures that
complicated cases receive clinical care and follow-up.  That is still the
main point I wish to make.

Again, I apologize for not being certain about the facts before I spoke.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html