Pardee,

I am glad to see this discussion posted.   I am also curious to see what
the standard of lactation care is at other hospitals.
I work at a large metropolitan hospital w/approximately 650 births per
month.  We staff 2.5 FTEs per day, 8 hours/day, 7 days a week.
I am estimating, based on 2.5 years of experience at this hospital, that
we have an initiation rate of @95%.  We probably have a any-breastfeeding-
at-discharge rate of @ 85-95%.  Usually closer to the original initiation
rate.
Every patient receives one visit from lactation as part of their delivery
package, almost always on day 1, not delivery day.  However, when the
census is high, we struggle to see everyone w/only 2.5 FTEs.  This has
become a source of tension.
The 2.5 FTEs are also required to see patients who request a lactation
consult in what we call our fee-for-service (FFS) program. I can't say
that I was in favor of this program.  I have very mixed feelings. When the
program was first introduced, it grew very rapidly and overwhelmed us.  We
were missing seeing all postpartum mothers for their one lactation visit.
They then added the .5 FTE.  It eased the tension somewhat and the program
settled into a more manageable number.  We may do anywhere from 1-6
FFSs/day.  These are shared by the LCs on duty.
We also see all mother's whose babies are admitted to NICU.  We do a
maternal assessment and pump set-up.  If babies are discharged from NICU
during mother's stay at hospital, we then go back to do a breastfeeding
visit.
We have a warm-line which generates a number of phone calls per day, which
we are generally required to do between patients.  Obviously on high
census days, this does not happen.
We occasionally get a walk-in to our Lactation Center (store) and one of
us will be called in to do a brief consult.  This is rare.
We are required to see mother's in recovery if requested. This does not
happen every day, although this last week I was called into L&D for a <1
hour newborn who "would not latch and suck".  And that same day I was
called in to see 5 hour old newborn (35 weeker)who "would not wake up to
breastfeed".

Sorry for the detail but I just wanted to give you a clear picture of the
job responsibilities of our LCs while they are seeing patients in
postpartum and to give you some idea of what our lactation program entails.

I look forward to others sharing what kind of lactation care is provided
in their hospitals.
Linda D. Kingsley, IBCLC

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