Melissa,

Here is how we do it and it works beautifully, without costing too
terribly much to the hospital. I am the only LC who is scheduled to work
as an LC. My job is to see complicated cases and to train ALL of the
nurses in basic breastfeeding support. I reiterate...ALL NURSES MUST BE
ABLE TO HANDLE NORMAL BREASTFEEDING!!!!!!! Management has got to get
behind this and give the IBCLC time to train them. We require an 8 hour
basic class, time seeing patients with the LC, and yearly competencies.
We offer, beyond all that, an ongoing lactation study group...open to
all nurses.

There are two (soon to be five) other IBCLC's on our staff but they are
actually there in other roles (staff nurse, home care nurse, clinical
educator, team leader). They do normal breastfeeding stuff  in their
roles and they also cover for me on my off days, vacations, high case
load times. They are not there just as LCs. They are there in another
role but, when an LC case comes up, the staff relieves them to spend
time with that Mom and Baby.

Finally, we have an on call LC every day. This is not for "normal"
cases. It is for high risk situations and special cases. I also have the
policy "if I didn't see you in the hospital, and you run into a problem,
I will provide one gratis outpatient visit."

I agree that no mom should ever be told "the LC is on vacation." At the
same time, a little creative planning can provide daily coverage without
bringing lots of full time LC's on board. An added benefit is...there is
lactation expertise in nearly every department related to OB, and boy
does that ever go a long way toward raising the level of acceptance
among staff nurses, getting policies that are baby friendly, and keeping
the continuity of care at a maximum.

I am hoping to get an IBCLC nurse anesthetist and then...wow, won't that
be interesting?

Susan Keith-Hergert RN, MS, CPN, IBCLC