Regarding Barbara's story...

Her client's situation could have taken place in my city or probably other
places as well. IMO, the "fault" for this situation lies squarely in the
SYSTEM, or to be more accurate, the LACK of a system for appropriately
taking care of breastfeeding women!!!  And YES, I'm shouting!

Ohio has official statewide policies including "recommendations and
competencies" for peer counselors working in the public health system. (And
for breastfeeding coordinators.) The PC policies include the requirement
that peer counselors report to a supervising IBCLC or RN or RD. Since I do
not work in the public health system at the present time, anyone interested
should contact Ann Twiggs at [log in to unmask]  [Ann, forgive me if
you're deluged by requests.]

The 1997 Perinatal Guidelines published jointly by ACOG and AAP specify that
before hospital discharge:
* "The baby has completed at least two successful feedings, and
documentation has been made that the baby is able to coordinate sucking,
swallowing, and breathing while feeding.
* "The breastfeeding mother-baby dyad should be assessed by trained staff
regarding nursing position, latch-on, adequacy of swallowing, and mother's
knowledge of urine and stool frequency." (pg 167)

I know a lot of nurses and doctors who have a hard time documenting a baby's
ability to "coordinate sucking, swallowing and breathing while feeding."
Around here, peer counselors are not trained in these areas, nor are they
considered part of the "trained staff" in hospitals. They are fabulous when
it comes to social support for normal breastfeeding. Again, PCs are not
interchangeable with IBCLCs. Just like doulas are not interchangeable with
midwives.

I wasn't on the scene for this particular baby, but I've done my share of
mopping up for the "broken system" for too many years. Why else would I be
renting breastpumps on Christmas eve, for crying out loud??  Breastfeeding
is IMPORTANT!  Important enough to hire enough lactation consultants
(IBCLCs) to do the job. And train the RN's in the basics. And train the RDs
and MDs and the housekeeping staff, if that's what it takes.  AND have peer
counselor programs for the mother-to-mother support. And PAY every provider
appropriately for their particular level of skill.

Read Jane Heinig's editorial in the December 1998 issue of the Journal of
Human Lactation entitled "Closet Consulting and other Enabling Behaviors"
for more on this subject.

I'm not done commenting on this.

Linda J. Smith, BSE, FACCE, IBCLC
Bright Future Lactation Resource Centre
Dayton, OH USA
http://www.bflrc.com