Marcia Glass writes:
< However the exact expectations for these new positions varies, often by setting.  An LC in hospital is expected to handle complicated problems as well as normal situations. The WIC-type LC's often just do counseling and aren't prepared to handle more complicated situations.  I may be wrong of course, but I doubt that many of them use SNS's and follow up premie moms and so on.  They would probably refer them out just as lay counselors should and do.  There is a pyramid of sorts, of lactation helpers.>

I don't think it's wise to generalize, about WIC, especially. Each project and each state have staffed their organizations partly according to the qualifications of the people available to them, just as each hospital has decided in what form lactation support will be staffed at their hospital.

I can speak only for our local WIC, where I am fortunate to be welcomed as a volunteer 8-10 hours a week. We are an administrative unit of a county public health district. We receive referrals from the prenatal clinics and other units in the organizaton. (I am retired after many years of hospital and later, public health maternity nursing background with that health district.) There are 3 full-time non-RN IBCLC's, each with an extensive LLLL background, and one with extra hospital and pump rental and private LC background on top of that, who are quite experienced in all stages of lactation and top-notch at helping to rehabilitate some of the "breastfeeding train wrecks" that emerge from more than one of our area hospitals on the 2nd-3rd or later days, as well as the mothers of premies. We continue to learn from each other as well as from the conferences we attend each year. 

<An LC in hospital is expected to handle complicated problems as well as normal situations.>

We have seem many instances where hospital LC's are mainly most familiar with the care of mothers and babies in just the first few days or first week, and are not permitted in the NICU without a formal referral for a consultation or a personal request from a mother. Unfortunately, we see that their hands are sometimes tied, and many others don't seem to realize what later effects often come from the course of care in the hospital. 

Not only prenatal classes and telephone warm-line and follow-up are provided, but office consults when necessary, at least 2-3 nearly every day, and in a few cases, even home visits. Our state supplied equipment includes a full array of various supplementers, shields, finger feeders, Haberman's, several brands of quality hand pumps, pump kits, and new double electric pumps. We counsel a large number of mothers who are pumping at work or school as well, with WIC provided and fully explained pumps. (This is something parents don't get when they rent from the local medical suppliers or buy from the baby/department stores.) In the past year, a group of peer counselors has been selected and trained, and many look to have potential as future IBLCE candidates. 

In addition, there is already one staff RD administrator who has gained her IBCLC after becoming active in LLL with her own babies. She takes every opportunity for continuing education and to observe many of our consults when possible. There are others on the RD, clerical and administrative who are very cooperative and interested in collaborating with us (as we collaborate with them on nutrition issues.) Several years ago, our project was honored by the Ohio LCA as the most breastfeeding friendly WIC office in the state. We are very fortunate, and no doubt better staffed than many other WIC offices around the state and nation, but I imagine there are other projects who have similar proud stories to tell.

We all agree that rule # 1 is "Feed the Baby". So admittedly, WIC is the # 1 purchaser of formula in the nation, in order to be able to supply a limited (note-LIMITED) amount of formula to each baby whose mother decides her own and her baby's situation requires it. Her own food package is adjusted downward when formula is chosen. But I want everyone to be aware that WIC's main mission is nutrition education, and I believe that a better general statement is that individual WIC LC's do their best to provide the most up-to-date breastfeeding education and 'state of the art' support that they are capable of providing.
Jean
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K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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