hello, fellow lactnetters!

i am writing today w/ a bit of a twinging conscience. i began working
on a volunteer basis as a breastfeeding follow-up counselor for our
local hospital 9 yrs ago, while tandem nursing my 1st two, who went on
to nurse until 5 yrs of age, each. i took all the hospital's bfing
training courses, joined lactnet and of course -being a lactivist -
read everything lactation-related i could get my hands on. before i
knew it, i was tandem nursing through an entire pregnancy and then
another and then nursing 3. and getting 13-25 new moms to help every
month from the hospital! i got all the moms of multiples and all the
more difficult cases as well as hospital employees.

i did this for 6 yrs, trying to accumulate my requirement of hours
needed to eventually become an LC. i have diagnosed sundry cases of
mastitis, tongue-tie, one hiatal hernia, one case of a dislocated hip,
more cases of thrush than you could shake a stick at, more cases of
nipple confusion and bad latch than you could shake a whole tree at,
helped 2 adoptive mothers to lactate or relactate, hooked up 4 moms w/
donor breastmilk, wetnursed 3 babies not my own and caught 2 babies
having seizures the mother didn't recognize as such in that time. i
love this work and i never thought twice about doing it for free or
doing anything else.

i went on to have 5 children total and have been nursing 2 or 3 at a
time for over 9 yrs now, over 10.5 straight yrs of lactating non-stop.
i think there's only one (commonplace) bfing issue i've not personally
dealt with and that's nipple confusion.

i have a great relationship w/ the hospital LC's here and don't
hesitate to refer up if i have a moment's doubt about a case. even an
overly jittery or nervous new mom can make me call and run the case by
one of them just to be sure i'm not missing anything. i've been sure
all this time what i was working toward, was to be one of them.

i've done my work all this time for free. i couldn't justify charging
a new mom for something that gave me such joy to help with, that they
were so grateful for and that was helping me reach my goal of
accumulating my documented hours. plus i wasn't sure i had a moral
right to charge if i wasn't an actual LC, my kids weren't that needy
and we were doing okay financially.

now the hospital program providing my services has been cut. my
supervisor was laid off. she never gave me my documentation for all my
hours when she left and now says all the records have been erased or
deleted from the computer when they cut the program.

i thought my clients (and possibly my interest) would just peter out
after the demise of the program. but i am still steadily getting 2-6
moms per month by word of mouth referrals. and i can barely manage it.
suddenly i've got this VERY needy multiple severe allergy child who
has to be seen at our children's hospital as well as University of
Michigan b/c dr.s know so little about his particular circumstances.
consequently, my area of 'expertise' has shifted focus from 'just
bfing' to 'bfing a child w/ food allergies - 2, actually ! - so much
so that i am now undertaking the daunting task of writing a book about
natural parenting under these circumstances.

all that to lead up to the dilemma at hand: i don't want to stop
helping moms w/ bfing. in fact, the 2 i have right now *both* have
babies that just got dx'ed w/ dairy allergy. i find more and more of
my moms have food allergy issues and while it's right up my alley,
it's incredibly time-consuming not only to sit down and go through the
bfing issues, but then to sit and go through food allergy issues and
mom's diet and a menu and allergen terminology and organic vs. allergy-
friendly... ugh, see? i'm tired just from writing it!

it all came to a head for me recently when i got a new mom at 7 wks
pp. w/out going into details w/ out her express permission, suffice it
to say she was a *very* nervous new mom whose birth had been
mismanaged in a typical way and left her feeling at a loss for
trusting that her body could make milk sufficient to keep a baby
thriving if it couldn't even give birth. i gave her tons of support
and even more facts on why everything was fine. her perspective was
still so 'worst-case-scenario', that i called my fave hospital LC and
ran it all by her. she agreed w/ me 100% that everything was fine, mom
just needed support and encouragement.

  i relayed to mom that i had run it by a hospital LC who also felt
there was no need for undue concern. i told mom if she wanted, i could
give her the LC's info and she could have a consultation herself. she
wanted. she went in and paid $80/hr to be told exactly what i'd
already told her. then she thanked me profusely and told me how much
better she felt, having heard it from an LC. and continues to call or
text me more than weekly for bfing help and support. my other mom this
month has gotten more and more time-consuming and demanding, as well.
she felt she had a very urgent situation recently and i was home w/
the 5 kids (2-10) while hubby was at work. we have no family or
friends close enough to leave the kids with. i told her she was very
welcome to come over after work and i'd take a look. mom expressed
that she'd 'freak out' w/ 5 kids running around.

my 1st thought was: "it's a good thing *i* don't freak out about
hormonal new moms and fussy babies"! my 2nd was: "i think i need to be
getting paid for this". i trundled my 5 kids in the vehicle, put a dvd
in and let them sit in her driveway, watching it, while i went in and
helped her by the front window.  is it possible these are cases of,
"it must not be worth much if it's free." thinking? am i giving away
the milk for free when i could have sold the cow? (sorry, couldn't
resist that one on a bfing list, you know!)

i've talked to the local LC's about it and they think what i do is
wonderful and moms are so lucky to have me, but they tell me i need to
get paid or i will burn out. it took me all these yrs to start to b/l
it. i thought by now i'd just go ahead and do what i need to, to
become an LC but:

1. all my hours of documented time working one-on-one w/ moms are lost.
2. i'm not sure i have the time to fulfill the rest of the
requirements w/ everything else i have going on.

but, i'm still getting the moms that need help. and if they're coming
to *me*, it's not your average mom w/ the average problems. it's a
very well-informed, already- knows- enough- that -you- better -be -on -
your- toes type mom who is going to want facts, documentation,
demonstrations, etc... and probably have food allergy issues on top of
it all. so do i have any right to start charging them now? ( i already
told the current 2 i am going to have to start...)  if so, i'd love
some tips on how much, what guidelines to have and how to justify it
if challenged.

if not... i hope i don't get booted off lactnet for this, but i am not
sure i want to become an LC anymore. from working w/ the ones at our
hospital, i know they can't dx mastitis. they have to send mom to a
dr. that's asinine to me. i see mastitis, i darn well tell mom in no
uncertain terms it's mastitis and what to do about it. they can't
disparage or criticize formula. i'll just pass by that one w/ a
chuckle and forego the similes about how someone telling me i couldn't
speak my mind about the risks of formula would go over like a _______
(fill in your fave simile). there are a ton of other hospital policies
i could go into, but you get the idea.

i couldn't afford to set up my own little practice and provide a
professional environment to be an independent LC in and if i became an
LC and tried to do it from my home... well, i don't think i'd be able
to charge much b/t the 5 kids that would be clamoring to hold the baby
and the giant great dane wandering in and out.

i'm starting to think, i've got more experience personally w/ bfing
than most LC's (that i know around here), i've got an admirable amount
of time working w/ bfing dyads, i've got freedom to work, do and say
what i want, how i want, when i want and w/ whom i want and now i've
got this extra specialized area of knowledge that i think is going to
be increasingly necessary to this work (food allergies) - i should be
able to justify getting paid now.

i'd love some feedback, thoughts, or ideas. i don't know how much to
charge, i'm not sure i'm comfortable justifying it to anyone but
myself yet and i really don't even know how to go about presenting it
and keeping it consistent w/ new moms. what to do about those moms
that text me all day? how about the ones that love to email? should i
charge more if they wake me up and want to see me at midnight? should
i have a website? would this be considered income and therefore
taxable? or more like babysitting and money passing b/t private ppl
like a gift? (if i charged $50/hr, i would have made less than $200
this month - as much as $1,000 the month before).

sorry so long and hope it isn't considered too off-topic... and here's
what i'd really love to know:
  do you really prefer being an LC? what do you love most about it and
what is the hardest part of it for you to deal with? if/when you did
it on a volunteer/unpaid basis, could you have justified charging moms
for your help? would you ever want to go back to doing the same work w/
out being certified for any reason?

feel also free to reply offlist if you prefer at :
[log in to unmask]

~jacqui gruttadauria, bsw
(near detroit, michigan - and don't know if i'm more eager or more
nervous to see replies to this!)

             ***********************************************

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