You have posed a good question about who in JCAHO sets the rules (re: lactation services in hospitals in the US) and on what basis. Now, however, ILCA has two reps either on the JCAHO board or advising the JCAHO board. As for me, I am one of three full time IBCLCs in my hospital, for the last year, who owe our jobs to JCAHO's insistence that the hospital set up a formal Lactation Program. We do expect questions from them when they come to survey us in late Sept. We have almost nonexistent followup. One of our dozen or so clinics in on the same campus as our hospital. They call us several times a week to run over right now to help a mom with BFing problems. The other clinics are S.O.L. at this time (short on luck). Hosp staff expects us 100% on the floor seeing moms. Hosp admin expects us to spend time attending & working for about 8 different Admin committees, write new P&P, and write now patient ed materials on 4th grade level (which means rewriting absolutely everything). Future plans are to educate staff on BFing. But there are innumerable obstacles on that one. We did get formula bottles removed from the crib drawers of declared breast-only babies. It's easily available if mom asks for it, but at least it's out of sight. We are still trying for phone followup to determine continuation rates. We get info from about 25% of attempted calls. Admin is slow to recognize that continuation rates are almost directly related to the availability of postpartum followup help. We also have a population that tends to take babies to the doctor only if there's a health problem they can't resolve. They ignore regular well-child checks, immunizations, etc. They come back again when the child is ready to go to school & are faced with immunization make-ups. If JCAHO asks us about our program, I maybe we can plead "novice program" still in the "developing" stage. As soon as they return from Acapulco, perhaps they can fill us in on the history and of lactation regulations set by JCAHO. Phyllis Adamson, IBCLC [log in to unmask] BTW: Acapulco was GREAT!! 90% hurrays!! 10% boos, but who expects perfection? More later from a lot of us, I'm sure. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html