Dee Kassing reminds me of why I found it so useful to offer pump trials. Not only did the mother walk out with the kind of pump that would work best given her set of circumstances, I got to really learn about how the various pumps functioned. This helped me better advise my clients, and to know when body size and shape made them a better candidate for best results from one pump vs another. Because as an IBCLC I have an ethical framework within which I have agreed to practice, clients got my best clinical judgement, not my most self-serving economic benefit as the driving principle in terms of their care. I like to think this worked pretty well. The extremely sad part about the way equipment companies marketed and the way hospitals took over equipment provision is that it was sold as a way to fund hospt. lactation services. As if lactation support were not the basic standard of care after delivering a baby, but was some fluff add-on which needed to be funded from the gift shop sales. Would we fund physical therapy following orthopedic surgery from the sale of crutches??? Often clerks (rather than LCs) merely sold (rather than counseled) mothers on equipment use. In my experience, a half hour of anticipatory guidance provided during a pump trial with sterilized external parts (pumped milk discarded) resulted in my own clients going on to have much success and an average of 12 mo. of pumping during employment. I've always been proud of that. When the retailing of pumps in baby store outlets and hospt. rentals hit our town, my own practice suffered such economic devastation that I closed my clinic and returned to a home-based, home visit practice that no longer did anything with pumps. The down side of that for women in our city has been that my considerable expertise in guiding mothers through those choices is no longer routinely available. Equally sad is the fact that as the economy worsens, hospt. based LCs are more and more pulled back into multiple nursing functions and therefore less available for lactation help. I always said that the day would come when the hospts would jetison those services iin a cost-cutting frenzy, and by then many of the priv. practice LCs would be gone due to inability to compete with low-ball pricing and store-front types of equipment marketing. The total irony of this is that as the big Ad Council/Dept. of Women's Health marketing of breastfeeding campaign gears up, I often wonder do we have the infrastructure to even deal with increased referrals? Barbara Wilson-Clay, BS, IBCLC Austin Lactation Associates LactNews Press www.lactnews.com *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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