In a message dated 2/10/99 10:22:26 AM Central Standard Time, [log in to unmask] writes: << Feb 1999 09:46:53 -0600 From: "Maurenne Griese, RNC" <[log in to unmask]> Subject: Breastfeeding care for inpatients MIME-Version: 1.0 Content-Type: text/plain; charset=US-ASCII Molly M, Bryant RNC,IBCLC Sacred Heart Medical Center NICU-level 3 Eugene, Oregon wrote a long post asking several questions about lactation education and support in the hospital setting, with particular interest in what NICUs do. Well, here's another long post regarding what we do at our hospital that averages 750 births per year. We have one full-time RN,IBCLC on our staff. She does all of our postpartum follow-up phone calls (BF and ABM), outpatient and inpatient consults. She does not consult with every breastfeeding mother. According to Riordan and Auerbach (1999, pg 714), many hospitals are staffing based on a 1 LC to 1000 birth ratio, which still provides only part-time service and which was quoted by same as "woefully inadequate" (I agree). We have no one (IBCLC or CBE) "on-call" for evenings, nights or weekends and we all know that the need for BF assistance extends beyond 9 to 5! I can't tel you how many phone calls I've received at home in the evenings or weekends for breastfeeding assistance! It is expected that any nurse that cares for a BF mom/baby in our hospital be competent in assisting with normal breastfeeding situations and routine problems we see in healthy moms/babies -sore nipples, poor latch, engorgement, etc. That expectation comes from management, peer pressure and patient input. Approx. 1/3 of our RN staff are also CBEs-Certified Breastfeeding Educators. They are very skilled in assisting with normal breastfeeding and common breastfeeding problems and provide great care MOST of the time. If our nursing staff can't solve the problem, they discuss it with our IBCLC, who may offer additional suggestions or may see the patient herself. If a patient needs an in-depth individual consultation due to special or complex circumstances (and I would regard a NICU admission a special circumstance), then our IBCLC is consulted. For inpatients, a physicians order is not required since this is considered a routine service offered by the hospital, such as a dietitics or social services consult. We are not a part of a bargaining unit with a union. That's an issue that I'm not willing or able to discuss further as I am a manager at my institution. We offer at least one local BF conference each year and we also send 2 or 3 nurses to become CBEs each year. Each nurse completes a breastfeeding competency upon hire and every 2 years. In my opinion, I do not think you have to be an IBCLC to provide good nursing care to the families we serve. It may be necessary in some cases to receive third party reimbursement, but not in the inpatient setting. Those of you who are IBCLCs may be able to comment on third party reimbursement better than I can. Quality care for breastfeeding families takes a comprehensive team approach and involves many disciplines-prenatal care providers, childbirth and breastfeeding educators, La Leche League Leaders, IBCLCs, physicians, pharmacists and public health providers (did I forget anyone?). In a Level Three Perinatal Care setting, you really need to develop a comprehensive breastfeeding program if you haven't already. We have the only hospital based IBCLC for 60 miles to the east and 200 miles to the west. She gets a number of outpatient referrals and we are only a level 2. Many administrators (and sometimes managers!)confuse an IBCLC and a CBE/CLE, thinking they are one and the same. I think it is because they are new professions. They need to be made aware of the differences between the two types of breastfeeding assistance providers so they avoid misrepresenting services provided in their institutions. Staff education has been the KEY to our success. It can't be a one time deal. It has to be ongoing and it involves a vested interest from everyone involved-nursing staff, physicians, management and administrators but most importantly-the patients! Hope you find this information helpful. Maurenne Griese, RNC, BSN, CCE, CBE Director, Educational Services Mercy Health Center of Manhattan, KS USA -------------------- Date: Wed, 10 Feb 1999 09:52:33 -0600 From: "Jane D. Squires" <[log in to unmask]> Subject: Good new subject MIME-Version: 1.0 Content-Type: text/plain; charset=us-ascii On the same subject of good news. In November our local newspaper changed the cribside logo from a stork carrying a baby (not great) to a bottle and pacifier (I could not believe it). I wrote a very nice letter telling them how the bottle and pacifier showed no human touch, in fact it depicted the opposite in my mind >>