Lactation Consultants-On Staff?

[SuperFlyRN]

I want to clarify, we are the only Birthing Center in a city of 300,000 that does not include the surrounding counties up to 100kms away. We do azpprox 300 births/month. Have 8 HR L&D, 40 PP, 48 AP/PP, 8 triage and a 30 bed NICU. We often get transfers from other hospitals due to our NICU.

I just have a question. I've been reading some of these posts related to breastfeeding (this is a huge issue at our facility) and I am confused. I work in a combined LDRP and HR L&D. Our LDRP is staffed with crosstrained L&D/PP RN's. We only have RN's -nothing else. We start our own IV's, transport patients, transition babies (we have no "delivery" nurses for babies), etc. In our community we have only three registered LC's. Our Clinical Practice Manager is one (but rarely is at the bedside) and two in the community that if patient's wish to see,they must pay for. They are generally reached when the patient goes home. When patient'e are discharged they are booked a Maternal-Newborn clinic appt usually after one full day at home. This is essentially a well-baby check-up, weight, VS and assisting with nursing. Only primips or first-time breastfeeders are allowed this service (Government funding, you know?)

Breastfeeding teaching falls to the RN's and, unfortunately more recently, teaching videos because our assignments have gotten so insane and often quite unmanageable.

Do most hospitals have LC's on staff 24/7 to assist or is it a similiar set-up? I worked in the US for a while and I had an IV team and a full-time LC (I thought I was in heaven). My patients came to me showered, dressed, all lines d/c'd and ready to go home if they wished -this was a socially upscale hospital, shall we say? In Canada we have socialized medicine so it is a whole different ballgame.

Just wondering-I sort of rambled but they are asking for our advice and ways to fix this horrible situation that we seem to find ourselves embroiled in so I am just researching and picking some brains.

Thanks a lot

I need to add. Our unit had recieved a Government grant to initiate our Birthing Center and management even feels it was poorly established. We have moved units 5 times in the past 2.5 years to accomodate our growing needs. We merged with another hospital in the area and a lot of our L&D nurses want nothing to do with crosstraining,they admit they *hate* PP and vice-versa with PP to L&D. We have a teaching sheet that 98% of the time does not get completed or is done inaccurately.

Anyway, any input would be greatly appreciated as we are in some dire straights and they (for once!) are asking for our opinions so I would love to bring something solid to them. We recently posted 18 positions for our unit (9 FT and 9PT) and NO applicants-that is how bad things are getting-word is out!

[RNnL&D]

Do most hospitals have LC's on staff 24/7 to assist or is it a similiar set-up?

We have a LC Monday through Friday from 9-4, and on call on weekends. Other times, teaching falls to the RN. We only have about 100 deliveries/month, with 12 LDRP's, and 14 PP beds. I can't imagine with a unit your size, not having an LC. Being that busy, I can imagine the difficulty in assisting new moms with breastfeeding.

[rn/writer, RN]

I work PP at a large urban hospital with a very diversified clientele. Our birth center delivers about 400 babies a month.

We are very blessed to have 5!!!!! LCs on staff. On any given week day, we'll have at least two with overlapping coverage that lasts 10-12 hours. We have one on the weekends.

Not everyone sees them. Moms with no risk factors have to try for 24 hours and often are beginning to find success at the end of that time. But very young moms, those who have NICU babies, moms of multiples, or anyone else who has extenuating circumstances can get a quicker referral. The LCs are really good with the patients and try very hard to be nurturing and encouraging. We appreciate their efforts and feel extremely blessed to have them be so readily available. Hearing your circumstances makes me feel even moreso.

[SuperFlyRN]

I work PP at a large urban hospital with a very diversified clientele. Our birth center delivers about 400 babies a month.

We are very blessed to have 5!!!!! LCs on staff. On any given week day, we'll have at least two with overlapping coverage that lasts 10-12 hours. We have one on the weekends.

OMG-that is awesome! I feel so bad when a patient asks if they can see an LC. We do have the nurses that work the Maternal-Newborn Clinic they will go in and assist but they are NOT LC's. BTW, they have nothing good to say about our PP nurses but they a little far removed from the bedside and forget what it is like to juggle paitents.

It has always been my experience the young patients (teens) do amazingly well, the moms that never took a class, do spectacular-it is the primes that come in and breastfeeding is held like a badge of honor and it is a do-or-die thing that have trouble because they are so tense. The ones that never took a class are like a clean slate, others that have read/watched are getting a lot of information, some of it not always right.

Thanks

[camay1221_RN]

We have two LC's on staff, but we also have four lactation educators that work on different shifts. Our LC's mostly work day shift, 0800-1700, but one of them will be working 1700-0100 after she comes back from maternity leave.

I am usually very happy when I see lactation hasn't had to see my pts as, they are usually doing very well. However, I still always ask one of the LC's to pop her head in the door so the pt at least knows she is there if needed.

[fergus51]

I work in a large hospital in California, our LC coverage was extremely spotty. I really feel PP nurse should be well trained in breastfeeding and encouraged to get their LC themselves. Our unit in Canada had a couple of LCs, but the nurses did the majority of breastfeeding teaching. The best thing we did was to get a free nurse each shift as a "helper". Then if there are a couple of bad feeders, she can either focus on them or lighten their nurses' loads so they can help.

It sounds like your unit is the problem. I think things are often difficult when a unit is established out of nowhere.

[sweetcheekers]

I work in a small rural hospital that delivered just under 400 babes last year and we have at least three LC and possibly four RNs in OB that are also LC's. They are not necessarily always on duty, but can be called to meet with a patient having difficulty if needed. They also do many of our follow up visits once mom's are home. Guess based on the numbers I am seeing we are really fortunate.

[nursecave]

We have 3 or 4 full time and several part time LC's on staff. We deliver an average of 20 babies a day. We delivered almost 6900 last year!!! I couldn't imagine not having LC's on staff. We do take an 8 hour class to train our nursing staff, but on a normal day we don't have a lot of time to help and on busy days have no time to help our mom's. We try our best and really encourage breastfeeding and have an 80% breastfeeding rate, but even with so many LC's and trained nurses, it is a real chore trying to help these moms as much as they may need. The more LC's we add, the better our services have become. We even have one who floats to 11p-7a on occassion and the mom's really love that.

[SmilingBluEyes]

I'm at a med size community hospital, one LC on staff Mon-Fri 8 a.m. to 1 p.m. she also calls all patients after d/c to see how it's going and makes appts for those needing special help or is having difficulties. Also, she goes to each patient's room who has delivered and is Breastfeeding, just to see how it's going. She is super, really!