Tell me about lactation at your facility

SmilingBluEyes · Aug 2, 2004

we have an IBCLE-certified lacation consultant (she is very good)---who works part-time on our floor. she also will see people after they have delivered and follow-up calls all nursing moms after they have discharged home, to see how it's going.

palesarah · Aug 3, 2004

We had 1 IBCLC and another RN,IBCLC who split lactation duties for our unit, plus 3 other nurses (2 on the floor, 1 is our clinical coordinator) who are IBCLCs available to fill in as needed. The IBCLC just recently graduated from nursing school and is orienting to the floor now, so our clinical coordinator and one of the floor nurses have been filling in until we hire on another IBCLC solely for LC duties.

We have an IBCLC on the floor everyday, usually from about 8am to 3 pm; they make rounds on all breastfeeding patients daily, create plans for couplets with breastfeeding difficulties and work extensively with them, folluw up with discharged patients and see outpatients (discharged mom/babies who come back for weight checks, or additional help). They are also in charge of all pump rentals and the limited equipment sales that are made (Boppy pillows, pumps, pump parts, etc). There is no charge for the outpatient visits; it is all conisdered a continuation of the initial visit (birth or transfer to our Level 2 from an area NICU; we take babies back from 2 hospitals to feed & grow).

The RN, IBCLC also teaches a monthly prenatal breastfeeding class and leads a weekly new parent support group.

In additional to the IBCLC staff, approximately half (I think, maybe not quite) of our staff RNs and a few of our per diems are CLCs who have taken the week long Certified Lactation Counselor course. The hospital is trying to rotate us all through that but can only get so much budgeted for it each year, so each year about 4-6 more RNs are certified. Since I'm still one of the new kids, I haven't been able to take it yet, but am looking forward to it. We have enough RNs that are CLCs now that their is always some sort of LC available, so if a frustrated new mom calls in the middle of the night there is always someone competent to take the call.

Well, we're all competent, since teaching and supporting breastfeeding is a vital part of our job, but they've got an extra set of skills, and a greater knowledge base, to be able to help more efficiently.

We are not a magnet facility. We are also not part of the Baby-Friendly initiative, (yet? I think it is one of our eventual goals). We have 10 LDRP rooms, 1 smaller room for post-op CS/gyn surg/boarder moms of nursery babies, plus 4 triage rooms. (LOL, when we're busy, they're all LDRP rooms!) We do about 60-80 births in an average month, and are located on the NH seacoast.

I don't know our breastfeeding rates off the top of my head, I believe it is around 85% at discharge, with our 6-month follow up rate somewhere above the national average. We don't "loose" too many in the first few days to discouragement; if a mom/baby are having a really hard time we devote extra nursing time and they often stay an extra night. The powers that be are VERY proud of our breastfeeding success rates. This is the only hospital I've worked in, so I can't personally compare our patients' breastfeeding experiences to what they would recieve in other area hospitals, although I have heard from some patients that the environment at a couple area hospitals is not as supportive.

I have also heard that those other hospitals call us the breastfeeding nazis

I'm not sure what a Lactation Educator is, so I'm going to say that we don't have any of those. I hope the info I've been able to give you has been helpful!

mitchsmom · Aug 3, 2004

I am not even a nurse yet, but I am a bf group leader so I'm somewhat familiar with the services at our two small hospitals.

The first hospital doesn't have anyone with extra lactation training or offer anything extra that I know of. There used to be one nurse there who was interested in pursuing IBCLC but I think she has moved. There is at least one more who is very knowledgeable/encouraging about bf and the rest are luck of the draw. (this is a very low volume unit, so there aren't many nurses)

The second has a "bf educator" - I am not sure if she has attended any workshops or short courses for a CLE type designation or not. She is basically a regular L&D nurse who takes a special interest in it and she also teaches bf prenatal classes if requested (I understand they rarely have them d/t low demand). If you are having problems, she may see you - but then again I've had people call me from the hospital during their pp stay for help, and tell me they've never heard of her when I ask if they have worked with their nurse, or her, or ???. As far as I can tell from the grapevine, the rest are the luck of the draw here too. Many times they are going on veryyyy outdated/wrong information and advice. There is no protocol or guidelines and patients constantly get conflicting advice from one shift to the next (at both places).

I hope that doesn't sound too negative... there ARE some people who are good but I regularly hear pretty appalling feedback too. I try to give the benefit of the doubt and assume that something got lost in translation and the mom doesn't remember something the way it was told to them or whatever, but it happens too often. Plus, some of it is told to me by a couple of the L&D nurses themselves. I am so thankful to those who really try despite having to swim upstream!

I guess maybe our hospitals are too small to want to invest in more continuing ed or IBCLC's, or maybe there is a lack of interest from the nurses, not sure.

We have one LPN/IBCLC in our town who works for healthy start (my group co-leader was also one, but she just moved), and our WIC bf counselor is very knowledgeable and good.

I think the hospitals have fair initiation rates.

I think the rates should be compared to, say, 2 weeks out... as well as 6 months out. A lot of moms quit much closer to the discharge-2wks postpartum end than the 6 month end of the statistics. In other words, initiation rates are probably a lot different than the rates at 2 wks out. Sorry, on another tangent as usual :)

I hope to take the IBCLC exam next summer (I've got to call them as a matter of fact and see if I'm going to be eligible or if I'll have to wait another year)... and I also hope to be working in L&D before too long so hopefully one of our hospitals will soon have an IBCLC after all! :)

SmilingBluEyes · Aug 3, 2004

I hope to get my CLC one day soon...but IBCLE prolly never. BF is a huge part of what I do but not the ONLY part....and I have only so much time to invest (as well as money) in getting my RNC and that plus Healing Touch, hopefully next year.

webbiedebbie · Aug 3, 2004

At the hospital where I work at, I have been on a newly created Breastfeeding Task Force committee for about a year now. It is comprised of me (representing PP), 2 Nursery RN's, Health Dept rep IBCLE, occ L&D RN's, Maternal Child Health Educator, OB nurse manager, Peds nurse manager, and Dietary LPN.

A new position was created for Lactation Specialist. A L&D RN got the position. She IS NOT IBCLE certified or certified at all in Lactation! She works M-F 8-4 only but does some teaching for prenatal classes.

Nursery currently "owns" breastfeeding. My manager says we do not have time on PP to do breastfeeding. I am trying to change this! We offer rooming in to our patients and we have a Nursery operating 24 hrs. I am pushing for a position to be created for a Lactation Specialist on 11-7.

We are not a magnet facility. The hospital is looking to become one.

LauraLou · Aug 3, 2004

We have a traditional setup with separate L&D, Nursery and Postpartum units. Postpartum has 35 beds and usually has between 25-30 patients. The hospital has four Lactation Counselors, all of which are specially trained RNs. Every patient has at least one consultation with a LC, usually two. The LCs are only there from 7:00 to 3:00, so the Nursery nurses provide assistance after 3:00 or when the LCs are busy. Mothers are given contact information for the LCs, in case they have questions once they get home.

Our breastfeeding rate is about 85-90% at discharge. We are a private suburban hospital with a well-educated, upper middle-class cliental, who are very knowledgeable about the benefits of BF. We have many Indian, Asian and Middle Eastern patients. Very few of these patients bottle feed. There seems to be a lot of cultural and family support for breastfeeding among these patients.

RNmommy · Aug 4, 2004

Thank you so much for all of your replies. LauraLou~ your facility sounds the most similar to mine. Can I get a few more responses? Thanks so much :)

mitchsmom · Aug 4, 2004

Danielle, you may also be able to search the lactnet archives for some helpful info if you haven't already:

http://peach.ease.lsoft.com/archives/lactnet.html

I don't know if there's anything here that may interest you too:

http://www.geocities.com/breastfeedinglinks

Brenda-RN,BSN, WA. · Aug 4, 2004

We have four RN's who are IBCLC who work from 6 am-6 pm everyday, two at a time. They work with mom's who request them, or the nurse requests them. They also help in the SCN. I work at a hospital that delivers anywhere from 200-300 babies per month in Washington State. We also have a women's clinic which is open Mon.-Sat., there are lactation specialists there to work with mom's after they go home, and answer a lot of phone calls regarding lactation. They are so valuable on our unit because we are so busy. I have spent an hour or more at a time helping a mom breast feed, which is great, but I have 3 other couplets I need to be working with, but it is so important to help them. I would say at least 95% of our moms breast feed their babies, and we encourage breast feeding, although we support bottle feeding parents as well. I can't imagine not having the lactation specialists at our facility, it would be total chaos without them. It's difficult that they're not there between 6 pm- 6 am! But, we take what we can get. I think any hospital that promotes breast feeding needs lactation specialists.

We are going through some transition regarding the use of Lactation Consultants at my facility. I am curious to know what is going on elsewhere. Do you use LCs? Are they IBCLE certified? Are they RNs? Do you use Lactation Educators? Are they RNs? Do you have another type of lactation specialist? How many do you have on staff? Do all patients get to meet with the LC? If not, which patients get to see the LC? How many deliveries does your facility do each month? What are your breastfeeding rates? Where in the country are you located? You don't have to answer every question but will you give a brief synopsis of your current lactation program? Also, if any of you are at a magnet facility, I would be ever so interested in the specifics of your program. Thank you so much.

SmilingBluEyes · Aug 5, 2004

I, too, wish we had an LC on our night shift. (let alone weekends). This is partly why I wish to pursue my CLC. I am woefully inadequate in the face of true breastfeeding complications and sometimes, these issues don't occur in the hours of 9-5 on Mon thru Fri!!!!!!!!!! It is an honest-to-goodness goal of mine to do this so I can function better to help troubled BF couplets afterhours, not just make my feeble attempts (while trying to care for my other couplets and GYNs)---- and tell these beleaguered moms that help is coming in the morning! I just need to be able to pony up the $700-800 to do the classes and then test!