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7 Common System-Level Responsibilities in Providing Breastfeeding Support

Hospital system
At a conference recently, I spoke with hundreds of IBCLCs. Most were nurses in hospitals, but that’s about the only generalization I can make about the diverse group. Some were young, some older. There were those from urban and rural settings. Some had been in their jobs for a few months, while others had a few decades of clinical experience. They served a wide variety of communities across the country—and around the world. But all seemed to voice concerns about what might roughly be categorized as system-level responsibilities.

As we talked, I had a sense of deja vú. These were the same system-level responsibilities and issues I had struggled with, too. When I said “been there, done that,” many seemed genuinely surprised! I guess they assumed that I entered the lactation world, fully-grown.

Oh, no, not so. In fact, I had a rather prolonged “lactation infancy” during my days as a staff nurse. I had a tough time trying to tackle system-level responsibilities and problems. I am very glad to have “grown up” so that I can help others to solve these problems!

Here are some of the system-level responsibilities, issues and problems I struggled with. If you’re going through similar, we should talk!

Evidence-based practices

Scheduled feedings and liberal supplementation with infant formula were the norm. Prolonged mother-infant separation was not just encouraged—it was enforced. In my early days, I had no idea how to change that.

An effective breastfeeding policy

Breastfeeding policies existed in a few hospitals, but most were a jumble of suggestions and how-to statements. What we needed was a coherent and guiding document. But staff, as well as nurse administrators, didn’t seem to know the difference between a policy, a procedure, a protocol, or a guideline.

Staff training

Although there was a clear need for a staff education program, I had to figure out how to develop one. Nowadays, I develop learning programs for hospitals with this need, but I remember how daunting it can be to start from scratch! Back then, even getting continuing education approval for programs was a huge obstacle!

A breastfeeding and lactation program; having system-level responsibilities that knit units and services together

At the time, the phrase “program development” wasn’t in my vocabulary. But intuitively, I knew that my job was to knit together the existing disconnected pieces, and find the missing pieces of lactation management in both inpatient and outpatient units needed to be rolled into a real program.

Quality improvement studies for breastfeeding issues

Initially, I didn’t have the remotest clue on how to hitch breastfeeding issues to quality improvement efforts. But when I mentioned the need for this to happen, my enthusiastic boss said “Go to it, Marie!” Can you imagine? I didn’t even know how to track exclusive breastfeeding rates. I can do this now. But I sure didn’t acquire this knowledge in a day!

A curriculum for our prenatal and postnatal classes

Our haphazard approach changed from week to week, or from instructor to instructor. Staff people were available to teach the courses, but they needed clear guidance about what to teach. At the time, I needed to figure out how to delegate this without making the education a “free for all,” willy-nilly situation.

But alas! That brought out another whole issue: I didn’t know how to delegate! (And I’ve since learned that there’s a clear line between delegating and abdicating!)

Staffing a telephone helpline, or similar

The first time I was asked to interview candidates for staffing the breastfeeding helpline, and provide my boss with a recommendation, I found myself in over my head. I had no idea how to conduct interviews or mentor new hires. Whether the helpline is phone-based or a chat service, make sure it’s well-staffed. That can make a big difference for new mothers once they’ve left the hospital.

Bosses often call on clinical experts to take on system-level responsibilities. Or, impassioned clinical experts want to take them on, but feel ill-equipped to do so. As one RN-IBCLC recently said to me, “I know this is all so important, but I am totally out of my league with that stuff.”

At this stage in my career, I am only too happy to share my hard-earned knowledge with others. If you’re facing one of these—or any other—system-level challenge, let me know. I’m confident I can help.

What system-level issues are you facing? I’d love to hear from you.

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