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Northwestern cuts lactation consultants, trains staff

by Alicia Barney
Oct 14, 2008

Lactation consultants have become a standard fixture at hospitals across the country in recent years, employed to help new mothers learn to breast-feed. But at Northwestern Memorial Hospital, the highly specialized consultants are being replaced by staff members trained to be breast-feeding counselors.

Lactation consultants are board-certified specialists that help mothers with problems like babies having difficulty latching onto the breast, painful nursing and low milk production.

Last month Northwestern’s Prentice Women’s Hospital officially rolled out a new model of breast-feeding care, laying off all but three of their 11 lactation consultants.

"Over the course of many years we have really struggled trying to meet patient needs and patient requests,” said Ann Schramm, director of women’s health at Prentice Women’s Hospital. “We felt like there was a void with staff nurses seeing that lactation consultants take care of breast-feeding …. We need to make sure that someone is providing that support every time [the patient] had contact with a caregiver.”

While lactation consultants have been laid off elsewhere for budget reasons, Schramm said the move at Prentice is not a cost-cutting measure.

“It’s costing us about the same because we shifted where the dollars are going,” she said. “It’s not a tremendous money saver, we’re just getting more return for what we’re investing. To reach the level of contact we want with patients with lactation consultants, we would need many many more of them, and they are very costly to add [to the staff].”

Previously, the consultants visited patients who requested their help or were recommended by doctors, explained Schramm.

The busy consultants were often not able to see a patient until just before she checked out, she said.

“It was a big dissatisifer for the patient and lactation consultant,” Schramm said. “I see this as being something given to patients as opposed to taken away.”

Beginning a year ago, Northwestern began sending labor and delivery nurses to a two-day training course to become breast-feeding counselors. The hospital now has 100 breast-feeding counselors on staff to help mothers within the first hour of their baby’s life.

The hospital now employs one full-time and two part-time consultants, who supervise and mentor the hospital staff and help with advanced problems, said Schramm.

Providing training to hospital staff is a positive step to help to mothers earlier, said Nancy Mohrbacher, an independent Chicago lactation consultant, chair of the Chicago Area Breastfeeding Coalition and author of several books on breast-feeding.

“Some of what they’re doing is on the right track, but the actual cutting of the lactation consultants is not going to be the best thing for mothers and babies,” Mohrbacher said. “They need the right mix between good breast-feeding practices from the beginning and consultants on staff to help with problems.”

Even with help from trained counselors, three breast-feeding consultants are not going to be enough to serve the hospital, Mohrbacher said.

“I’m very concerned about what happens at Prentice because they are largest birthing hospital in Chicago,” she said. “These people are going to need breast-feeding help ….”

Chelsea Hall of Hyde Park had her son at Northwestern at the end of August, during the transition to the hospital’s new plan.

“I did choose to breast-feed and as soon as they handed my son to me someone was there to help,” she said in an e-mail interview.

While there was a communication glitch when the nurses’ shifts changed that left her waiting for additional help for a couple of hours, Hall said she was happy with the care she received.

“When she did come, it was incredibly helpful, but I do wish it hadn't taken so long,” Hall said.

While Northwestern is training employees about breast-feeding to offset the loss of consultants, lactation consultants are being cut from the payrolls of hospitals around the country. This means patients lose out on the research knowledge and specialized skills consultants have, said Diana West, a lactation consultant and director of professional development for the International Lactation Consultant Association.

“It’s happening in Chicago and it’s happening all over,” West said. “The hospitals look for ways to cut, quote unquote, optional services. They don’t see direct cost benefits. There are many long-term benefits but they aren’t looking at that.”