I am trying to understand the new SoP.  In my hospital in my capacity as
a non nurse IBCLC, when there is a tongue tie, it will not be clipped
until I see it, see the baby on the breast, make the diagnosis, and
write my findings in the baby's chart with my recommendations to clip or
not to clip.  Is this now outside of my SoP?  We are the main center for
tongue clipping, and the only hospital where you can get this service.
Will mothers and babies now be denied this because of the new SoP?
 
AS for prescribing "alternative meds", or herbal remedies, I have to say
that I have seen colleagues with absolutely no training in homeopathy
prescribe various remedies which may have put the mom and baby in
danger, and in one case resulted in surgery due to encapsulated abscess
which did not respond to antibiotic treatment.  Maybe our profession
should create a sub-credential and a course for those who want to
prescribe alternative medications instead of limiting them.  I have seen
colleagues prescribe galactogogues for poor milk supply rather than fix
the latch, get the mother pumping, and get the baby transferring more
milk.  
 
Many of my colleagues who have been in the profession for almost 20
years as I have are also questioning the need to recertify.  
 
Breastfeeding is not medical.  When I am questioned about the fact that
I am originally a teacher by profession and not a nurse, that is my
answer.  Breastfeeding is not medical.  It is about teaching mothers to
do what their babies are born to do instinctively, about teaching
medical staff how to better help mothers, and about sharing information
with the public to counteract the ubiquitous misinformation which has
been circulating for years.  It is about milk transfer and information
transfer.  
However, it is also about recognizing certain medical conditions which
may cause problems along the way.  I am sure that many of us have been
the first ones to diagnose submucosal cleft palate, ankyloglossia, and
even laryngomalacia, because that is what we are trained to look for and
we understand that those conditions may make the natural process of
breastfeeding more challenging.  
Many of us have even saved a mother's health by informing her that
cessation of breastfeeding due to a plugged duct, as her doctor
prescribed, is not correct.  NO matter how much we played with words to
cover up the doctor's lack of knowledge, the fact remains that this was
incorrect recommendation and not telling the mother could be
malpractice.  Until the doctors are educated about breastfeeding enough
to give correct information to the public, we have to be able to
contradict them.  To this day, most docs here in Israel get information
about breastfeeding from artificially processed cow's milk companies.
(That is what I am calling artificial milk these days when I realized
that most parents do not even know that it is cow's milk.  After all, it
is called milk substitute, right?) The medical schools are still not
taking breastfeeding seriously.  
 
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
 

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