I am a newbie IBCLC.  Today at work I had my first "What the *#@$!" moment.
   
  A G2P2 mom with a 3day old fullterm, healthy infant was told to stop BFing for 48-72 hours and formula feed until follow up with doc on Tuesday for a bili check.  Mom and infant are being discharged today.  No other "therapy" for Jaundice was prescribed.
   
  The bilirubin level was 6.3 on day 3(this am).  The only risk factor for Jaundice is ABO incompatibility, infant was Coombs positive. This infant was born via C-section post Fetal Distress during labor, CANx1.  On day 2 bili level was 5.1.

  Now, I stayed out of the recent discussions regarding our Professional guidelines as far as supporting primary caregiver's etc.  But, I couldn't ethically go into that mom's room, set her up with a pump and not give her any inkling that I disagreed with that MD's recommendation.  To be honest, mom and I had already discussed supplementing, she already has Harmony hand pump that I gave her yesterday and was to be pumping post feeds to stimulate increased supply.  I do not necessarily disagree with the MD recommending supplementing(they all do when Jaundice is a factor), its the complete forbidding of BFing that's got me perplexed.
   
  So, I went to the AAP's website and downloaded their "frequently asked questions" R/T jaundice info.  I also printed out the graphic that shows the normal vs high bilirubin levels corresponding to infant age in hours(also from the AAP website).  I gave both of these to the mother. I recommended renting a Hospital grade pump and offered to set it up for her if she was not going to BF for 2-3 days.  After she read the info I gave her she began to question things.  I gave her the docs office number and she says she is going to question MDs recommendation.  Now, the baby's nurse has told me that he will transfer the call to my lactation number when the MD calls up here screaming about this.
   
  So, here I sit cowering in my tiny little lactation room awaiting the wrath of this MD.
   
  Just had to share.  Any advice?  
   
  Mary Herrington, RN, IBCLC
  Lactation, Hermann Memorial Northwest
  Labor & Delivery, Hermann Memorial The Woodlands

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