Nancy Wight makes the point that it is dangerous to be getting care
from different people possibly in different places who aren't
communicating with each other, which is an argument for sharing
information and (possibly, though I am not convinced) an argument for
designating one profession as having authority to coordinate the
teamwork of all the others. I wonder how one decides which physician
gets the last word about children who are cared for by members of
multiple specialties? I'm not trying to be snotty here, really - I
am curious.
But mostly I'm guessing that Nancy's view is colored by her work
setting, with vulnerable babies, often in hospital, whose nutrition
(and general health) may be precarious and certainly not something
they can be assumed to fixing on their own. In such cases, where
there are concurrent medical problems impacting on, and being impacted
on by, the feeding, it is only natural that all parties involved
behave like a team. Where I live, the de facto coordinator of such
teams is the mother, because nobody else talks to everyone on the
team, they don't usually have meetings with every discipline present.
Not saying this is desirable, and in fact many parents complain at the
lack of a coordinator in the herd of clinicians they have to be in
touch with regularly. But it's the way it is. (Also, the only
children here who are regularly seen by pediatricians are the
chronically ill children and I don't mean the ones with frequent
stuffy noses. Normal children in need of care for a single episode of
non-serious illness would be seen by their family GP.)
For many breastfeeding problems there is no earthly reason to involve
any health care providers, except the IBCLC (assuming we consider
ourselves health care providers, and not 'normal life advisors' or
'infant cuisine experts' or whatever). If the child is well but the
mother is very sore, or struggling to establish supply, or maintain it
after going out to work, or just trying to find her way with
breastfeeding as her healthy child matures and changes, she needs
contact with someone who understands breastfeeding. Period. If in
the course of working out her problem the IBCLC uncovers medical
factors of significance, it would be natural to refer the woman to
whomever she normally gets care for those kinds of things - and I
would make sure she had something in writing from me to share with
that practitioner so they know why I have advised her to seek their
care.
Seems to me IBLCE could benefit from a field trip into the world where
we practice, to see the diversity in the way health services and whole
societies are organized.
Rachel Myr
Kristiansand, Norway
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