Barbara Wilson-Clay,BSE,IBCLC wrote:
>
>        Kathy Koch writes about a mom with sores or cracks on outer side of
> nipple.  Over the phone, mom has assured her that positioning is fine. I'd
> have a million bucks by now by if I had a nickle for everyone who has
> assured me over the phone that their positioning was fine.  Somebody who
> knows how to assess latch-on needs to look at her.  This would take about 10
> min to fix, and points out the limitations of phone consultation.  I have
> done freq. phone consultations for 17 yrs, so I feel qualified to make that
> remark.  I continue to be dismayed by how quickly people assume that some
> exotic problem with the frenulum or suck must surely be the problem when
> re-positioning solves the vast majority  of the problems I see involving
> sore nipples.   Lactation Consultants exist because some problems need to be
> SEEN.

I agree completely, which is why I encouraged her to seek out the services of an IBCLC.

<snip from my original post>

"I explained the risks and limitations of nipple shields and suggested
to her that she ask her doctor to refer her to an IBCLC for very close in office
monitoring--not over the phone."

I explained what those letters stood for (and she wrote it down) and strongly suggested
she find someone who is board-certified.  I did explain the limitations of
phone-consulting and she seemed to understand what my limits were at 9:00 on a Friday
night!  When I reviewed positioning with this mom, she told me positioning had been
taught to her by the LC at the hospital after delivery.  She also told me how the baby
had been positioned and it sounded correct.  She also consulted with an LC when she
rented a pump.  I don't know the qualifications of these LC's.  I do realize, however,
that we are often told only part of the story which, again, is why I asked her to ask
her doctor for a referral and also gave her some referrals.  I also don't think it is
unreasonable to ask a mom if she notices a problem with the baby's tongue or suck.  I
asked her those questions because I wanted to know if there were other reasons to refer
her on.

Kathy Koch
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Alexandria, VA