First of all - I want to respond to some comments about breaking confidentiality: nothing is written to anyone - without a written consent from the mother.  That is a given.  

Also - mothers do not have to get a referral from a doctor to see me - they call me directly, they hear about me through WIC or La Leche League or from a friend, or find me on-line and call.

I NEVER consider my report or communication to the doctor as "asking permission" of a doctor - but rather as a collaboration - and at times (especially in a few cases where the mother was involved in situations I had no knowledge about - such as drug use) it has been VERY important that the doctor be aware of what I had been or not been informed about.

This request (to sign a consent) can often be a way to open up conversations that can lead to helping the mother beyond breastfeeding - into learning how to communicate and deal with health care providers.  In fact, in the La Leche League support group meetings we discuss the importance of mothers learning how to communicate and collaborate with doctors, teachers, and others who will be part of the team that provide services for her baby.  Some moms are lucky and rarely have to deal with specialists (whether medical, educational, psychological, etc.)  - but even so, we have to deal with coaches we feel are inappropriate or neighbors that are problematic.  

New baby and breastfeeding situation are only the BEGINNING opportunities for mothers to learn how to deal with people who some believe are "above" them - but in fact are not.  Mothers need to know how to communicate, agree and disagree (without being disagreeable) and when necessary,  even "firing" them!  (I had to "fire" my mother's doctor!)  At times in our group, mothers even role play what to say and other mothers share their experiences - successful and unsuccessful. 

When I began as an IBCLC I WAS resentful of the need to communicate with the doctor - and DID agree that "this is a free country, and moms have a right to see me if they want to, and I shouldn't have to 'report' to the doctor"...

HOWEVER - now I think of writing the report to the doctor for a variety of reasons (This may be US-centric, but that is where I work): 

 - as a protection for ME (after having some scary situations arrive at my doorstep or home visits I made where clearly the baby was in danger and mother was refusing to follow physician and my recommendations about supplementation).  

 -  a way to promote my profession and increase the knowledge of the provider about breastfeeding and what IBCLCs can do.  

 - as I explained above, because my "hat" as a Public Health Nurse never leaves me, even when I am seeing a mom as purely and IBCLC, just as my "hat" as an IBCLC never leaves me when I'm acting as a Public Health Nurse at a community meeting - I believe my job includes helping a mother learn how to communicate with her doctor (or any other person who will be working with her and her baby such as a teacher), and advocate for what she wants/needs (tongue tie assessment, thrush treatment).  I believe when I model the behavior of respectfully providing evidence-based lactation evaluation, this helps my client, too.

Don't think this works out perfectly for me or the mom - many doctors have refused to provide a tongue tie assessment referral to a surgeon (that IS a requirement in our area) but at least the mother and the doctor both are aware of what I recommend.  It is almost always - except in situations that the baby is in danger - the mother/family who decides what are the next steps she and her baby will be taking.  

I truly believe that facilitating communication is better than avoidance in most cases...

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA - USA



 

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