In response to the post about jaundice info that contradicts the
pediatrician: The June 15th issue of the Center's for Disease Control's
Morbidity and Mortality Weekly Report reports on 4 cases of kernicterus in
otherwise healthy term infant males that apparantly resulted from elevated
bilirubin levels secondary to poor breastfeeding.
I think that it is important to remember that first time moms don't always
know when feeding is going well or poorly, and when intake is poor, a
cascade of events can occur that lead to increasing problems. The solution
is always increased help for the mother and baby that certainly should
include more assistance with the breastfeeding. However, when a medical
condition exists, LCs must be cautious about contradicting the doctor. For
one thing, the doctor may have more information about other health issues
involved than we do. For instance, a level of 17 might be too high for a
37-38 wk gest. age infant. For another, this puts the mother in the middle
between a tug of war between her helpers. In such a situation, I might call
the doctor myself and say: I am the LC working with Sue Smith to try to
improve her breastfeeding. She tells me blah, blah, blah. Can you help me
by giving me a sense of when we can move forward with the direct
breastfeeding?
Or, you could write a brief, faxable report stating that Sue Smith has
approached you for additional info about breastfeeding during jaundice, and
you have provided her the following info (share a couple of journal refs --
NOT info from breastfeeding books, but rather from medical journals) and as
Sue is his/her patient, you want to make sure that your advice fits with
this baby's specific situation.
We have to understand our scope of practice and also to work as a team
member.
There are, of course, times when information coming from another team
member is so alarmingly incorrect that I recommend obtaining a second
opinion. This can and should be done when appropriate.
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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