Jan Barger wrote:
>Denise says:
><<would like to support Rachel's interpretation that there is no
>requirement for IBCLCs to send reports to other health care providers.  I
>know from my US colleagues that this is common practice, and there's
>nothing wrong with that.  And I see it as an excellent way to educate other
>practitioners.  I feel it is necessary courtesy to send a report to a
>referring health care provider too.  However if the mother comes from other
>sources then I don't feel a letter is required, UNLESS there is a reason to
>refer her on ie. you're recommending baby have a medical review.>>
>
>How then would you interpret number 23 of the IBLCE's Code of Ethics:
>
>23.  Require and obtain consent to share clinical concerns and information
>with the physician or other primary health care provider before initiating a
>consultation.
>
>It seems to me that is pretty straightforward that the IBCLC is obligated to
>share information with the primary health care provider -- either the OB or
>the peds or the midwife....

I agree with Denise. Maybe I can help explain the situation in
Australia, at least for private practice LCs. Mothers usually
self-refer, after being given our names and numbers, sometimes from
multiple sources, such as Australian Breastfeeding Association
counsellors or their child health nurses. These are overwhelmingly
mothers who delivered in a hospital, although we get the odd one who
had a homebirth.

These mothers often are very vague about their doctor, although I do
always ask for a name. Here, you only go to a doctor if you are
actually sick or injured, and then decide who to go to. So often they
don't really have one specifically and may rarely see a doctor, if
they are basically healthy. Many mothers are 'between doctors' when
they have a young baby - they have not yet chosen a doctor that might
be better for them now they have a baby than the one they might have
seen previously. They might give a name of a practice where there are
a number of doctors, and they see whoever has an available
appointment at the time they are sick. These doctors are GPs - not
OBs or paediatricians. These latter specialists are usually only used
short-term - the OB for pregnancy and the birth itself (or whoever is
on duty, if they are public patients). The paed is only seen over a
longer period if there is some specific ongoing health problem in the
baby that cannot be handled by a GP. They might have seen a
paediatrician in the hospital (either a private one or the one of
duty), who checked over their baby, but that is probably the last
they see of him/her. With the private OB, they would see him/her once
more at their 6-week checkup. That's it. From then on the monitoring
of the mother and baby is basically in the hands of the child health
nurse, unless the baby or mother becomes sick or has some other
health problem, and the nurse refers the mother to a doctor.

As an LC I am not prepared to provide a consult to a mother who has
no medical coverage - at least a midwife, child health nurse or
doctor. I do not want that level of responsibility for the baby's
wellbeing. However, I do not usually report to these people - they do
not expect it. The mother will invariably tell her child health nurse
at her next visit about how breastfeeding is going and about the
consult. All my clients have always been attending their child health
centre. Other than that, the arrangement is between the mother and me
- just like if I go to my physiotherapist or my chiropractor, my
doctor never finds out. The doctor would only get a report if he/she
actually made a direct referral to the other practitioner. If this is
how the referral comes to me, then I would report to the doctor in
that case, in the same way as the physiotherapist would report to a
referring doctor, but not if the patient self-referred.

I have to admit, when I first read the IBLCE Code of Ethics clause
you quoted above, I felt that this was written with the US situation
primarily in mind and no consideration was given to different systems
in other countries. What was the consultation like when the Code of
Ethics was written? Was it just done by only Americans?

Now I have probably put my foot in it, but in my experience this is
the way we generally work here.

Joy
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Australian Breastfeeding Association counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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