Micki, IBCLCs need to send an HCP report on every consultation or 
helping situation they do. It is unethical otherwise. I work for WIC and 
find it very hard when mom doesn't have a physician (rather is using the 
emergency room due to either being medicaide or no insurance). I see her 
anyway, as I am a WIC employee and she is a WIC client. If she gets a 
doctor later, I will send him the report. At least the HCP report goes 
in the WIC folder that belongs to this family.

This is why phone or email helping is problematic and can border on 
unethical for IBCLCs. My understanding is that when an IBCLC talks to a 
mother about her problem, whether in person or on the phone, our duty is 
to communicate with the HCP afterwards. With phone or email helping, one 
can not easily get written consent to send an HCP report. Plus, once you 
talk to a mother on the phone, you own the problem and are responsible 
for follow up. The other problem with phone or email helping is you can 
not weigh the baby or see the baby and really know what is going on. You 
just have a one sided explanation that may or may not be what is going on.

Follow up is mandatory for an IBCLC but often hospital staff can not do 
so after discharge.

Hospital staff document on the clients medical record or chart. Some 
IBCLCs have a standard checklist or form that goes in the medical chart 
when they work for a hospital. Others write in the care notes pages.

The IBCLC does not have to get the HCP's permission to work with the 
client but the client has to give written permission for the IBCLC to 
send a report. I have told mothers that I could not work with them if 
they refused me permission to send an HCP report. I try to tell mothers 
this on the phone as I am gathering information beforehand.

Another thing we need to be doing is writing a care plan. The best way 
is to have a two or three part form, you keep the top copy and mom gets 
the bottom copy. You write out what things she needs to be doing or what 
the concerns for the baby are.

Kathy Eng, BSW, IBCLC

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