This is from Ros Escott, from Tasmania. Please respond on the list to her,
and copy her as well.  Ros is at:  Ros Escott <[log in to unmask]>


 Thank you. Kathleen


-------------
 
Ellen Penchuk wrote:
I have held back in saying this, and I am sure I will be flamed for voicing
it now, but I doubt that this would have happened while Joanne was at the
helm.  She must be rolling over in her grave at this turn of events!
 
Many of us who knew Joanne have had the same thought. It is almost as if
they waited until she was gone to announce the new SOP. She would be livid!
 
-------------------------------------
 
I worked closely with JoAnne Scott for 15 years and heard her present on
ethics and scope of practice matters many times ­ I can tell you, the
information in the IBLCE¹s Scope of Practice is nothing new and is
consistent with what JoAnne taught. If she were still with us, she would be
hitting this argument on the head very succinctly and I¹m sure she would
agree that the current concern about the SofP arises out of
misinterpretation. Some further explanation of the language will hopefully
address and this.
 
I have on my computer the presentation that JoAnne Scott gave at the LLLI
Conference in July 2005 and the VELB Conference in May 2006. She was
representing IBLCE¹s perspective on both occasions. I have extracted the
following, without editing, from the slides in her presentation:
 
Recognize when you are out of your professional depth.
Your scope of practice as an IBCLC covers non-medical management of
breastfeeding only.
 
What if the Doctors in your Hospital don¹t want you to ³Diagnose?²
³I don¹t want you telling my patients their babies have tongue-tie. Sore
nipples are just a part of breastfeeding.²
You cannot directly contradict a doctor¹s orders.
The IBCLC is a member of the health care team. The doctor is the team
leader.
Educate, refer, but work within the team approach.
 
Reporting
What if you know your client's primary health care provider will contradict
you? (I've looked at your nipples and you don't have thrush).
You still have to report.
You may again suggest other primary providers if the client reports
dissatisfaction.
 
What if your client doesn't want you to report to her primary health care
provider?
Tell her that you are sorry but you cannot accept her as a client.
You may suggest, however, that she change health care providers if she is
uncomfortable reporting to the one she has.
Obtain her permission to report, in writing, before proceeding with the
consultation.
 
You are given samples of a new galactagogue; should you ask mothers to try
it?
Research it first. Get documentation of effectiveness.
If preliminary research results look promising, seek your institution¹s
approval to conduct a clinical trial.
If you are in private practice and you think it may be useful for a
particular client, first ask the approval of the primary health care
provider.  
Remember that it is outside your scope of practice to give it out without
medical approval.
 
 
I too have presented many times on ethical issues relevant to the Scope of
Practice. In the syllabus for the 2005 ILCA Conference Professional
Development Day you can find detailed notes from my presentation, which
JoAnne had read and thoroughly approved.
 
I talked about ethics and working as a member of the health care team, and
recognising the role of the primary health care provider. I relate it to the
reporting requirements (in the Code of Ethics), and that it is unethical to
make negative comments to a client about the practice or beliefs of another
member of the health care team, regardless of your own opinion. I caution
IBCLCS about becoming another party in the conflicting advice scenario,
where the mother is ultimately the victim.
 
Mothers can misreport what the doctor said; the IBCLC may not have all the
facts; there may be a medical complication the IBCLC is unaware of; or the
mother may be saying this because she wants an excuse to wean.  I then talk
about the options for dealing with it:
·        With the mother¹s permission, you can call the doctor on mother¹s
behalf; and perhaps fax some supporting information
·        The mother can return to her doctor to discuss it further;
encourage her to tell the doctor how important breastfeeding is to her; you
can give her information to take to her doctor
·        You can tell the mother that ³there are differing opinions on this²
and remind her that she has a right to seek a second opinion.
 
The bottom line is that the IBCLC (if that is her sole scope of practice) is
not medically qualified to contradict or ignore the advice of a client¹s
health care provider. It can be a challenge to find ways to help a mother
while not contradicting her health care provider, but it can be done ­ an a
mother support counsellor with a similar scope of practice I have been doing
it for 20 years. IBLCE could not defend a SofP for IBCLCs that said
otherwise.
 
Ros Escott IBCLC
Tasmania, Australia
 

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