Andrea:  I'm not really frustrated, just careful to cover my ___ legally.  
Whenever I talk with a mother, be it a face-to-face or telephone contact, 
about ANYTHING, my parting words are always to let her doctor know what we 
have talked about and what my recommendations are.  And then I document 
that I said this. When discussing fenugreek with a mom I always tell her to let 
her docs know that she is taking this herb, especially her ped.  Because 
fenugreek makes one's urine smell like maple syrup, I don't want a ped to panic 
and unnecessarily work a baby up for Maple Syrup Urine Disease.
If we are discussing prescription medication, I tell the mother to talk with her 
doctor about the medication.  I very rarely have a doctor refuse to write a 
scrip based on my recommendation - they just like to be included in the loop.  
I frequently encounter the opposite - either the mom will call and tell me that 
her doctor told her to talk to me about XYZ medication and should he 
prescribe it? or the doc will get testy with me for "bothering" him with an issue 
he considers me the expert on anyhow. And remember, many of the herbs and 
medications we would routinely recommend are available OTC (including 
domperidone outside the US) and the mother on her own can purchase these 
without any input from a HCP.
For you doctors on the list, I am here to make your lives easier.  What I 
expect from a doc is a medical diagnosis, so that I can then help the mother 
and her baby fit breastfeeding into the context of the diagnosis.  When we all 
learn to play nice together in the sandbox of life, everyone's lives will be that 
much better!


Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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