Marie -- a friend of mine just e-mailed me privately with the same Q.  You
must be on the same list!  Here is how I answered her, though I have, um,
tidied up my reply a bit since I don't know my 3,000+ Lactnet friends as
well as the original inquirer:

Here in the USA we embrace the notion of reporting "up" to the docs; in part
to create a protective paper trail (that old fear-of-litigation thing) and
in part because the model for the IBCLC profession is largely built on the
hierarchical (patriarchal?) model of Westernized medicine that puts M.D. (or
primary health care provider/HCP) at the top of the authority chain.

In other countries (U.K.; Australia), IBCLCs report to the HCPs only when it
is, well, worth it to report to the HCPs.  Run of the mill position and
latch changes, and nighttime feeding issues, or return-to-work pumping
consults, are not worth "bothering" them with.  Tongue-tie or failure to
thrive or horribly injured nipples -- ya, send a report and pull the health
care *team* in on the picture.  Note, tho, that this is common in countries
where most IBCLCs have come to the profession via midwifery -- so they have
already had the "luxury" of practicing independently, as health care
professionals.  Think of it this way:  an M.D. isn't going a send a report
to a D.D.S. when she sees a patient for a check-up, right?  But if the
doctor sees the patient, and realizes there is a systemic infection that may
have originated with poor oral care, then she may well seek a consult with
that patient's dentist.

If you read Tenet 23 of the IBLCE Code of Ethics literally, you will see
that it only requires consent from the mom, prior to the consult, to send a
report to the other primary health care provider to "share clinical concerns
and info."  If you have no clinical **concerns** then you probably don't
need to send a report.

Private practice lactation consultants (like me) know the value of using any
legitimate excuse to fax a report to a doctors' office, as part of our
marketing.  But that is a different incentive altogether.

The problem is when the mother  has no "regular" doctor ... or just moved to
this area and hasn't found one yet ... or -- most problematic of all -- the
one who does not WANT you to send a report to her doctor.

Couple of ways to handle that one.  An IBCLC is within her professional
rights to refuse to see the mom, if mom is unwilling to have the IBCLC share
a report with her HCP.  Another is to give the mother the report **to take
with her** when she leaves, with all sorts of firm instructions to "bring
this with you the next time you get ANY medical care for yourself, or for
your baby."

Use a check-off, carbonless form if need be (so "writing" the report is
almost as simple as filling in a chart) so you can quickly and easily give
it to the mom.  Have a blurb in there that says "I am the mom and the IBCLC
has explained to me that I should bring this report the next time I seek
medical attention for me or my baby."  Then have mom sign it.  And chart
chart chart in your own records that you have explained to the mom that your
role is to report concerns to HCPs, but since she doesn't "have one yet" you
are using this form.

It is better than nothing, and it allows the mom to be seen by a competent
practitioner.

-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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