Wow, I can't believe I am disagreeing with Kathy Auerbach on this one  <<I do
not feel that a recipe book including management protocols would be all that
helpful.>>
Perhaps it is a symantics problem with the word *recipe*.
What I said was <<most areas simply discuss the problem but not how to treat
it when it occurs. . .  (I)  am frustrated that treatment modalities are not
discussed at any length in any text.>>
Karen Foard  added
<<If prolactin levels are nil when they are supposed to be high, we
need protocols or something to see what is going on--if only to have a
reason, and not leave a mom high and dry as to why she wasn't "normal" in
her breastfeeding.>>
While I totally agree that << every management situation requires
individualization of recommendations.  What would work for one mother would be
the worst possible suggestion for someone else.>> I do believe that
similarities in cases exist.  Even the best physicians admit that no two
situations are alike, But if there aren't similarities,  what's the point of
even having protocols?  Or text books for that matter?
Take a look at a book like the Lippincott Manual of Nursing.  In many ways it
is a recipe book, yet the protocols are broad enough to encompass
individualization of treatment.  *Nursing alerts* pepper the text that draw
attention to dangerous situations, abnormal lab values etc...  I can easily
find normal values for men, women, children and infants for everything from
vital signs to lab tests.
Why can I not find normal values  for prolactin based on the number of weeks
post partum?  How long is a serum pregnancy test for HCG (Human Chorionic
Gonadotrophin)  positive and at what levels post partum?  What are the signs
and symptoms of retained placenta?  If I hadn't learned them in nursing school
and then specifically as an LC to lack of milk production, how would I know?
Lawrence devotes only one paragraph to retained placenta.
When a mom or a FTT baby is referred to an LC, including a host of lab
tests--how can we possibly incorporate them to help us plan our care with the
mother and baby?


Hasn't our profession come to the point where we AS professionals NEED access
to diagnosis and treatment recommendations for the problems we see?  Don't
physicians, who actually do the treating of the medical problem need this
information as well?  When the doctor wants to be this supportive of
breastfeeding why do we leave them and mom hanging?

Again I reiterate--if we are supposed to be the experts --what do we say when
the doctor asks "OK.  What do I do now?"

<<A book that discusses various ways of managing problems would be something
I could live with>>  This IS what I am asking for.
Marie Davis, RN, IBCLC