It is not necessarily *unethical* for an IBCLC to perform (and get paid for)
a consult which is of C- or D+ quality.  The IBCLC who shrugs her shoulders
at the distraught mom can still be practicing within the ILCA Standards of
Practice (our behavior "shoulds") and the IBLCE Code of Ethics Principles
(our behavior "musts").  (The Standards and Code may be viewed at the
appropriate websites, www.ilca.org and www.iblce.org.)

Whenever we see a mom "after" another IBCLC, there can be professional
tensions.  And, often, we are only hearing the mother's view of events.  But
let us assume that we are seeing a mom who really, truly, had a lousy
consult from another member of our profession.  What to do?

The same Standards and Code give us a great opportunity to upgrade the
quality of care our colleagues dispense:  our required report to the health
care provider.  As we are considered members of a health care *team,* a copy
of the lactation consult can be sent to the IBCLC#1 in addition to mom's
MD/midwife, pediatrician, etc.  Mom will no doubt consent to having a report
sent to IBCLC#1 -- after all, wasn't mom bellyaching about her earlier
consult when she saw IBCLC#2?

This gives IBCLC #1 a chance to see what sort of care plan and follow-up are
suggested by IBCLC#2 -- and why.  This is a non-confrontational way for #1
to see how others would handle the very same case she did.  As a result, she
may be more open to changing her consultative practice for the next mom.
Being optimistic here, there might even be a healthy exchange between #1 and
#2 ("Say, that was a great idea to do a weight check before and after the
feeding.  I think I'll start doing that.")

It is not #2's responsibility to make her colleagues (and competitors) be
better IBCLCs.  It is her job to provide the best care she can for *the
mom*.  In so doing, though, perhaps #2 can nudge #1 to a higher standard of
professional care.

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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