Cristy wrote:
In reference to the baby born at home whose mom had not yet chosen a ped:
"This is a very difficult position that you are in.  But, as a health care
provider, I believe that you would be obligated to report this type of neglect to
the state children's services.  It is obvious that this baby is at risk for
several things including lack of appropriate medical care and malnutrition. "

I don't get it--we are going to report a mother to protective services b/c she did not have good bf'ing help or information for the first 36 hours?? Or b/c she has not yet chosen a ped? Or b/c her baby hasn't seen a ped? Or b/c she had  a homebirth?

This is what Amy said about the situation:
"This week I was requested by a homebirth midwife to see a baby in a crisis. "

So, the midwife appropriately referred the family to an LC.

" When I saw the baby she showed several signs of dehydration but was turning the corner after a traumatic birth and a rough first 36 hours.   Nursing appeared to be going well, from everyone else's perspective, but mom had a cracked nipple and baby was not stooling, besides one immediately after birth. "

How many babies in hospitals have only had one stool by 36 hours?  How many nurses or docs would not pick up on the cracked nipple as an indication of feeding difficulties? I had one client who returned to her hospital at 5 days pp with severe pain only to be told by the LC on staff that this was normal. Within 36 hours, this baby was already seeing an LC--how often does that happen?

"The midwife seemed stumped as to what to do and said she deferred to my judgment but seemed shocked when I suggested that this floppy, dry, listless, non-responsive baby see a physician! "

Well, if the baby was indeed turning the coner and good bf'ing management was coming into play, I would think that seeing a doctor would be a matter of decision for the parents, not any of us. How many babies go home from the hospital in this same situation and do not see a ped for a week or two?

" I asked for the name of the pedi and the mom told me she had a recommendation for one that they had not yet seen.  I mentioned that there was another very breastfeeding knowledgeable pedi in the same practice (no comment on the intended choice) and mom jokingly said "Oh, then THAT'S our doctor!!"

When you choose holistic care for your children, it can be very, very difficult to find a ped that you are compatable with. And, if you are not going to vaccinate, what is the urgency in general to see a ped anyway? The midwife does the newborn assessment, and while the LC and midwife may have disagreed on some things, the midwife still got the mother care promptly. If this is a breastfeeding issue, then what do most doctors have to offer anyway? Amy did not say that the baby was still going downhill and I assume that she planend to follow-up with them. My second baby did not see our ped for 6 weeks--she said, "well, midwives do great newborn assessments; come in when you are ready". From my perspective, reportin g this family would be a dangerous knee-jerk reaction that shows little respect for the right of families to choose how they care for their own children. I would just send the report to the midwife (the mother's PCP) and ask the mom which doc she would like me to send the other copy to.
Jennifer Tow, IBCLC, CT, USA