Dear Cathy,
Thank you for your response.  I did not see this mom, she called me on Wed.
afternoon.  I do not have her phone number but plan to obtain it from the
pediatrician.
You wrote:
    Did you do a thorough history? Did you suggest to the =
mother
that she should do one sided nursing and continue night nursing in
opposition to the specialist=92s orders? Or did you refer her back to =
the
specialist for dialogue and a discussion of her discomfort with his
recommendations/orders? Did you discuss the consequences of disregarding
physician=92s orders with the mother, including the risks of involvement =
of
child protective services?  Did you provide a written report discussing =
your
consultation with her health care provider? Did you follow the standards =
of
practice for an IBCLC and an RN in doing this consultation?  If not, you =
may
be at risk of an ethics violation.=20
The mother discussed with me that she did not feel comfortable with these
instructions from the GI doctor, this is why she called our services.  I did
agree with her that breastfeeding per se is not the cause of this baby's problem.
Maybe there is poor milk transfer but if the mother continues to give the
Pediacare and increase calorie food prior to nursing (which this baby enjoys),
how is this unethical advise?
I did tell this mom to discuss her issues and concerns with her primary and
if she choices to return to this specialist, to discuss them with him.  I do
not see how it would even be remotely possible that this could be reported to
child services.
I called her pediatrician's office today and he will be out until next Tue.
I left a message and will follow up on that day.  I will let him know why she
called, her concerns, and mine.  I will recommend Early Intervention and find
out what tests he has done and what he is thinking.  Then I will try to find
out why he did not refer her to our services when the baby was slipping on the
growth chart.  I will use this opportunity to discuss what types of problems
we could be helpful to assist him with in the future.  With this in mind, that
maybe in the future to capture problems earlier than this one.
I'll keep this group posted on the progress and I will try to see if this mom
will make a visit with us.
Ann Perry, RN, IBCLC
Boston, MA

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