Amy --Your post about whether an oral assessment is within the scope of
practice of an LLLL highlights why one who wears both an LLLL (or ANY peer
counselor) hat, and an IBCLC hat, has to be hyper- vigilant about not
sliding from one role to another.

I agree: most mother-to-mother counselors (LLL, NMAC, WIC, whomever) are
NOT trained in how to do an oral digital assessment.  I know I certainly
wouldn't have known what to look for if I had offered an exploratory finger
to a baby back in my NMAC days.

The hat you have on determines what your responsibilities are ... and
 (here's the kicker) it is the MOTHER who "decides" which hat you are
wearing, if you have failed to be very clear, up front, about your
appropriate role.

So the Q becomes:  what do you do, if you in fact HAVE been trained, and
CAN do a competent oral assessment, and today you are wearing your
LLLL/peer counselor hat?  Do you pretend you don't know how to do that
stuff?

My advice is ... yeah, you sort of do have to act like you don't know how
to do that sort of stuff.  It is conservative advice, to be sure, but it
also removes all of the gray area of whether or not a counselor is sliding
over into something more.

And it is the gray area that comes back to bite us in the butt.  Some folks
-- including those who have posted thus far -- have found a way to
carefully walk the tight rope between being a counselor, and a healthcare
provider.  It ain't easy.  Doing it wrong means:  the IBCLC runs the risk
of incurring the wrath of other organizations to which she belongs ... or
the mother will have raised expectations of what can be done for her (for
free) ... or peer-counselor colleagues *without* specialized training will
see the IBCLC doing an oral assessment while in a counselor role, and
assume that means they can do so, too.

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

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