Mention is made, in response to a post about short tongued babies, of the
appropriate role of a LLLL and/or IBCLC when visiting a mother.  Suggestion
is made that "you may and should perform as a LLLL to the best of your
abilities (which includes any abilities that you have because you are IBCLC
certified)."

I respectfully disagree.  When one wears "both hats" the primary
responsibility is to pick ONE hat to wear, and do only what that ONE hat
allows.

LLLLS are volunteers who offer mother-to-mother counseling, on customary
breastfeeding and new mother matters.  They are NOT allied healthcare
providers, as IBCLCs are.

LLL provides insurance, as an organization of  trained volunteers, to cover
the **volunteer** role of its members.  Some folks are lulled into thinking
LLLLs are "insured" to see a mother -- the way an IBCLC or MD or RN carries
malpractice insurance. Wrongo Grande.  LLLL insurance covers what a
volunteer does, not what an allied healthcare provider does.

When an LLLL-who-is-also-an-IBCLC is visiting a mother **while in a League
context** she has to be very careful -- and it is hard to do -- not to
"stray" from being a mother-to-mother volunteer helper into the territory
of being an IBCLC.
Because once that happens, ALL the requirements for competent and ethical
 IBCLC practice come into play:  obtaining consents, doing assessments,
developing care plans, creating a chart, sending reports (where
appropriate), following-up and GETTING PAID.

So let's say the LLLL is visiting the mom at home, and it becomes readily
apparent that there is more at play than ordinary, new mom concerns.  The
LLL simply INFORMS the mother!  "You know, based on our conversation so
far, I think it is important that you be seen by an IBCLC. There appears to
be more going on than a peer counselor can help, and you and the baby
should be fully assessed for breastfeeding issues.  I do also have a
practice as an IBCLC [or work at the clinic or doctor's office as in IBCLC]
.... and my fees/obligations/etc. are as follows.   You can also look at
the IBLCE and ILCA websites, [or this referral list I am handing you], if
you think another IBCLC might be a better fit."

Can the visit instantly transmogrify into a lactation consultant?  Of
course it can -- with all of the IBCLC's ethical, legal and professional
obligations now kicked into play.

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

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