Dear Amy, I would suggest that you use a standard form that the mom fills
out and signs to give you permission to send a report to her health care
provider. I fax over a copy to the pedi at least, sometimes to the
ob/midwife. The Lactation Institute has one you can purchase. I ask moms to
fill it out and sign the bottom before we get started. I tell them straight
out I will be sending a report to their pediatrician.

Are you weighing the baby on a Baby Weigh Scale before and after nursing?
This type of proceedure gives you credibility in your reasoning for telling
the parents what needs to be done. For example, if you had weighed this baby
and seen poor intake at breast along with a loss of 10%, you could use
LLLI's handout on how to know if baby is getting enough to back you up on
the need to see a physician and feed baby more.

Are you giving mom an individually written care plan when you are done
working with her and assessing her situation? I use a two part carbon-less
form that I had made by a copy place with my name and information on it. I
write down whatever I think mom needs to know. The Lactation Institute also
has these forms. On the care plan, I always write the weight and the intake.
I also give out handouts that give credibility to what I am telling mom,
especially the ones written on poops, pees, weight loss, and gain.

Be careful how you say things so you don't offend people -- use "I"
statements and back it up with references so it doesn't sound like opinion.
("I am concerned about this weight loss because....")

The more professional that you come across, the more you will build
credibility with clients. Dress up a little bit and use professional forms,
give a professional medical receipt, etc. Have a business line, or pager of
some kind so they aren't calling your home. Carry liability insurance.
Whatever it takes to polish your image will help in these situations.

Kathy Eng, BSW, IBCLC

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