The problem is that the *fear* of being sued in the litigious-happy-USA
often clouds the clinical picture.

I can share one related "case study" about a USA-based hospital.  A mother
with a history of alcoholism (complete with ER visits for same during
pregnancy) delivered an infant, who showed signs of withdrawl but no fetal
alcohol syndrome.  Mom wants to BF; mom regularly visits NICU and brings
expressed milk; mom showing no signs of alcohol use since delivery;
neonatologists have "ordered' mom's breastmilk [I love medical terminology.
An "order" for breastmilk always conjures for me an image of the doc, feet
planted and arms akimbo, yelling at the mom, "Breastmilk, stat!"].  Mom was
receiving repeated support and encouragement from IBCLC (in NICU) and
hosp-based social workers (to arrange follow-up).

RNs were still leery of the ethics of providing the pumped breastmilk, for
fear it might have alcohol in it, and they would be held liable for offering
a tainted substance to the baby.

Now -- I am well aware that alcohol and cocaine are metabolized differently
-- but I am telling this story to describe the behaviors of the health care
providers and administrators.  I am paraphrasing here the outcome, as it was
described to me in an e-mail:
*  The hospital's ethics cmte met, and decided there was NO ethical dilemma
... further, "that the mother's right to BF took precedence over any other
rights."
*  The risk manager stated that there is no precedent for legal action
against an institution or its staff  under such circumstances
*  Physician insisted it was her responsibility to determine whether or not
it is safe to feed the pumped breastmilk.

I guess the moral of the story is:  run it up the chain of your hospital
*now.*  Ask the risk managers and ethics cmte to review the situation of
risks and liabilities for staff and the institution, in your country or
state, when you don't have the emergent situation of a drug-positive mom who
delivered TODAY, and must initiate lactation TODAY.  Discussing these
scenarios as hypotheticals allows, frankly, for a much better analysis of
the variables in the situation, when folks are not freaked out that they are
about to be served with papers, and lose their job and license ... and are
making decisions based on such fear.

Jake Marcus described succinctly the *other* responsibilities that may
attach, as we deal with Crack Mom. Yes, the health care providers may be
mandated to report Crack Mom to social services, so that agency can initiate
an investigation ... including the ultimate sanction, of removing baby from
the mother.  But that decision will not be made in the first handful of days
of life, when the mother and baby are in the hospital.  It is NOT
inconsistent to support breastfeeding during the time this whole ugly
scenario gets played out.

Liz Brooks JD IBCLC
Wyndmoor, PA, USA

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