I just checked. This is my third post for the day (whew, you are all
saying).
First of all, I apologize for saying that IBLCE did not have their BOD
posted on their website. They do, and I appreciate all those that pointed it out
to me. It is: _http://www.iblce.org/board%20of%20directors.htm_
(http://www.iblce.org/board%20of%20directors.htm)
Secondly, I thought I'd share my letter to the IBLCE with you. It is
directed to Maureen, as she is ILCA's rep to the IBLCE, and ILCA is my professional
organization. It was copied to Roberta Hewat, board chair, Casey Goldberg,
executive director, and Becky Mannel, president of ILCA:
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Dear Maureen,
At first I was excited to see that there was an official Scope of Practice
on the IBLCE website. I had not known this was coming out, so it was just
serendipitous that I found it the day it was posted.
Then I read it.
Oh. My. Goodness.
It was hard to believe I was actually reading something that was targeted to
the IBCLC. What was even more astonishing was your post that said this had
been passed by the ILCA BOD!!
Quite frankly, it effectively ties my hands as an IBCLC practitioner. As an
RN, I am quite free to make a nursing diagnosis of a medical condition, give
"medical or nursing" advice, and prescribe alternative therapies, OTC drugs,
herbs, etc etc. But you see, I'm not practicing as an RN. I'm practicing
as an IBCLC. I was not hired to work for our pediatric practice because I am
an RN. I am not called by mothers because I am an RN. At this point in my
life, I am an IBCLC first -- an RN incidentally.
Case in point: one of my moms just called me not 1/2 hour ago. She wanted
to know if she could take Advil. Her doctor (not her OB) told her she
couldn't take Advil while she was nursing.
According to the scope of practice, I cannot contradict her HCP. Period.
If I pull out Hale and read his recommendations, I am contradicting her HCP.
If I remind her that ibuprophen was given to her in the hospital, I am
contradicting her HCP. If I tell her that "many mothers have found..." I am
contradicting her HCP.
I could, of course, say, "I can't answer that question, but please have your
HCP call me and I will fax him the pages from Hale and he can call you back
with his recommendation." I'm wasting my time, his time and her time.
Ridiculous.
I went through nurses' training nearly 40 years ago. This "gagging" harkens
back to the days when we were instructed to stand when the physician came
into the nurses' station, and couldn't tell the patient her blood pressure or
temperature because that was the province of the physician. We never
questioned them, and never, ever corrected them. That was the 1960's. Today, if
the nurse doesn't catch and correct the physician's mistakes, she will be held
AS LIABLE as the physician.
Lord knows I don't want to go back to those days, but this S of P puts us
right there.
I told her to take the Advil.
If I have a mother that would benefit from taking an herbal galactogogue
along with increased nursing and pumping to increase milk supply -- I am now
prohibited from doing so -- because I am not to prescribe/recommend the use of
alternative therapies -- though I suppose this could be considered a "dietary
supplement." But are dietary supplements alternative therapies?
If the physician recommends heat, rest, and frequent nursing for mastitis,
that is medical advice because it came from the MD. If I recommend the same,
is that considered medical advice? Where does one stop and the other begin?
What the IBCLC is able to do, according to the scope of practice, is
something anyone -- breastfeeding assistant, lactation educator, counselor, La Leche
League Leader -- anyone -- can do. What differences will be made in the
scope of practice for the "lower credentialed" person you are anticipating
certifying in the next couple of years?
Why do I need to certify to do less than I can do simply by being me? In
point of fact, if I continue to practice as I have been, I assume you can take
my certification away. I wonder if I should save you the trouble and just
give it back? You see, this bothers me no end. If I want to practice as an
RN, I don't have to be an IBCLC to do that. And as for my non-RN colleagues?
This S of P effectually muzzles some of the most brilliant minds in
lactation.
Perhaps I've misread it. Perhaps your definition of alternative and mine
aren't the same. Perhaps your definition of "contradict" and mine aren't the
same. Perhaps your definition of "medical advice" or "medications" and mine
aren't the same. Perhaps your definition of "invasive procedure" and mine
aren't the same. (mine is: anything that goes in the baby's mouth other than
the mother's nipple or his own hand is invasive which precludes me from doing a
digital exam).
Perhaps some definitions are in order. Perhaps some clarification needs to
be made. Otherwise, the only difference between the IBCLC and the Certified,
Bonafide, Sanctified, Justified and Clarified Lactation Lady is $400 in
IBLCE's coffers.
I'm supposed to recertify for my 20 years in 2007. It never, ever occurred
to me that I wouldn't. Until yesterday.
Jan Barger, RN, MA, IBCLC
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