> In trying to understand the rationale behind the scope of practice 
> changes,=
> I think the intent was perhaps to keep the LC from contradicting the 
> docto=
> r, like the doctor says to supplement and the LC says not to? ....If you 
> are see=
> ing a client and feel a certain way, send a report to the doctor with your 
> =
> recommendations and give a copy to the mother. The main problem I run into 
> =
> is tongue tie, in that I feel intervention is warranted and the doctor 
> does=
> not; but I must defer to the doctor, as an LC and as a nurse.

I find myself wondering, with this new scope of practice, why any La Leche 
League Leader would be interested in becoming an IBCLC, since it seems to me 
it would actually restrict her ability to help mothers. If I was contacted 
by a mother whose doctor had advised her to supplement the baby, I would (as 
a LLL Leader) feel quite comfortable discussing her situation and sharing 
information with her and helping her come up with a plan, which may or may 
not be the same as the doctor's. If a baby was tongue-tied and the doctor 
didn't recognize it or didn't want to clip it, I would suggest the mother 
see one of the two doctors in our area who will clip tongue-ties (and who 
take self-referrals). Is this contradicting her doctor? I guess it is, but I 
certainly see this as appropriate and within my role as a Leader.

I don't believe in deferring to doctors. I take responsibility for my own 
health care, and for that of my children when they were little. I see the 
physicians and other health care providers I've chosen to work with as 
people with more knowledge and information in particular areas, and I will 
take the information they share with me, weigh it against my own priorities 
and information I gather from other sources (including, but not limited to, 
other health care professionals), and make my own decisions about the 
treatments or interventions I will choose. I see my role in working with 
mothers in the same way - I am someone with more knowledge and information 
about breastfeeding who can share with the mother so that she is helped to 
make a more informed decision by weighing what she has heard from me along 
with what she hears from her doctor, her own instincts, etc.

Teresa Pitman (not an IBCLC) 

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