Hello All,

 

I agree with everyone else who has posted on this subject and will go ahead
and throw in my 2 or 3 cents as well.

 

I just posted to another group regarding recertifying and how I couldn't see
myself ever not recertifying - I have my 10 yr recert in 2010 - I love what
I do and I love being part of more widely recognized part of the allied
healthcare team.  However, in light of this new Scope of Practice - what is
the point of recertifying?  I can't do my job like I do if I follow this SoP
100%.  And my clients will suffer as a result.  Apparently, I am to be
nothing more than a highly (and expensively) educated breastfeeding
educator.  So, to maintain my own personal ethics about following the rules
and doing what is right my clients and my practice will suffer.

 

One reason I never became a LLLL was specifically due to the muzzle put on
LLLL including those who are IBCLC.  In one role you can say this in another
you can't.  Those of you who know me know I have issues with authority - I
hate double standards, unethical behavior and restrictions that make no
sense.  I work for myself in private practice because of this.  I practice
in the most anally retentive ethical manner you could imagine.  My friends
make fun of me because I am so ridiculously aware of the rights and wrongs
of my practice.  I even irritate myself sometimes with it.  I am not sure if
I can work under this new SoP and maintain my own personal ethics regarding
my professional certification.  I can, however, work within my own personal
code of ethics knowing that I am giving out information that is appropriate,
factual and extremely helpful to my clients.  I have a 95% success rate with
my clients - that is pretty darn good if you ask me.  That rate will go down
because of this new SoP - if I follow it to the letter.  NOT good in my
book.

 

To me, this new SoP makes no sense.  In fact I can see in some ways it is
contradictory.  We are supposed to present evidence based information - but
if that information contradicts the MD then we can't - but we are supposed
to - Catch 22.

 

We are supposed to differentiate between normal and abnormal BF issues - BUT
we can't diagnose (ok) and we can't contradict the Dr.  So if baby clearly
has an issue (whatever it is) and it is impacting the BF but the Dr says the
issue doesn't exist or is not a problem then what do we do?  If I can
provide the research to back it up to the Dr but cannot contradict the Dr.,
and he ignores it, then what?  I now can't say anything to the parent
without violating the new SoP.  Again - Catch 22.   Parent suffers, baby
suffers - how ethical is that?

 

We cannot give out information on or recommend alternative therapies but we
are supposed to provide evidence based on alternative therapies and how they
impact milk supply and baby - ???  There is no way that the studies are
going to be done in a timely enough manner on what we already do recommend
in order for us to be able to recommend them.  So how many babies will
suffer until someone does evidence based research on CST, massage therapy,
Bowen therapy, neuromuscular therapy, Ortho Bionomy - ALL of which I have
seen have had a profound effect on baby and mommy.  

 

One more example.  We have several MD's who are also IBCLC's.  They can give
out information as both - However, apparently now they must specify in what
role they are giving it:  "Dear client, as your IBCLC I can only "say" that
your baby "appears" to have a TT, however, as your MD, I can diagnose a TT,
but again as an MD I have been taught that these rarely need clipping,
however, as your IBCLC I know that evidence based research states that they
do need clipping, however, due to the fact I cannot contradict an MD
(myself) I cannot tell you that my education is wrong, so therefore, I can't
tell you anything.  Good Luck."  ???  Now I know this is stretching it a bit
and being somewhat sarcastic - but come on here.  Is the MD supposed to jump
back and forth with "As your Dr I can say this, but stepping back into my
IBCLC role I can tell you this."?  I know I sometimes will 'take off of my
LC Hat' to give a personal opinion about a question asked by a parent and I
make it very clear to the parent that I am doing this - but if you happen to
have several certifications that could be quite a bit of jumping around -
and I'll tell you what, new parents want the information - they don't always
care what hat you are wearing when you give it to them.

 

I am very frustrated with this.  Can you tell?  Apparently I can't even
instruct a mom how to remove a sliver from her child's hand as this could be
construed as a simple surgery.should I be concerned that I might perform
this simple surgery on my child??  Oh wait that would fall under my
"license" of MOM - so that must make it OK, right?  If we give appropriate
and evidence based information on how to treat plugged ducts or mastitis are
we also bordering on diagnosing and treating?  We all know what mastitis is,
how it presents and how to best treat it.  We also know that it doesn't
always warrant a Dr. visit and antibiotics.  But does this now constitute
diagnosing and treating?  I am not doing anything more than an MD would do
if antibiotics are not needed.  How about the mommy I am working with who is
dealing with the nipple bleb from hell?  Her Dr refused to touch her - she
called me.  Am I supposed to sit there and act 'Dumb' when I know darn well
how to take care of it and how to tell her how to take care of it???  What
about the Dr I worked with last year who had one - I told her how to treat a
bleb - she couldn't bear to do it herself and ended up with terrible
mastitis and involution because NO OTHER DR would do it for her!  She
certainly didn't seem too upset or put off that I gave her that information
although she was deeply discouraged that other MDs refused to help.

 

I have 2 final questions.  Question 1:  to our Atty's on list - what is your
take on this legally?  Is this a SoP that is violating freedom of speech,
illegal, unethical, etc??  What are your thoughts?  Question 2:  Who wrote
this and WHY?  What was the motivation behind this wording - was there some
incident or lawsuit that prompted this?  Why did we as IBCLC's NOT have
anything to say about this??  I am confused as to why no-one was alerted
that there was a change going to occur. Did the writers not see the
potential major problems with this??  What were their intentions behind
this?

 

I guess I am done ranting now.  My biggest frustration here is that just as
we are gaining the ability to be recognized as an important part of the
allied health care team we are effectively shut up by our own.  This is a
muzzle that is overly restrictive, contradictory and does not serve to help
the clients we see, the Drs we work with or the society we live in.
Everything this new SoP says we are able to do is immediately and
effectively dismissed as soon as you start reading what we can't do - mainly
by the "Don't contradict the MD."  We can provide all the evidence based
research we want but if the MD says it ain't so based on his/her own
personal opinion - well then we have to keep our little mouths shut.  

 

To all of our esteemed Docs on the list and to those I have worked with in
my community who do have a clue and respect us as part of the health care
team - thank you for being open and receptive - it helps us IBCLC's more
than you know.

 

Jaye

 

 

 

 

 

 

 


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