I see both sides of this issue. At Nancy's hospital there is "a standing
order, "lactation consultation prn" - which mean the doctor, nurse or
patient can request a consult.  The LCs cannot just initiate their own
consult." This sounds reasonable and proper, and by the way, that hospital
sounds like an outstanding facility.
Where I work, the nursery nurses give me a list of the bf moms each morning,
and tell me any tidbits of info that I may need to better help her, like she
is only 16, or this is her 4th baby but she has never bf any of them, or the
baby is Coombs positive and already has elevated bili levels, etc. (Is this
a breach of confidentiality?) I can consider that this was a nurse-initiated
consult. Also sometimes the nurse tells me this mom has been waiting for you
to come in, she really wants to see you. This is a patient-initiated
consult. Occasionally a doctor will initiate a consult, for example a mom
who needs to pump for a premie, but I would have been alerted to that dyad
anyway by the nicu staff. Next I go to the mother's chart and get a very
brief history from the L&D record: gest. age of baby, birthweight, mom's
age, her medical/surgical history and I write this on a brief intake form. I
might note if she is on a blood pressure med, is a smoker, had a biopsy of
the R breast, whatever. I also note time of birth becoz I ask and track time
of first bf. I also take down her phone no. which I confirm w/ her becoz I
do make f/u calls. I don't know if this is going out of bounds and a more
formal consult process will be/should be required.

In the case discussed earlier on lactnet, the LC came to know that the mom
had hep B and was told not to bf (I assume by the nursery staff? that is how
I would likely have been told), also that the doctor instructed the staff
not to have the LC see the mom. This is a difficult situation and a tough
call. Like I said if the doctor specifically instructed that I not see her,
I would fax or call him w/ info. If she asked to see me, even if the doc
instructed me not to, I think I would. I would provide her the info and refs
and I would not say it is OK or not OK to bf. I would not put it that way.
The pt/parents have rhe right to make an informed decision.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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