Pat asks how we can support mothers and babies who need to use products that
are readily available in stores, and marketed using non-Code-compliant
methods.
Well simple -- by following your current IBLCE Code of Ethics, IBLCE Scope
of Practice, and ILCA Standards of Practice. These are our practice-guiding
documents. They tell us how we are to work with families when we discuss
products, complementary treatments, and our own conflicts-of-interest.
So, again, let's use an easy-to-accept hypothetical. Mom is referred to you
by ped because baby was born at 36 weeks gestation, is now 2.5 weeks of age
(38.5 AGA) and still not back at birth weight. You assess baby at breast -
he latches, but that is about it. He transfers .2 ounce in 25 minutes of
"breastfeeding" -- and *that* was with breast compression.
You discuss with Mom the need to boost her rate of milk production, since
baby is "demanding" about as much as a sparrow, and that is the amount Mom
has at this point. You describe skin-to-skin (Mom like that), frequent
feeds (ditto) and hand expression (she says "Gross!"). So now yo discuss
using a pump, and describe the difference between using a hospital- or
rental-grade pump, vs. a pump from the toy store, vs. a pump on eBay. Mom
tells you her sister has a pump she used only a few times -- is that OK? So
you discuss the ramification of multi-person use of a product intended for
single use.
Are we seeing a theme here? It is called "information and support, so the
mother can make an informed decision about her, and her baby's, care.
Now remember: This pretend baby is 2.5 weeks of age, still under birth
weight, and Mom has a low supply *today.* What is Rule No. 1? FEED THE
BABY (thank you Coach Linda Smith). So you tell Mom about the cool HMBANA
milk bank that is just 1/2 hour away, and you know the ped. will write a
prescription for human milk. But, sadly, Mom says "Gross!" So now you
discuss alternatives -- including the ramifications of using cow's
milk-based formula, vs. soy-based formula, particularly in light of her
family history of allergy to cow's milk.
Last but not least, you discuss with her the mode by which this articial
supplement will be offered to baby. Supplementer at breast; supplementer by
finger; cup/spoon feeds; bottles. Mom loves the supplementer tube you used
at today's consult, but knows there is no way she is monkeying with that at
2AM. She figures Dad will be great at offering the formula supplements
while she pumps -- but she knows there is no way on Earth he is dealing with
that little cup. So you discuss paced bottle feeding (thank you Dee
Kassing), the rates of flow of various bottle nipples (thank you Lisa
Marasco and Diana West) and so on.
So, by my count, I have just had a consult where I have had to discuss
*three* of the four items that fall under the WHO Code: formula, bottles,
and teats. But I have not *marketed* a one of them. I have discussed them,
one-on-one, with a mother, in light of her own situation and contribution to
*her* care plan.
That makes me ethical, Code-compliant -- and a good IBCLC to boot.
--
Liz Brooks JD IBCLC
Wyndmoor, PA, USA
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