Treesa asks for suggestions on how to deal with a situation.  She works with
clients who, after getting advice from a particular IBCLC, have difficulty
knowing how to get the baby to the breast, because the advice seems to be
that babies under 35 weeks can't suckle.

What has her response been when you have approached her about this?  If you
haven't had direct contact, it sounds like it is high time.  Maybe a letter
concerning a particular patient (though not with name of patient unless you
have cleared it with them), or even a phone call asking to meet with her to
discuss how best to meet the needs of the mothers you both work with?  After
all, if she has a plan in mind, it would benefit the mothers if those people
who will be following them up are aware of what it is!

If you have seen any written materials supplied by this IBCLC, you could use
that as a starting point.  It is not clear from your post why mothers of
twins, premies and special care babies automatically are seen by this
particular practitioner.  Is she on the staff of a tertiary care unit?  Does
the unit itself have any written materials for mothers you could see ahead
of time, before you met with her, so that you could have a better idea of
what exactly the mothers are being advised to do?

If she is unwilling to meet or to acknowledge the need for some kind of
relationship to community resources of which you are a part, you will of
course want to know why.  Are the mothers expected to continue to go to her,
and are choosing your practice for economic reasons, so that she sees you as
a competitor?  Or is she actually finished with her part of the job when
they meet you?

I would go for the direct approach.  'Hi, we work with the same group of
women, and I have some concerns about how best to follow them up after they
have graduated from NICU (or whatever!).  It would help if we could get
together and go over our routines and see how they mesh.'  And remember,
whatever you know of her from the mothers is second hand, so may be subject
to misunderstanding.  Try to go into it with a really open mind and assume
that she has their best interests at heart until proven otherwise.  And hope
you find nothing to suggest ill intent!

Rachel Myr
Kristiansand, Norway

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