There has been plenty of discussion on Lactnet and elsewhere about the
whole "diagnosis" thing. You are correct -- IBCLCs are not empowered to
"diagnose" **but*** we are empowered to assess, and offer information and
support.  We can suggest to the person who DOES have diagnosing authority
those factors, symptoms and conditions that are "consistent with" various
clinical situations.

It's all in the language -- tho sometimes, even when we are Letter Perfect
in how **we** phrase it, the mother may paraphrase differently.  But if our
own report (those reports again!) are always written in the correct style
of assessment, information and support, then the HCPs will soon realize
that the mother is merely filtering, because they will become familiar with
our own clinical note style.

As for  "it doesn't say that the IBCLC has the authority to share her
belief or findings with the mother" I would suggest the following very much
define your duty and right to discuss lactation matters with the mother.
 Again; you will wisely and professionally discuss sensitive matters, but
discuss and report you will ("Your history and description of symptoms
makes me think your hormones may be imbalanced.  Hormones ABC are important
for BF because they do XYZ.  I am going to send a report to your
doctor/midwife with my assessment.  There may be some tests they can order
to see if we can get to the bottom of your problem.")

From the IBLCE Scope of Practice:

"IBCLCs have the duty to protect, promote and support BF by ... educating
women, families and health care professionals and the community about BF
and human lactation .... acting as an advocate for BF as the child-feeding
norm ... providing holistic, evidence-based BF support and care ...using
principles of adult education with teaching clients, health care providers
and others in the community"

"IBCLCs have the duty to provide competent services for mothers and
families by ... performing comprehensive maternal, child and feeding
assessments related to lactation ..providing support and encouragement to
enable mothers to successfully meet their BF goals ... using effective
counseling skills when interacting with clients and other HCPs

 "IBCLCs have the duty to report truthfully and fully to the mother and/or
infant's primary HCP and to the health care system by recording all
relevant information concerning care provided ...."

"IBCLCs have the duty to act with reasonable diligence by ... making
necessary referrals to other HCPs and community support resources with
necessary .... functioning and contributing as a member of the health care
team to deliver coordinated services to women and families ... working
collaboratively and interdependently with other members of the health care
team."

 From the IBLCE Code of Professional Conduct:
"Principle 1: Provide services that protect, promote and support BF.
Every IBCLC shall: 1.3 Supply sufficient and accurate information to enable
clients to make informed decisions.
"Principle 2: Act with due diligence.
2.1  Collaborate with other members of the healthcare team to provide
uified and comprehensive care.
"Principle 4:  Report accurately and completely to other members of the
healthcare team.
4.1 Receive a client's consent, before initiating a consultation, to share
clinical information with other members of the client's healthcare team."

-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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