Euhm, Jeanette... sometimes I think the very best thing we can do is to tell
parents to go against MD instructions, as long as we simultaneously tell
them about why we think the instructions were not only incorrect, but maybe
even dangerous and potentially destructive with regard to the breastfeeding
relationship.
Agreed, we should not spend all our time on talking down the other hcp; what
we should focus on, I guess, is explaining what we think about the decision
the parents are about to make.
Even if we 'only' do that, it will be perceived as going against the
instructions and sometimes quite right so.
Fortunately, we are no longer bound our Scope of Practice to refrain from
contradicting doctors.
(This is what the old version of the SoP said about this specific issue:
"The following activities are outside the scope of practice of an IBCLC:
· Contradicting or ignoring the advice of a client’s health care provider.")
There are too many of them with no clue whatsoever, to, as a rule, say that
we should not tell parents to go against them.
(There is a difference, by the way, between not telling them to against it
and telling them not to go against it... ;-) Don't know which one you
mean...?).
As long as doctors and other hcp's go against the best interest of babies
(and moms) in often brutal ways, we have a double role: we should inform
both the parents AND the doctors.
In my book, however, the parents come first, because they are my client. It
is not my main role to be friends with unprofessional 'professionals', when
doing so harms babies.
Sure, being 'friends' with them helps to solve problems and prevent bad
policies in the long run, but that is second to my advocacy for and helping
of mom and baby.
I would not consider myself as practicing ethically, if I take for granted
that a couple of dyads are 'lost', but at least my 'good relationship' with
the hcp has not been ruined.
I must admit, though, that I often don't know where to start, when it comes
to tackling non-constructive or plain wrong policies...
This weekend's case about fortifying human milk with formula did not even
mention whether the babies had a growth problem in the first place.
And even if they did... I think bf policy ought to be improved first, before
suggesting such a 'solution'.
The first step the doctor should have taken, is refer to an IBCLC, just as
we are supposed to refer to a doctor when health problems are present.
The doctor had better raised his voice against the unavailablity of
necessary products, instead of suggesting something as sad as he did... :-(
I hope we agree on that! ;-)
Bye,
Marianne Vanderveen IBCLC, Netherlands
-----Oorspronkelijk bericht-----
From: Jeanette Panchula
Sent: Monday, November 29, 2010 3:50 PM
To: [log in to unmask]
Subject: [LACTNET] mixing formula into ebm THANK YOU
I have not been part of this discussion, but wanted to give you a "heads up"
that:
1. we should NOT tell parents to go against MD instructions - we can
encourage them to call to clarify the instructions, and explain our
concerns.
2. I know personally of VERY supportive MD's who instruct parents to mix
formula with breast milk for babies who are being discharged from NICU and
need the extra calories (usually this is done for SOME not all the feeds, as
breastfeeding is still encouraged).
3. The cost of the breast milk fortifiers, along with their unavailability
(a mom with twins called me in a panic after driving for over 3 hours trying
to find it) has led many doctors to use this method to increase caloric
intake.
Jeanette Panchula, RN, PHN, IBCLC
Vacaville, CA, USA
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