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Lactation Information and Discussion <[log in to unmask]>
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Fri, 31 Mar 2000 14:46:04 EST
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Nikki says,

<< I ask you, Jan, where is  the legal support for a lactation professional
 to prescribe or recommend any substance? >>

And I ask you, where does it say, in writing, that a lactation professional
cannot recommend a particular substance?  Not in the ILCA SOP.  not in the
IBLCE Code of Ethics.  A non-health professional IBCLC only has those
guidelines to go by.  If recommending OTC remedies is not within the SOP of
the IBCLC, then it needs to say so somewhere.

OK, on to the health professional.  Now, while I realize that the Nurse
Practice Act varies from state to state, let me share what the Illinois Board
of Nursing says:

<<The foregoing shall not be deemed to include those acts of medical
diagnosis or prescription of therapeutic or corrective measures that are
properly performed only by physicians licensed in the State of Illinois.>>

The key here is "properly performed ONLY by physicians licensed..."
Recommending ibuprophen, say, to a mom w/ mastitis, is not something that can
be done ONLY by physicians licensed...  It is within the scope of a pharmacy
technician (who, BTW, may or may not be certified, may or may not have taken
any sort of program) to recommend/advise whatever, OTC medications/herbals
etc etc.  As I was noodling over this whole thing a few weeks ago, I
discussed it with my dh who is a pharmacist by trade, and was, in the recent
past, the director of a pharmacy tech program here in the Chicago area.  I
pulled this off the web, and his opinion of it was that as an RN, I have the
right to recommend OTC medications.  And I don't care how it is phrased,
whether we use the oblique, "many mothers have found..."  or we say, "In my
experience I have found that using ibuprophen when you have a mastitis helps
with the inflammation."  or, "I recommend that you take ibuprophen for the
inflammation of the mastitis...."  Same difference.  Do I ask her if she has
allergies?  Yes, I do.  Do I ask her what she normally takes for a headache
or other aches & pains?  Yes, I do.  I also usually phrase it, "you can
try...."  Do I write it down for her (such as the dosage of Fenugreek)?  Yes,
I do.  Do I tell her that as an RN I'm not allowed to tell her what
medications or herbal preparations might be helpful for her low milk supply
or yeast and to go ask her doctor?  No, I don't.  I tell her exactly what I
would recommend based on my experience.  This is part of my role and and my
responsibility as a lactation consultant.  Let's say that in my professional
opinon she needs Reglan (metoclopramide).  Do I write a prescription for it?
Not on your life!  I don't have prescriptive powers and that is a
prescription drug.  I will discuss it with her, and recommend she discuss it
with her primary health care provider, or I will call the physician in
question and discuss it w/ him/her myself.  Usually what happens when I do
that is that the nurse/receptionist takes my message, and what the doc hears
is "Jan Barger is working with Mrs. Smith who has a very low milk supply, and
she wondered if you would be willing to prescribe Reglan for her."   And
sometimes the doc will call me back and we'll talk about it, and sometimes
they'll just go ahead and prescribe the medication.  Diflucan is another
medication that I can think of.

Nikki also talked about moms who call wondering if they should take St.
John's Wort for their depression.  I'm not in the business of treating
depression.  That is not my area of expertise.  So I wouldn't tell her yes or
no either -- my job in that situation is to give her the information about
St. John's Wort & breastfeeding, pure and simple.  She can take St. John's
Wort with or without my telling her yes or no.  I'm not going to tell a mom
who is depressed, "Oooh, you need SJW."  I will tell her, however, if she
wants to take it, that she should discuss it w/ her health care provider,
suggest that she seek counseling for PPD or whatever it is, and then give her
the information about the safety (or not) of SJW w/ breastfeeding.  If a mom
calls and wonders what to take for a cold, I will ask her, "What do you
usually take?"  She says, "I want to take Nyquil."  My job is to look it up
and give her the written recommendations regarding Nyquil and breastfeeding.
She might then ask, "What do you recommend?"  and I might say something like,
"most OTC, one ingredient, short acting medications are OK w/ breastfeeding."
 Frank Nice has written a lovely article (2 of them actually) on OTC drugs
and breastfeeding, and I refer to those quite frequently.

Now Nikki a question back to you:  Do you ever diagnose yeast in the mother
or thrush in the baby?"

Jan B -- hoping a few more people will get into this dialogue.  We've got a
few docs on this list -- what do you think?

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