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Lactation Information and Discussion <[log in to unmask]>
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Thu, 2 Nov 2006 11:31:07 +0800
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On 02/11/2006, at 5:06, Pamela Mazzella Di Bosco wrote:

> However, I have no problem with making it obligatory to report to a  
> hcp all
> visits.

The problem I have with this is: it is outright illegal to do so here  
without the mother's express, informed and non-coerced consent.  
Exceptions are only made in situations such as a subpoena, or a major  
emergency in which the person is not competent speak for themselves.

An professional code of ethics or scope of practice can't trump  
national law. If a mother chooses to withhold consent for a  
practitioner to share her medical information with another  
practitioner, would the practitioner have a solid basis for refusal  
of care? I wouldn't like to try to make a case for that.

I doubt the refusal would happen very often, but when it does happen,  
it is entirely the mother's (legal, and in my opinion moral) right to  
choose her own level of autonomy, to be informed of any risks  
involved, and to still be able to access care.

> I think our scope of practice should be limited to all things  
> related to
> lactation.  Of course, lots of things relate to lactation, but  
> surely not
> assessing vaginal repairs or surgical incision healing or whatever  
> other things
> were listed as things they have heard of LCs doing.

Earlier in the conversation someone mentioned enquiring about lochia  
and incisions - I would have thought that these are very much related  
to lactation? Retained placenta or wound infection can impact on milk  
supply. A very painful perineal or C section wound may be causing  
problems with sitting and positioning. This doesn't mean that the LC  
takes on diagnosis and treatment of problems related to infection or  
wound complications, but including these questions in a full  
lactation assessment, and advising further investigation/action where  
indicated, doesn't seem inappropriate to me.

> Here comes this new edict of Scope of Practice though that states  
> all LC's
> must not contradict a hcp's advice...even if they are dead wrong!!

I agree that this is by far the "elephant in the room" with this  
document. I'm not an IBCLC, but I wholeheartedly offer my support  
those protesting against this. If some organisation tried to muzzle  
me with this sort of wording I would be marching on their offices. I  
think it causes outright legal peril to those practising, especially  
in the litigious USA but elsewhere as well.

(Just didn't want to be one of the "silent 3000" on that! Up till  
now, maybe some of these 3000 aren't speaking because they believe  
everyone else has already expressed their feelings, or because they  
are not directly affected by this.)

Lara Hopkins
family doctor in Australia

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