I'm sorry this is so lengthy.
Although I passed my IBCLC exam in 2000 I have only recently begun to work
as a RLC, so I am uncertain of how I should handle some situations. This
is also compounded by the fact that I am, like many of you also an RN. So,
I hope that some one can give me some advise about how I should, or should
not have handled a particular situation that occured yesterday.

I work in a hospital that just begain to deliver babies and opened a level
3 NICU 3 1/2 years ago. Up until 8 months ago we had no breastfeeding
policies and procedures for the OB floor or the NICU. Up until then I was
only working weekend/nights in the NICU as a staff nurse. An event occured
last March where a mother delivered at our facility and wanted/expected to
breastfeed her infant. She was told by a NICU/NBN RN that since she had
had a breast reduction she could not breastfeed (this was my first
official lactation consult). This mother did go on to fully breastfeed her
baby, but this is another story...

One of the most comman lactation problems in the NICU has been
insufficiant milk production.
After a lot of work I have just received the OK to initiate a breastpump
loaner program for our NICU moms. Hopefully this will help to resolve some
of the issues. But because the program is not up and running one of the
mothers I have been following is the mother of a 30 day old ELBW infant
delivered at 24 weeks gestation. This mother is very thin, she weighs 80
pounds and looks quite anorexic. I have stresssed repeatedly the
importance of her diet for her health as well as the baby's health.  She
did not, and still does not have the money to rent a hospital grade double
electric breast pump and she lives too far away to stay at the hospital to
pump. Her county WIC nutritionist gave her a battery/electric breast pump
which she has been using faithfully (8-12 times a day, with at least 1-2
night time pumpings) for the last month. The MOST milk she has ever pumped
at a time is 15-20 ml from each breast at a time. Within 2 weeeks even
this small amount dwindled to nothing. I had her try Fenugreek 2 caps 3
times a day this did not help so within a week I asked her to call her
Physician for a prescription for Reglan. The baby has had 2 NEC scares and
evey time she receives formula develops abdominal distention. This weekend
we ran out of breastmilk altogether, again.
Now I am finally going to come to the uncomfortable situation; when I
spoke to her on the phone yesterday she said that her physician had
prescribed and she had been taking Reglan 10mg. BID. I asked her again how
often she was pumping and she assured me she was pumping 10-12 times a
day. So I said, the Rglan dose is probably not an effective dose to
increase your milk supply, you need to be taking 10mg TID. As soon as I
got the words out of my mouth I looked up and one of the Neonatologists in
the unit was listening to every word I was saying. I instructed her to
call her doctor and ask him to increase the dose and if he had any
questions he could call me and I would send him the literature. Since our
unit is new we do not have a Lactation department and I am the only
lactation consultant and to make matters worse I have never worked as a
lactation consultant until now.
My question is:
1. Can I recommend a herb/drug and, or, the dose/strength of a herb/drug
to a client without risk of penalty or loss of my nursing license?
Thank you!!

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