Dear Lactnetters - The head of my department asked me today if we had any
research questions about lactation to suggest to a doctorial candidate. Her
background is in biochemistry, but it need not be limited to that aspect. It
would be wonderful if those of you who are dying to have research done on
some particular aspect of breastfeeding would send me their question by
Saturday. Thanks so - I will keep you posted. Please cc me - I think this
might be interesting to the whole list. Sincerely, Toby
Toby Gish RN, BA, IBCLC, LLLL (aapl)
mailto:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 09:35:53 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: IBCLC, liability,WIC
Comments: cc: [log in to unmask]
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In response to Brenda Phipps' concerns about her supervisor @ WIC possibly
not allowing her to do LC consults in the office due to liability/not
licensed hcp, etc:
I empathize with your and your supervisor's concern about this, and since I
don't know exactly how or what kinds of consults you do at WIC, I'm sure not
the last word on the subject, but my experience at WIC has been that
1) I almost never had occasion to do consultations that involved much (any?
well, with mom's permission I would assess inside of baby's mouth digitally,
gloved of course) touching at the WIC office - in my experience, it was
rarely a good enough environment for that kind of work - privacy issues (no
matter what I did to try to maintain privacy in my office, we were NEVER
immune to the general hubbub and demands of the WIC program at large),
comfort issues, both physical & psychological (too hot, too cold, baby often
either asleep 'cause all bundled up or agitated from disruption of being
brought to WIC, not really "normal" or comfy environment/furnishings, "my"
turf instead of mom's, etc.) Sometimes I'd take a look at mom's
breasts/nips, etc., and often I'd observe latch, nsg technique, positioning,
what babe was doing with tongue, mouth, head, hands, etc., but even then it
was not what I'd call a real good assessment. For a simple basic problem
(mom holding baby too low or too far off to the side, etc.) or basic
education, the office worked OK, but beyond that I would usually need to do
a home visit.
2) In NY, we IBCLCs were discouraged from doing the kind of extensive 1:1
work that you might do in private practice - we were not supposed to get too
in-depth with individual clients, or to be very hands-on. A minor example -
when I first began reading about the use of hydrogel for damaged nipples, I
asked the state BFC if this was something we could suggest to clients, or if
I could buy some with WIC $$, and was told very firmly that this sort of
thing was beyond our scope, that we were not to provide treatment but should
refer to the HCP. I understand the theory here, but there's a flaw in this:
I was the appropriate HCP to deal with these things in our community. So a
certain balancing act was necessary on my part, to appropriately fill my
role at WIC and give the best care I could. Another example of this - I
never would recommend herbal treatments in my WIC role, even though I knew
of many that would have been helpful, but if a woman came to me with very
specific questions, I could help her work through references & use resources
available to me to help her find more information. Tricky - if I ran into
her at the herbal supplement section of the health food coop, was I me,
Cathy Bargar, or was I RN IBCLC, WIC Breastfeeding Coordinator? I tried to
err on the side of caution...(and you all know enough about me by now to
recognize that that wasn't my easiest task!)
3) I was told by the director of our "sponsoring agency" - Public Health
nsg. that in fact in my role at WIC I was functioning NOT as a "licensed"
RN, but as an IBCLC, by reason of job description & requirements, pay scale
(which led to union issues), etc. In other words, the opposite of what
Brenda's supervisor is telling her. Hmmm...
4) Doesn't matter whether you're a nurse, a doc, an LC or Mother Theresa
herself, you can be liable for assault and/or battery if you touch any woman
and/or baby without explicit consent or if she feels that the touching was
inappropriate or caused harm. ALWAYS explain what you need to do, and ASK
FIRST. But, when it comes down to it, I can't say that I can recall ever
touching a woman's breast in the WIC office, or even on home visits. I did
sometimes put my hands on the outside of the mother's hands to guide them in
positioning or manipulating her breast (ALWAYS and ONLY with her consent),
and never felt that I needed to do more. (I used to just get the willies
when I worked at the hospital and would see other nurses grab women's
breasts and shove babies on. They used to squoosh up the mom's breast with
one hand, grab the back of the baby's head with the other, and jam the kid
right in, nose-first, bottom way out from the mom. Yikes!)
=========================================================================
Date: Thu, 4 Feb 1999 10:02:43 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: NECSI <[log in to unmask]>
Subject: Re: HIV+ In Oregon
Comments: To: Martha Johnson <[log in to unmask]>
Mime-Version: 1.0
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Martha and Lactnetters,
This situation is a tough one. Does anyone know where
there is some literature on where informed consent
leaves off and mandating particular kinds of care
starts? Is it in the legal literature? What do
various state DSSs have to say about mandated
reporters reporting this kind of "abuse and neglect"?
Sometimes the medical knowledge is wrong, in which case
we congratulate the people who bucked the system and
gave their children (or themselves) what they thought
was the best care. Other times medical knowledge is
right and we criticize the same people for their
"selfishness" etc. etc.
As far as I understand, we know that HIV can be transmitted
throught breastmilk butit isn't always transmitted and
we don't really have a good understanding of when it
transmits and when it doesn't. However, we do know the
effects if it does transmit - pediatric AIDS. and we
know that the prognosis on pediatric AIDS is usually deadly.
For this particular mother, is milk from a milk bank an option?
I , too am interested in other's thoughts and resources on this
issue, both medical, ethical and legal.
I assume that you are familiar with the similar case
of the woman in Maine who took DSS to court and won. The details
are probably different, but it may give some guidance here.
Naomi Bar-Yam PhD
P.S. Does anyone know where I can get a copy of
"HIV/AIDS and the Nutrition Rights of Infants"?
=========================================================================
Date: Thu, 4 Feb 1999 09:47:51 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: Re: BF song
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re: "Isn't it a pity..." etc.:
No, but I hope when you get the words you'll share them! In my real life,
I'm also a singer, so of course I have to collect songs that make mention of
BFing in any way.
Cathy B.
=========================================================================
Date: Wed, 3 Feb 1999 19:59:32 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Robert Cordes DO <[log in to unmask]>
Subject: busy / Kathy D's question
Mime-Version: 1.0
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I've been busy lately a lot of sick kids.
I've only briefly looked at Lnet enough to know someone
cursed and Kathy D asked about an extra bolus of antibodies
at 18 months.
I know of nothing that says there is an extra bolus of antibodies
at this age. This is an age for the last set of
baby/toddler immunizations (DTaP and polio) so mom might
want to BF through this for an improved antibody response to
the vaccines. Although there is some evidence that BF
babies continue to have better relative responses to
immunization beyond weaning. See Principles and Practice
of Pediatric Infectious Diseases Long, Pickering and
Prober editors.
-Rob
"There was a little birdie
It's name was Enza
I opened the window
And in flu Enza"
Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
mail to:[log in to unmask]
=========================================================================
Date: Wed, 3 Feb 1999 20:08:32 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Robert Cordes DO <[log in to unmask]>
Subject: ID text
Mime-Version: 1.0
Content-Type: text/plain
The text book I mentioned in my last post, "Principles and
Practice of Pediatric Infectious Diseases" Long, Pickering
and Prober editors has a good chapter on breastfeeding.
It even ends talking about promotion of breastfeeding.
-Rob
Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
mail to:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 10:13:32 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Kathy Parkes, RN, IBCLC" <[log in to unmask]>
Subject: Re: non-RN LCs and liability
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In a message dated 99-02-04 09:23:39 EST, Karen Z. writes:
<< As a non-licensed LC in private practice, I have a 'permission slip' at the
bottom of my new client information form (which the client fills out for
me) which says in part, ".....I understand that this may involve touching
my baby and/or my breasts." The client signs right below this.
I also ask, "May I touch?" before I do so, **always**. >>
Even as an RN, IBCLC in private practice, this is something I *ALWAYS* do. It
also gives me permission to share the consult results with both OB/GYN and
Pediatrician, to photograph for teaching purposes (PRN), and to have LC
interns participate in the consult. Every mom I work with signs this consent.
(I've never had a mom refuse to sign.)
Kathy Parkes, RN, IBCLC
The Lactation Connection (TLC)
San Antonio, TX
=========================================================================
Date: Thu, 4 Feb 1999 09:39:24 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Mary Kay Smith <[log in to unmask]>
Organization: Sinai Health System
Subject: What class said that?
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Janet, don't assume anything! Most likely it was NOT a CLE class. There
are many breastfeeding educator/lactation specialist classes out there
and the poster can clarify if she would like. Your message was helpful;
however there are many RNs in hospitals functioning as LCs who are RN,
CLE and since they are RNs they CAN touch patients as it is within their
scope of practice.
Mary Kay Smith
Romeoville,IL
=========================================================================
Date: Thu, 4 Feb 1999 09:46:18 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Dan & Liz Spannraft <[log in to unmask]>
Subject: biohazard ? IDPH CBI
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Does anyone have the Center for Breastfeeding Information statement on
breast milk and standard precaution? Also looking for any Illinois Health
Department standards for breast milk storage. Information sites or hard
data.
Liz spannraft IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 10:27:37 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Mary Kay Smith <[log in to unmask]>
Organization: Sinai Health System
Subject: Liability for non-RNs
MIME-Version: 1.0
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I'm as concerned as Brenda about this thread. Please discuss on line as
we'd all like to see it. As far as "just a piece of paper" goes...It is
an entry level exam which implies competencies in the areas we are
questioned on. True, it is not a license but most of our work settings
require that we demonstrate competencies in these areas and as IBCLCs
should be recognized as the expert. This is very touchy (no pun
intended) and I think the seminar givers are promoting the "requirement"
that all IBCLCs be RNs or other licensed personnel. We all need to check
our workplace and find out what liability coverage they provide. Check
out the ILCA publication: Standards of Practice for LCs. It states that
one of our responsibilities to "procure the mother's written consent
prior to initiating care." It is also our responsibility to communicate
and collaborate with the other health care professionals involved; we
are NOT the primary caregiver - that would be the doctor and if our
advice is in conflict with the MD, the mother is informed of her
options; consequences of outcome and the need to dialogue with her HCP.
Our legal responsibilities extend to "established parameters of
professional practice" and institutional standards. If there is any
question, I would contact my supervisor and see what the standards of
practice for that institution include. If other non-licensed staff can
give advice and touch patients, we should be able to as well.
Keep us updated, please
Mary Kay Smith,
Romeoville, IL
=========================================================================
Date: Thu, 4 Feb 1999 11:19:31 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Marsha Walker, RN, IBCLC" <[log in to unmask]>
Subject: HIV Mother and Breastfeeding
Mime-Version: 1.0
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I think I was contacted about this issue when it first came up. My response
was to heat treat the mother's breast milk or obtain donor milk from a milk
bank. Heat treating this mother's milk is not out of the question, it is
simply a question or option that people frequently forget in their reaction to
this problem.
Health agencies are so quick to push formula that they overlook easier and
healthier alternatives. I wonder if they have even bothered to test the
mother's milk!! Just because a mother is HIV positive does not mean her baby
cannot have human milk.
Marsha Walker, RN, IBCLC
Weston, Massachusetts
=========================================================================
Date: Thu, 4 Feb 1999 11:48:14 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Linda Spangler <[log in to unmask]>
Subject: Discharge Packs
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HELP! I am involved in the fight of my life. I'm the Patient Care =
Coordinator of the nursery in a small community hospital.=20
Formula reps have always visited the nursery, left gifts, etc., but =
thanks to being on this list, I have stopped this practice, or should I =
say - trying to stop this practice.=20
The formula rep whose company holds the WIC contract in our state (our =
clientele are 50% WIC and BFing rates are very low for this group, but =
that's another story) states that she needs to check our formula stock =
and discharge kits. I know you all dislike discharge kits, but you have =
to understand that my hospital has been giving them out since the =
beginning on time, and I am trying to change things slowly and =
gradually. The rep, of course, just wants to keep her foot in the door =
and to show her face on our unit.
When I told her we were taking the can of powdered ABM out of the BF =
discharge packs (remember gradual change) and NO she could not check our =
stock, she went straight to the only private Peds office in town and =
asked them to hand out her BF discharge packs. I'm not sure at this =
point what the Peds intend to do, but I do know their office looks like =
one big advertisement for Si*****! =20
I need references for the damage that BFing Discharge packs can do.=20
The formula rep has articles on how they do NO harm.
BTW, a lot of the RN's at my hospital (especially one very vocal one) =
would go ballistic if we stopped giving out the formula DC packs.
I would also like to convince the Peds of the harmful messages they are =
conveying by having formula advertisements all over their office. I =
intend to purchase some BF art for them to put up since one of the Docs =
said the reason they use formula stuff is because its free. I'll see if =
it works both ways. =20
Thanks for your help,=20
Linda Spangler, RN, CLE=20
Fighting an up hill battle, but reading Lactnet empowers me to the MAX.
P.S. Does anyone have a catchy name for a Telephone Peer Support system =
I am starting soon? Can't use Bosom Buddies as a local breast cancer =
survivors group has this name already.
------=_NextPart_000_00C1_01BE5034.3F9B0CC0
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charset="iso-8859-1"
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<!DOCTYPE HTML PUBLIC "-//W3C//DTD W3 HTML//EN">
<HTML>
<HEAD>
<META content=3Dtext/html;charset=3Diso-8859-1 =
http-equiv=3DContent-Type>
<META content=3D'"MSHTML 4.72.2106.6"' name=3DGENERATOR>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>HELP! I am =
involved in the=20
fight of my life. I'm the Patient Care Coordinator of the nursery =
in a=20
small community hospital. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Formula reps =
have always=20
visited the nursery, left gifts, etc., but thanks to being on this list, =
I have=20
stopped this practice, or should I say - trying to stop this=20
practice. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>The formula =
rep whose=20
company holds the WIC contract in our state (our clientele are 50% WIC =
and BFing=20
rates are very low for this group, but that's another story) states that =
she=20
needs to check our formula stock and discharge kits. I know you =
all=20
dislike discharge kits, but you have to understand that my hospital has =
been=20
giving them out since the beginning on time, and I am trying to change =
things=20
slowly and gradually. The rep, of course, just wants to keep =
her=20
foot in the door and to show her face on our unit.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2> When I =
told her we=20
were taking the can of powdered ABM out of the BF discharge packs=20
(remember gradual change) and NO she could not check our stock, she went =
straight to the only private Peds office in town and asked them to =
hand=20
out her BF discharge packs. I'm not sure at this point what the =
Peds=20
intend to do, but I do know their office looks like one big =
advertisement for=20
Si*****! </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>I need =
references for the=20
damage that BFing Discharge packs can do. </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>The formula =
rep has=20
articles on how they do NO harm.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2></FONT><FONT=20
face=3D"Comic Sans MS" size=3D2>BTW, a lot of the RN's at my hospital =
(especially=20
one very vocal one) would go ballistic if we stopped giving out the =
formula DC=20
packs.</FONT></DIV>
<DIV><FONT face=3D"Comic Sans MS" size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>I would also =
like to=20
convince the Peds of the harmful messages they are conveying by having =
formula=20
advertisements all over their office. I intend to purchase some BF =
art for=20
them to put up since one of the Docs said the reason they use formula =
stuff is=20
because its free. I'll see if it works both ways.</FONT><FONT=20
color=3D#000000 face=3D"Comic Sans MS" size=3D2> </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Thanks for =
your=20
help, </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Linda =
Spangler, RN,=20
CLE </FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>Fighting an =
up hill battle,=20
but reading Lactnet empowers me to the MAX.</FONT></DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" =
size=3D2></FONT> </DIV>
<DIV><FONT color=3D#000000 face=3D"Comic Sans MS" size=3D2>P.S. Does =
anyone have a=20
catchy name for a Telephone Peer Support system I am starting =
soon? Can't=20
use Bosom Buddies as a local breast cancer survivors group has this name =
already.</FONT></DIV></BODY></HTML>
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=========================================================================
Date: Thu, 4 Feb 1999 12:35:12 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Jan Barger RN, IBCLC" <[log in to unmask]>
Subject: IBCLCs and Liability
Mime-Version: 1.0
Content-type: text/plain; charset=US-ASCII
Content-transfer-encoding: 7bit
Brenda reported:
<< I am an IBCLC for a WIC office. Last week, my staff attended a one week
course seminar taught by two very well known women whose names I won't
reveal.
They were told that if you are practising as an IBCLC and are not in a
licensed profession (i.e. a nurse working at a hospital) where your job
description states that you may touch women, that you are setting yourself up
for a potential lawsuit. Evidently, there are quite a few cases pending
right
now in which LCs are being sued for babies who have died or become ill after
mothers followed the advice of an IBCLC.>>
Brenda,
Perhaps your staff members misunderstood what was said at the course? I'm
curious -- has anyone else heard of "quite a few cases pending of babies who
have DIED? because the mothers followed the advice of an IBCLC???" Is there
any documentation for this? The LC world is fairly small, and it is
interesting that this is not, to my knowledge, common knowledge. These seem
to be two unrelated issues -- one being potential "assault and battery"
charges if you touch a woman in the course of your job if you are not a
licensed health professional -- the other, lawsuits because of the
morbidity/mortality of infants who have died because the mother followed the
advice of an IBCLC. I do think if this was the case, the Wall Street Journal
would have hopped on this in a heartbeat.
Is the implication that if you are a licensed health professional you will
never be sued because of poor advice???
Also, I am unaware of ANY legislation that states that you cannot touch a
woman unless you are a LICENSED health professional that requires touching
within their job description. I do hope that your staff came back with
documentation for this statement, rather than just what the instructors said.
<< I stated that I do have liability insurance, but that was discussed at this
conference, and apparently it holds no water in a lawsuit if you are not a
licensed health professional in a job which requires touching in your job
description. >>
Of course, one of the reasons that you obtain consent from any mother with
whom you are working is to obtain her WRITTEN consent to touch her, her baby,
and her breasts.
It would be interesting to contact Pris Bornmann and the legal department of
LLL to get her take on this. If this information is correct, it is something
that needs to be disseminated ASAP through ILCA and IBLCE. I would certainly
ask your WIC director to hold on her dictum until you seek a true legal
opinion -- not just statements that came from a conference.
Certainly, everyone is entitled to an opinion. It may be the OPINION of these
instructors that you are opening yourself up to legal liability if you touch a
woman without a license to do so, but would it be legally defensible ?? What
does your job description at WIC say? If it says that you can touch women in
your role as an IBCLC, then you may do so. The standards of practice of ILCA
talk about what the responsibilities of the IBCLC is -- obviously it includes
touching the mother. It does not differentiate between licensed health
professionals and others -- it talks about the IBCLC.
What is a license? It is a piece of paper that says I fulfilled the
requirements to sit for, and subsequently passed AN EXAM that is recognized in
my state.
We, as IBCLCs are the ones that are in process of defining the profession.
These charges that have been brought forth by these instructors are very
serious ones. I trust that there is specific legal documentation for what
they have stated, as this needs to be addressed by the professional
organization and their legal beagles immediately.
Brenda, when all is said an done, I have to believe that this entire thing was
a misconception on the part of the students that attended the course. I've
been involved with ILCA and IBLCE for many years, and I have not heard these
concerns raised by others in our profession. As program director of a course,
I would be concerned if something like this came out of my course, and I would
want to be given the chance to clarify it immediately.
Jan Barger, RN, MA, IBCLC
Wheaton, IL
=========================================================================
Date: Thu, 4 Feb 1999 12:38:28 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: GJLanc <[log in to unmask]>
Subject: HIV/BF Continuing Ed
MIME-Version: 1.0
Content-Type: text/plain; charset=ISO-8859-1
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In light of the thread about HIV and breastfeeding, I am interested in CEU
offerings, preferably homestudy, which cover HIV and Breastfeeding. I need
something that will meet the mandatory requirements in my state for RN
licensure renewal.
As this is slightly off topic and likely would involve advertising, please
e-mail me privately.
thanks for your help,
Julie Lancaster RN
Melbourne KY
[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 12:36:17 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Marie Davis, Rn, Clc" <[log in to unmask]>
Subject: Speaking of Monkeys
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<<But all of the monkeys and apes carry their babies on their bodies.>>
There was a surprise birth at the LA Zoo. The keepers want to find out who the
father is because there may have been a vasectomy failure (either that or the
43 year old monkey was monkeying around). The keeper stated it would be at
least a year or more before they could "get to the baby" because mom would not
put the baby down until then.
Marie Davis, RN, IBCLC
BTW I was watching "A Tree Grows in Brooklyn." Two of the leads had babies at
about the same time. One in the hospital and one at home. It struck me as odd
that for the mother that delivered in the hospital (Joan Blondell) they were
worried about the baby dying while with the mom that delivered at home they
were worried about the mom dying.
Near the end of the movie Joan Blondell's character said "We've got to get
home. Steve's got to deliver milk to a lot of them babies that like that
bottled kind," and made a nasty, "can you believe?" face.
=========================================================================
Date: Thu, 4 Feb 1999 09:44:56 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Johnson, Martha (PHMG)" <[log in to unmask]>
Subject: Re: HIV+ In Oregon
Comments: To: NECSI <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain
Hello and thanks to Naomi, Jack, Cathy, Pamela, and All the Rest:
Jack, your question (why has this mom not been offered the option of feeding
her baby her own heat-treated milk?) is an excellent one, and in fact we've
been asking this question since the day of baby's birth. Apparently, there
is nothing in the literature which will support this practice. All of the
research which has been written up has involved Holder pasteurization
process, which requires fancier equipment than most folks have in their home
kitchens (even in the US!). It is extremely frustrating to me to hear (from
Pamela M) that home heat treatment is routinely recommended to HIV+ mothers
by the Zimbabwean Ministry of Health, then to run aross info that was
presented at the 1998 ILCA conference (Breastfeeding and HIV, speaker: Thom
Thiele) that says "...due to the lack of reasearch in this area, it would
not be prudent to suggest home boiling of mechanically pumped breast milk
with the hopes of feeding it to ones infant. Caregivers who give out
suggestions without a strong scientific background expose themselves to
legal issues."
Yes, we have referred this mom to her ped with a strong suggestion that
she get a scrip for banked human milk. I'm not sure what her progress is on
this one to date. And yes, we are aware of the Maine case. Can't say
anymore right now.
You can reach George Kent at <[log in to unmask]> for anyone who is
interested. His paper, once again is entitled "HIV/AIDS and the Nutrition
Rights of Infants", and you all should get a copy and read it.
Thanks for all the responses, let's keep our collective mind cranking on
this one, it is a case that I think will set some legal/ethical precedents.
Martha Johnson RN IBCLC
> ----------
> From: NECSI[SMTP:[log in to unmask]]
> Sent: Thursday, February 04, 1999 7:02 AM
> To: Martha Johnson; [log in to unmask]
> Subject: Re: HIV+ In Oregon
>
> Martha and Lactnetters,
>
> This situation is a tough one. Does anyone know where
> there is some literature on where informed consent
> leaves off and mandating particular kinds of care
> starts? Is it in the legal literature? What do
> various state DSSs have to say about mandated
> reporters reporting this kind of "abuse and neglect"?
>
> Sometimes the medical knowledge is wrong, in which case
> we congratulate the people who bucked the system and
> gave their children (or themselves) what they thought
> was the best care. Other times medical knowledge is
> right and we criticize the same people for their
> "selfishness" etc. etc.
>
> As far as I understand, we know that HIV can be transmitted
> throught breastmilk butit isn't always transmitted and
> we don't really have a good understanding of when it
> transmits and when it doesn't. However, we do know the
> effects if it does transmit - pediatric AIDS. and we
> know that the prognosis on pediatric AIDS is usually deadly.
>
> For this particular mother, is milk from a milk bank an option?
> I , too am interested in other's thoughts and resources on this
> issue, both medical, ethical and legal.
>
> I assume that you are familiar with the similar case
> of the woman in Maine who took DSS to court and won. The details
> are probably different, but it may give some guidance here.
>
> Naomi Bar-Yam PhD
>
> P.S. Does anyone know where I can get a copy of
> "HIV/AIDS and the Nutrition Rights of Infants"?
>
=========================================================================
Date: Thu, 4 Feb 1999 09:59:04 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Melinda Hoskins, MS, RN" <[log in to unmask]>
Subject: Liability, etc (long)
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We need to make a distinction between obtaining the mother's consent to
touch and exam mother and baby as a function to avoid charges of assault
and battery, and the issue of whether the LC is functioning within a
legally defined scope of practice.
Every health professional should obtain consent, either verbally or in
writing, before touching a client/patient. Such consent is given in
writing in the hospital admission papers, but obtaining verbal consent
for actions taken while caring for the individual respects that
individual's autonomy within the practice setting. Obtaining consent in
this manner is a protection for the practitioner from charges of assault
and battery.
Many states have clauses which define what actions can be construed to
show that an individual is "practicing" medicine, nursing, or other of
the health care professions protected by licensure. Licensure serves
two functions within our society: 1. protection of the public from
those who would practice without appropriate preparation, and 2.
protection of the professional practices (read that business, as in $$$)
of those who have obtained certain "bodies of knowledge" from
encroachment by those who have "lesser" skills. Okay, okay, there are
those who would argue that they are more concerned about "quality of
care" than they are $$$.
Thus when times are prosperous and those with "specialized knowledge"
are as busy as they want to be, those who might be viewed as
"encroachers" are generally safe from prosecution for "practicing
without a license." But when times become more lean, one sees many more
prosecutions and much more concern about the appropriateness of one who
is using techniques which may fall into the specially protected
knowledge, ie, prosecution for "practicing medicine or nursing without a
license."
Another time when there becomes concern over "practicing without a
license" is when someone who is perceived to have lesser qualifications
challenges or tries to direct the practice of the one who perceives
himself to be more qualified. We have probably all had experience with
the person who believes themselves to be better qualified, and yet like
Don Quixiote (sp?) is always seeing giants stalking him and strikes out
willy-nilly against others. When LC's find themselves dealing with such
individual's it would behove them to tread lightly, especially if the
LC's underlying qualifications are not in a field with examination and
prescribing rights legally defined by law.
The consent of the mother to touch and exam herself and her baby
protects one from charges of assault and battery, but does not protect
against charges of "practicing without a license."
It is in the area of "practicing without a license" that the non-HCP LC
seeks protection through the use of skillful interpersonal
relationships, professional behavior, documentation that describes
findings but does not give "medical diagnoses", and couching one's
information given very carefully (not as prescribing, or orders, or even
a plan of care [nursing holds that right] but as a statement of other's
experiences and options that the mother or her HCP may want to
explore). When dealing with HCP's the non-HCP LC can site relevant
literature which makes the recommendations that she would like to see
implemented, but she may have trouble if she makes the statement "My
recommendation would be . . ."
Hope this clarifies some of the issues raised. I think I had a
flashback and was teaching NURSING 101, Legal Issues . . . . Oh here I
am at my computer, hit send now, and get this off my screen! <VBG>
Melinda Hoskins, MS, RN
=========================================================================
Date: Thu, 4 Feb 1999 10:00:30 -0800
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Melinda Hoskins, MS, RN" <[log in to unmask]>
Subject: PPD screening, etc
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I recently discovered a site with info re PPD. Has articles, links,
books, screening tools specific to post-partum period. You might find
it interesting:
http://www.geocities.com/Heartland/1805/
Melinda Hoskins, MS, RN
=========================================================================
Date: Thu, 4 Feb 1999 11:09:35 -0700
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Tami Karnes <[log in to unmask]>
Subject: Herbs and contamination
MIME-Version: 1.0
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You should always be careful of what kind of herbs you are buying and where
they are coming from. Just like anything else.
I make all of my own herbals for just this reason. There are many companies
out there that will sacrifice quality for the almighty dollar. Always know
who your source is and where their priorities lie. It never hurts to get a
little background on the companies that you do business with whatever the
product is, but especially if it is a product that you ingest.
Questions can be forwarded directly to my e-mail or toll-free number.
Wishing you health and wellness!
Tami Karnes
Certified Herbalist
One With Nature
800-230-5166
=========================================================================
Date: Thu, 4 Feb 1999 12:21:44 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Maurenne Griese, RNC" <[log in to unmask]>
Subject: Unlicensed assistive personnel (UAPs)
Mime-Version: 1.0
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Part of my responsibilities as the director of our hospital's education
department is assessing, documenting, and evaluating competency of health
care providers-licensed and unlicensed. I provide consultation to the many
departments that make up our hospital, including those with personnel that
are unlicensed and set the competency standards for the hospital.
For example, how many of you have been touched by a nursing assistant,
scrub tech, or phlebotomist when they were providing you with care? They
are unlicensed assistive personnel (UAPs) and are critical members of the
health care team. They have demonstrated competency in their area of
expertise, much like a CLE, CBE or IBCLC would. This is a Joint Commission
(JCAHO) requirement.
While I understand a WIC clinic may or may not be JCAHO accredited, a
critical element of competency for these UAPs includes TOUCHING PATIENTS!
Caring for people, whether you are a nail technician, massage therapist or
lactation consultant requires touching people from time to time. Even as
an educator, we touch people. You ask permission beforehand! Common sense
tell us that if you are receiving a manicure, getting a massage or being a
consumer of health care may involve some TOUCHING! To avoid liability, we
have the pateint sign a consent for treatment and get informed consent.
There are times when touching the mother and or baby are essential in
providing care to mother and child, whether you are licensed or not.
Informed consent is informed consent, regardless of your licensure or
competency status. You ask permission before you touch.
The premise that a CLE or CBE that is not licensed can't touch a patient is
ridiculous. During your certification process you have demonstrated a
minimal level of competence so that you may use those credentials. I'm
sure there are finger sticks being done in the WIC office. Who is doing
it? Are THEY licensed? What is the problem with an unlicensed CLE or CBE
who is assisting a mother with breastfeeding touching her or her baby, if
she has given you permission to do so?
JMHO, this supervisor needs to worry about something else, like funding for
breastfeeding promotion or reimbursement for LC visits.
Am I just not getting this??? Dumbfounded on a lovely Kansas Day!
Maurenne Griese, RNC, BSN, CCE, CBE
Manhattan, KS USA
=========================================================================
Date: Thu, 4 Feb 1999 12:22:47 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Camille Foretich <[log in to unmask]>
Subject: IBCLC & Liability
MIME-version: 1.0
Content-type: TEXT/PLAIN; CHARSET=US-ASCII
Well said Jan Barger. I whole heartedly agree. It isn't just "other" health
care professionals that need to show documentation concerning their
statements! When unsubstantiated and generalized statements are made that
instill fear in one, I'm suspicous as to the motive. Camille Foretich, BS,
IBCLC Jackson, Mississippi
=========================================================================
Date: Thu, 4 Feb 1999 14:18:43 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Ilene Fabisch, BrocktonWIC" <[log in to unmask]>
Subject: Prozac info requested
I have a client who is currently BF her 3 1/2 year old daughter. She
nurses 2-3 XD for less than 5 minutes each session. This woman has been
diagnosed with chronic atypical major depression. Her condition is to
the point of rendering her non-functional. She is currently taking
Zoloft, 75 mg a day. Both she and her doctor know that this is not the
appropriate medication for her. They would like to try Prozac, but the
doctor(an M.D.)is not willing to prescribe Prozac because the patient
refuses to stop BF. She believes in baby-led weaning. The client has
been willing to "sacrifice" herself up until this point for the benefit
of her daughter, but her condition continues to worsen. The client now
feels comfortable exploring the alternatives because her daughter is
older and BF less in frequency and quantity.
The doctor has extremely limited knowledge of BF, but has stated that if
the patient can produce information that would intimate the relative
safety and efficacy of Prozac in this BF situation, the doctor would
reconsider her misgivings.
I am looking for an opinion on the safety of Prozac and BF in this
situation, preferably from a medical source. If possible, please do not
address the preferred use of Zoloft(as it has already been used and found
to be ineffective) or Paxil(as it has been determined to also be
inappropriate for this client as she is not suffering from an agitated
depression.) Information on other alternatives would also be
appreciated.Ilene Fabisch, IBCLC, LLLL
WIC Bfing Coordinator
Brockton, MA
___________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at http://www.juno.com/getjuno.html
or call Juno at (800) 654-JUNO [654-5866]
=========================================================================
Date: Thu, 4 Feb 1999 14:29:41 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: "Carol Kelley, LLL Leader" <[log in to unmask]>
Subject: Discharge pack references
Comments: To: [log in to unmask]
Mime-Version: 1.0
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Linda,
I'm sending you a list of references on discharge packs. I've sent some of
this info to Lactnet before, but this list has a few extra references.
Auerbach K. Discharge milk samples. Pediatrics 1993 Feb; 91(2):518-519 a
letter by Lactnet's own Kathy A on the 1992 Dungy article
Bliss MC, et al. The effect of discharge pack formula and breast pumps on
breastfeeding duration and choice of infant feeding method. Birth 1997 Jun;
24(2):90-97. see also comments by Bliss in Birth 24(4):202
Howard C and FM Howard. Commentary: discharge packs: how much do they really
matter. Birth. 1997 Jun;24(2):98-101
Howard CR et al. Attitudes, practices and recommendations by obstetricians
about infant feeding. Birth 1997 Dec;24(4):240-6
Howard CR et al. Antenatal formula advertising: another potential threat to
breast-feeding. Pediatrics 1994 Jul;94(1):102-4
Howard, CR et al. Infant formula distribution and advertising in pregnancy: a
hospital survey. Birth 1994 Mar;21(1):14-9
Howard FM et al. The physician as advertiser: the unintentional discouragement
of breast-feeding. Obstet Gynecol 1994 1993 Jun;81(6):1048-51
Dungy CI et al. Hospital infant formula discharge packages Do they affect the
duration of breastfeeding? Arch Pediatr Adolesc Med 1997 Jul;151(7):724-729
Losch M, et al. Impact of attiudes on maternal decisions regarding regarding
infant feeding. J Pediatr 1995 Apr; 126(4):507-514
Neifert M, et al. Effects of two types of hospital feeding gift packs on
duration of breastfeeding among adolescent mothers. J Adolesc Health Care 1988
Sep; 9(5):411-413
Speer ME. Use of hospital discharge packs-1995. Position of the Texas
Pediatric Society Committee on the Fetus and the Newborn. Tex Med 1996 Sep;
92(9):52-57
Wright A, et al. Changing hospital policies to increase the duration of
breastfeeding. Pediatrics 1996 May; 97(5):669-675
Two of these papers were cited in the AAP statement: FM Howard (1993) and CR
Howard ( Birth 1994).
Hope this helps.
Warmly,
Carol Kelley, LLLL
Taylors, SC
mailto:[log in to unmask]
=========================================================================
Date: Thu, 4 Feb 1999 14:37:19 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: kathleen sheridan bellis <[log in to unmask]>
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
"I saw a bumper sticker today I thought y'all might appreciate. It said...
"Silence is the voice of Compliance"
how true!!"
Oh Cheryl, if only I could convince my children of that! ;-)
Kathleen Bellis
Penn State College of Medicine
Class of 2002
=========================================================================
Date: Thu, 4 Feb 1999 14:30:19 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Cathy Bargar <[log in to unmask]>
Subject: Discharge packs
Comments: To: Linda Spangler <[log in to unmask]>
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Hang in there, Linda! I've been down that road, as have a lot of your fellow
lactnetters; and you're right, slow steps may be frustrating but they get
you there. (How many cliches can I string together here?)
The AAP statement on BF'ing (Dec. 1997) says "Pediatricians are encouraged
to work actively toward eliminating practices that discourage breastfeeding
(eg, infant formula discharge packs...)".
Then there's always the WHO Code on the international marketing of
breastmilk substitutes: WHO 1981 , and WHO Protecting, Promoting, and
Supporting Breastfeeding: The special role of maternity services. WHO
1989:13-18
This is an old reference, and probably not the best for your purposes since
it deals more with the effects of providing a breast pump @ DC than the neg.
effects of formula sample packs (my reprint comes from the M____a br. pump
co., just as a hint to the bias): Claibourne, Christensen-Szalanski, Losch,
& Russell. Effect of discharge samples on duration of breastfeeding.
Pediatrics Vol. 90 No. 2, Aug. 1992, pp 233-237. Compares women who rec'd a
DC pack including formula samples to those who re'd DC pack w/no form., but
with a br. pump: greater BF duration in group getting the pump (4.18 wks. vs
2.78 wks, mean)
Burgevin, Dougherty, & Kramer. Do infant formula samples shorten the
duration of breastfeeding? Lancet. 1983; 1:1148-1151. Well-ed. white women
in Montreal; more likely to be BFing @ 1 mo. if no DC sample of formula.
Frank,Wirtz, Sorenson, Heeren. Commercial discharge packs and breastfeeding
counseling: effects on infant feeding practices in a randomized trial.
Pediatrics. 1987;80:845-854.predominantly low-income non-white women in
Boston MA; no formula samples, women who rec'd "research pack" (br. pads &
ed. materials) more likely to exclusively BF longer and to be still ptly BF
@ 4 mo. (vs. women who got nothing).
Seems to me I read a study more recently in JHL, but don't have it right at
my fingertips. (But look, I upped my organizing since that flurry of posts,
and I have these others right at my elbow!)
Good luck - you will get there, because you have right on your side! Cathy
Bargar, RN, IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 15:06:30 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Pat Bull <[log in to unmask]>
Subject: OLIVE OIL ??
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Hello Netters,
I know we are supporting the usage of Olive oil more and more. My questi=
on
to you all, since I have had a lenghthy discussion with Linda Kuntner abo=
ut
this and tryed to do a lit search on olive oil, I would like all your inp=
ut
on: anyone aware of effects of olive oil in regards to allergies, effect=
s
to infants or children? There is not been one case of any allergies or
problems with olive oil and usage on the mothers skin or to infant that h=
as
orally licked/sucked the nipple of a mother that had olive oil on the
nipple. Does anyone have any clinical experience or anidotal info on
olive oil???? You can e-mail me directly, if you want. =
[log in to unmask] Thanks
"If we do not change our direction, we are likely to end up where we are
headed?" By Ancient Chinese Proverb
Pat Bull, RN, IBCLC
The Breastfeeding Connection/Medela, Inc
Naperville, Il - sunny and getting warmer
=========================================================================
Date: Thu, 4 Feb 1999 15:08:40 EST
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: [log in to unmask]
Subject: ethics and liability
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dear melinda and all,
your post has some excellent thoughts. but i am still wondering about the
mention of "not making a medical diagnosis" - how does this relate to using
the superbills? also, what about advising women to use various things on their
nipples, cabbage leaves, tinctures, etc.?
you can't cure eveyone, so there is bound to be some room for disappointment
on the part of the client. i also am still waiting to know some particulars
about the claimed "cases of advice by LCs that caused death."
carol brussel IBCLC
=========================================================================
Date: Thu, 4 Feb 1999 20:16:59 +0000
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: heather <[log in to unmask]>
Subject: discharge packs
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
If free formula in whatever guise it appears didn't mean *more* women used
formula (and therefore breastfed *less*...duh) then the industry wouldn't
*bother* giving the stuff away...this is lesson one, surely, in basic
marketing techniques, ancient and modern.
It is also a technique used by drug dealers (' hey, kids, your first hit is
free!' ) and computer software manufacturers ('download our basic version
for nothing, and maybe we'll be able to sell you the de-luxe version').
The formula industry is so keen on it, the only way they are stopped from
doing it anywhere in the world is by making the technique illegal...and
even then they do their hardest to maintain it!
Heather Welford Neil
NCT bfc Newcastle upon Tyne
=========================================================================
Date: Thu, 4 Feb 1999 16:00:42 -0500
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathleen Bruce <[log in to unmask]>
Subject: WHO CODE paper copy
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
Does anyone have a paper copy of the WHO Code that I could borrow quickly?
Reply privately please. Thanks K
Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
Williston, Vermont
mailto:[log in to unmask]
LACTNET Archives http://library.ummed.edu/lsv/archives/lactnet.html
=========================================================================
Date: Thu, 4 Feb 1999 14:41:24 -0600
Reply-To: Lactation Information and Discussion <[log in to unmask]>
Sender: Lactation Information and Discussion <[log in to unmask]>
From: Kathy Dettwyler <[log in to unmask]>
Subject: Monkeys, apes, what's the diff??
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
The surprise baby was a chimpanzee, and chimpanzees are APES not monkeys.
This is one of my pet peeves (among many). Monkeys have tails, apes do
not. Chimpanzees are apes, not monkeys. TIME Magazine this week has an
article where they refer to "chimps [such as] sooty mangabeys." ARGH.
Sooty mangabeys are MONKEYS. This is like referring to dogs as cats. Both
Order Carnivora (chimps and monkeys are both Order Primates), but not
terribly similar.
Kathy D.