Joanna, as you probably already know, phone and email consultations are on 
shaky ground for IBCLCs. I do not mean the follow up type, I mean the 
initial contacts where mom only wants to talk over the phone or email.

Number one, we can not see the baby or the mom in person and are essentially 
guessing with our advice. Number two, we can not give her a written care 
plan over the phone. Number three, we will not be able to weigh the baby for 
accuracy sake. Number four, we need written permission to send an HCP report 
(working closely with the HCP is part of the IBCLCs standards of practice 
and/or code of ethics). Number five, how many of us have talked to a mom 
over the phone who is so sure she knows what the problem is and then when we 
do the actual in-person assessment we find it is something else entirely? 
Number six, when an IBCLC counsels a mother, the IBCLC then "owns" the 
problem and must follow through to make sure things work out for mom and 
baby. There is a responsibility involved each time we counsel a mother, both 
legally and ethically speaking. Number seven, we must keep good written 
records of these situations, including mom's name, baby's name, ages, 
weights, etc.

When I did PPLC work, I came up with my game plan after reading posts on 
Lactnet. After we said hello and she explained why she was calling (5 
minutes maximum and I often timed this on my watch), I would ask mom if she 
is looking for phone help only or a professional in-person lactation 
consult. Right at that moment -- before we got any more involved -- I would 
refer her to LLL Leaders for free phone help. I would not ask any questions 
or offer any advice until she booked an appointment to see me in-person.

If mom pushed it, I explained that my services were in-person only and cost 
X amount which included telling her the list of things I would do (test 
weights, written care plan, two hours in-person, HCP report, etc.). I would 
tell her that "I really appreciate that you have called me but it is not 
ethical for me to only help you over the phone." (or email)

The other thing to keep in mind is that if we, as IBCLCs, are hesitant to 
insist moms to get an in-person consultation, then we are saying this 
profession isn't worth using. We must be careful not to give the message 
that the value of an IBCLC is really low or one of poor professional 
service. When we do quicky email or phone helping, we may be giving that 
message -- after all, what doctor does phone or email consults only? When I 
started thinking of it this way, I felt very ok about refusing to do phone 
help only.

Kathy Eng, BSW, IBCLC 

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