There are protocols printed up and available for purchase; don't have this 
at my fingertips but I've seen them for sore nipples, engorgement, etc. 
There is also a Triage Tool available. Here is what I would suggest:
While it is frustrating to be asked to come up with such protocols, I think 
it might be better to do it rather than to say it's in your head. (Mine are 
too, and I never follow an outline during BF classes either, but sometimes I 
do forget to say something).
When I go thru protocols with a client and then have to chart, I write 
"options discussed, strategies to increase supply discussed" and such 
statements, rather than being very specific (unless the situation is 
serious, then get specific). You could ask each LC to take 1 or 2 protocols 
and then ya'll could meet and swap them to see if something could be added 
or streamlined. Keep it simple if at all possible.
So you could do something like this:
Low milk supply
-- maternal and infant physical assessment
-- assess maternal and infant medical-surgical history
-- medications (contraception, cold preparations, others)
-- assess previous lactations
-- assess position and latch issues
-- assess BF patterns (this could include scheduling, separation, solids, 
pacifiers)
-- assess pump use - type (size flanges?) and frequency
-- assess BF support

-- discuss options for management:
-- BF assessment, pre/post weights
-- position and latch mgmt
-- tongue-tie? or other anatomical issues - infant or maternal
-- Bf patterns
-- maternal medical and/or endocrine workup
-- discuss appropriate pump use, other BF aids such as nipple shields if 
indicated
-- discussion of galactagogues - client to discuss with MD
-- supplementation and alternate feeding methods
-- support groups
-- follow-up, weight checks

Did I forget something? I bet I did.


Laurie Wheeler, IBCLC, MN, RN
N.E. Mississippi, s.e. USA

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