Personally, I have found the Acacdemy's protocols to be of a tremendous
help to me in getting policies changed and getting my physician
colleagues "up to snuff" so to speak as far as becoming more knowledgable
in the area of breastfeeding.I was especially pleased when I finally had
access to the hypoglycemia protocol. Of course it was also wonderful that
one of our local Connecticut physicians was one of the authors of that
document (Kathleen Marinelli at Connecticut Childrens Medical Center).
Why shouldn't physicians have their own organization? If they feel more
comfortable, get good information, and their practice changes for the
better, who cares? It is a benefit to our mothers anad babies. As Nancy
Wight said, breastfeeding is not just the province of IBCLC's. I am very
pleased to have one of those physicians who practices "breastfeeding
medicine" right here in Connecticut. I have referred to her on many
occasions and I find her to be receptive to me as a nurse and as an IBCLC
as well. Just because her practice is labeled as "breastfeeeding medicine"
does NOT mean that she has medicalized breastfeeding. It means "one stop
shopping" for someone with breastfeeding difficulties. Like it or not,
there are many breastfeeding issues that are out of my scope of
practice;either as an RN or an IBCLC and I am glad to have the rapport
with physicians who will cover me and compliment my practice.
I have noticed the greatest change in the management of tongue tie. We
always had the same ENT's here (in my 18 years at my hospital), but with
new (pediatrician) physicians and my continued push, we are seeing a lot
of clipping.Just the other afternoon, the ENT came to seek me out (before
she even looked for the physician or mother/baby)to ask if I had evaluated
the tie and what did I think? Clearly, we are making inroads.
As far as contradicting and/or questioning physicians, that is a big part
of my role as an RN and a patient advocate as well. I do that a lot! That
role did not change when I became an IBCLC. (I do that as a childbirth
educator as well). If anything, it enhanced my role and gave me a leg up
over many of the physicians. I feel that we compliment each other and I
feel proud when the OB's call me and ask me for "that thrush protocol you
told me about" and they then prescribe based on the information I give
them.I am referring to Jack Newman's thrush information on prescribing.
I think much has to do with how we present ourselves and I am not foolish
enough to think that there are not some doctors out there who are
impossible to work with. WE all know that. There are probably some LC's
out there as well who are difficult. There are those in every field and we
are not going to get every physician to jump on board. We have to do the
best we can with what we are given.
Does it bother me that there are "physician only" organizations? No, it
does not because those speakers (for instance) that were present at the
last ABM conference (Dr.Ruth Lawrence to be exact)have spoken at other
lactation conferences that are open to all of us non-MD LC's. In fact, Dr.
Lawrence will be one of the keynote speakers at the International
Conference on the Theory and Practice of Human Research and Breastfeeding
Management that will be held (as it always in)in Orlando in January. I'll
be there to learn what I can regardless of who else is there and who the
speakers are.
While I will agree that some parts of this new SOP are poorly written
and/or vague, I think the intent was good. I am sure that the IBLCE was
attempting to protect itself (and all of us) from incompetent
practitioners and resulting litigations. There are incompetent
practitioners in every field (medicine, nursing and lactation consulting
included).
I still firmly believe (as Laurie has pointed out again)that much has to
do with how we say what we say. I still maintain that some of us have
advantages that others of us don't have. That probably isn't likely to
change quickly. I am never going to have the clout a physician has(and
frankly I don't want it)and those in lactation without the "another
certification or licensure" may, indeed, have the hands tied. That's life.
As Dr. Wight said, we WANT physicians on our side and if the ABM can
disseminate the proper information to doctors and educate them, then that
is wonderful! We need more physicians who practice "breastfeeding
medicine" as it were. If this practice leads to more babies being
breastfed, then so much the better.I don't think the general public would
think the term "breastfeeding medicine" meant that breastfeeding was being
medicalized. That's just semantics and the only ones who have picked up on
this are lactation professionals who are offended by the latest SOP.
Let's take a step back, take a deep breath, and see what comes of this and
while we're at it, let's keep helping those mothers and babies who need us
so much!
Betsy Riedel RNC, IBCLC (and proud of it just the same)
Connecticut
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