Greetings, all.  I offer this post at the risk of repeating others who
may have already answered, since I am behind on my Lactnet reading and
have not the patience to wait until I'm caught up to reply :-)

 
On Fri, 16 Mar 2007 14:12:44 +0000, Pamela Morrison
<[log in to unmask]> wrote:

 I hear on LACTNET again and again how
>paediatricians, say in the USA, support formula feeding and how LCs
>are unable to contradict this medical advice.  Surely, though, the
>SOPs we're discussing don't preclude the IBCLC from offering
>up-to-date research and guidelines in support of protecting and
>maintaining breastfeeding? >>

Pamela, that is the $64,000 question.  If I were certain that the answer
to your question is, "Of course, IBCLCs, this SOP does NOT preclude you
from offering up-to-date research and guidelines" then I would not have
a problem with this SOP. But I am a plain-spoken gal (not to mention a
former elementary school teacher), and as a general rule take things
literally.  And the meaning, in my opinion, of the SOP's phrasing on
this subject is clear.  We may not "contradict the advice" of her health
care professional.  It doesn't say, "unless he's wrong" (LOL, sorry, I'm
getting testy already!)  It doesn't say, "This does not preclude the
IBCLC from offering..." etc etc as you just said.  It just says we can't
contradict their advice. Period.  That is a huge blanket statement.

It is lunacy to try to prevent us from giving women evidence-based
information but that's what it sounds like the SOP is saying, because it
doesn't exempt any circumstance, any situation....any case in which the
evidence is in fact contrary to the health care provider's advice.  In
short: it seems to be blind to - to fail to see - the many MANY times
when the "health care provider's advice" is out-of-date and (to put it
kindly) most unhelpful.

(And a word on the subject of cooperating with said HCP: we're assuming,
in this SOP, that she has one.  Or that she knows his name and number.
I work for WIC in the U.S - public health.  Very often my clients do not
have health insurance.  Very often my client's HCP was the emergency
room doctor that told her she should wean now that she's got mastitis.
I can't exactly call him up and discuss the subject with him.  And
according to the SOP, I can't "contradict" him, either.)


 If this is not the case, do I understand
>correctly that MDs and OB/GYNs and pediatricians in the US (or any
>other country) are able to give so-called "medical advice" which is
>clearly not only harmful to health but also out of date??? >>


In a word:  YES!  A thousand times YES!  (sorry - that was five.)

Let me just stop myself right there.  Breathe, Regina, breathe.  In with
the good air, out with the bad.  :::counting to ten slowly:::



<< It occurs
>to me therefore that the "fault" here is not with the IBLCE SOPs, but
>with a health insfrastructure that does not require breastfeeding to
>be endorsed as an absolute health requirement, but sees it through
>the eyes of a bottle-feeding culture;  at best an optional extra;  at
>worst condoning medical "advice" NOT to breastfeed, which IBCLCs are
>unable to contradict.  >>

Agreed.  100%.



What is the solution?  Perhaps to strengthen
>Dept of Health initiatives to protect and promote breastfeeding -
>including the logical requirement that primary healthcare providers
>should be prevented from giving out-of-date non-evidence-based infant
>feeding "advice".>>


Again I totally agree.  The problem is: how do we IBCLCs help our
clients in the meantime?  Yes, major changes to the health
infrastructure need to occur.  ***But until they do***, women still need
to hear the evidence.  We cannot be told NOT to offer it.  Sometimes
we're the only ones they know (and have free access to) who HAVE it.

And by the way, I asked IBLCE what to do in those circumstances.  I have
sought their guidance. I asked, politely, how they want me to handle a
situation where I KNOW that the HCP's advice is out-of-date. What do
they wish me to say, when (for example) the doctor has told her that the
baby's frequent, loose, yellow and seedy stools (in her abundantly
healthy baby) are diarrhea caused by her breastmilk/she should wean?
(YES, this happens.)  I asked IBLCE how they expect us to handle those
situations - months ago. I did not receive a reply.  

And for the record if I had to call every doctor who said something
out-of-date I'd spend more time on the phone with doctors' offices than
I do with my clients.  I can't call them all, even supposing my clients
have them.

One more wrinkle: sometimes a woman who doesn't truly want to nurse will
put words in her "doctor's" mouth that he didn't actually say.  For
example: she says he told her to wean because her breastmilk isn't
strong enough to sustain her 9-pound baby.  Sometimes, in fact, he said
no such thing; she's lying about the poor man. It is impractical to
expect me to call up every doctor and verify whether or not he said what
the client claims he did.  It is much more efficient to simply give her
the evidence and urge her to discuss it with her doctor (and yes, offer
to speak to him for her if she prefers). But if I can't give her the
evidence, because it contradicts the doctor, then our conversation (as
well as hers with him, which needs to occur) is over before it even
began.


>Once again, it seems that the
>"fault" is not with the IBLCE Board, but with a global healthcare
>system that doesn't yet recognize the IBCLC credential.>>

What is IBLCE's fault is creating a poorly written SOP that fails to
see, much less deal adequately, with the circumstances in which many of
the world's IBCLCs find themselves.  Many IBCLCs work in settings where
the health care infrasturcture is out-of-date and clinging to a
breast-is-theoretically-best-but-just-plain-untrustworthy worldview.  My
clients come to me and are RELIEVED to get an evidence-based answer. I'd
rather give up my board certification than deny them the answers they
need and deserve.  I live in the hope that it doesn't come to that.  

I'd love to discuss this with her doctor.  If she had one.  Or if he or
his nurse would return my phone calls. Or if I didn't have so many other
women to help as well, etc, etc etc.

::Sigh::  

Regina M. Roig-Romero, BS IBCLC and the daughter of a pediatrician!
Senior Lactation Consultant
Miami-Dade County Health Dept WIC/Nutrition Program
7785 NW 48 ST, Suite 300
Miami FL 33166
(786) 336-1333 x162

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]