-----Oorspronkelijk bericht----- 
From: laurie wheeler
Sent: Monday, December 12, 2011 2:51 PM
To: [log in to unmask]
Subject: requirement to report to primary hcp

**Dear Laurie, dear all,

I do understand both sides of this issue. You can make an argument either 
way.

**I think it depends to a great deal on the local/national habits (and laws) 
which approach makes sense and which one doesn't. Depending on your culture, 
an approach may seem very logical and normal to the one and very out of 
place to the other.

However, the code we are following is for IBCLCs and not for lay bf 
counselors. IBCLCs are designated, I believe, as "allied health care 
providers" and not as independent practitioners.

**Really...? I do see myself as an independent health care provider. And in 
the Netherlands, it also works like that. A mom can call me in fully on her 
own account, because *she herself* feels she has a breastfeeding problem 
that I could help solve. She has to ask not one single other hcp whether it 
is okay for her to call me and neither do I have to ask one single other hcp 
whether it is okay to do a consultation for her. It happens quite regularly 
that noone else knows (family doctor, midwive, well-baby clinic) that she 
had a consultation. And when we solve the problem, that's it. No single 
other hcp comes into the picture, but her health insurance *does* cover the 
consultation if requirements are met (i.e. she having a policy that covers 
it and I being a member of the professional lc organisation, which I am). 
That seems pretty independent to me. ;-)

In my opinion, the IBCLC credential is not just an add-on credential to show 
you know alot about breastfeeding, but a credential showing you are 
certified and intend to work with challenging and difficult bf cases, and 
therefore you would be working with the primary hcp(s).

**Challenging situations are not only challenging when another hcp feels 
that way and is already involved. If the mom feels it is challenging, she 
can call me and I write a report for her afterwards that she is free to 
share with whomever she likes and that I share with hcp's when she is still 
under their care (midwive for early postpartum moms or who else may be 
relevant).

Other allied health care providers are physical therapists, occupational 
therapists, respiratory therapists, for example, and don't they work under a 
primary hcp and have "orders" to see the patient?

**Like I said: I don't have orders to see the mom. She calls me in; I'm not 
send by whatever hcp is treating her. Even if the midwive suggests I could 
be of help, it will usually be the mom who calls me.

I wonder what the "code" is for LLL and other mother-to-mother counselors, 
and do WIC (in USA) peer counselors have a mandate to report things to 
mother and/or baby primary hcp?

**In the Netherlands, LLL-leaders and VBN-counselors do not have house 
visits as their 'core business'. They are allowed, but not expected to do 
them. And if they would, I think I would consider that the visit of an 
experienced other mom (peer-to-peer!). Neighbours and aunts and grandmothers 
also don't report to other hcp's, do they? ;o)

Pamela, on reading your message I wondered if you were aiming at asking for 
permission *to report to an hcp after the consultation* (I do agree that 
this may indeed be necessary, even if the mom has not given permission) and 
asking for permission *from an hcp before initiating a consultation*. These 
are two very different things, in my view. The first I can see fit in 
specific situations and very necessary, too, when there is a serious medical 
situation. It is the latter I have problems with, as I feel it infringes 
upon maternal autonomy. Like Nina said: hcp's don't own their 
patients/clients. In the end, patients/clients make their own decisions. 
Just the other week in a consultation: mom and dad said that it was the gyn 
who decided to use the vacuum. I said, it was in fact *their* decision: the 
gyn ought to explain the options and then not using the vacuum could easily 
have been understand by the parents as a more risky approach than using it 
and then of course they themselves would agress with that intervention. It 
was a whole new idea to them that indeed THEY were the ones who chose.
People often make themselves very dependent, as if the 'higher-up person' is 
the one who knows best and they just have to agree with whatever that person 
says. This is not so and for the sake of parental empowerment, those 
higher-up ought to be careful in order to prevent creating a situation or 
behaving in a way in which this thought is stimulated.
By the way... I'm pretty sure you feel the same, Pam! hahaha
I think you have simply been working in such difficult situations with such 
high risks... many of us (and certainly I) probably cannot imagine the 
pressure you've been under regarding life and death.

Warmly,

Marianne Vanderveen-Kolkena IBCLC, Netherlands

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

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