Dear Jeanette,
I will snip a bit and respond with ** to a few of your lines in between your
e-mail below.
-----Oorspronkelijk bericht-----
From: Jeanette Panchula
Sent: Wednesday, December 14, 2011 6:55 AM
To: [log in to unmask]
Subject: where to start-Multiple caregivers
First of all - I want to respond to some comments about breaking
confidentiality: nothing is written to anyone - without a written consent
from the mother. That is a given.
**That is what I would do, too, except when we see (as others mentioned)
harm being done to the infant.
Also - mothers do not have to get a referral from a doctor to see me - they
call me directly, they hear about me through WIC or La Leche League or from
a friend, or find me on-line and call.
**That is also how it works in the Netherlands and as I said, the
consultation even gets reimbursed, provided I am a member of the
professional organisation (which I am).
I NEVER consider my report or communication to the doctor as "asking
permission" of a doctor - but rather as a collaboration - and at times
(especially in a few cases where the mother was involved in situations I had
no knowledge about - such as drug use) it has been VERY important that the
doctor be aware of what I had been or not been informed about.
**I agree; the problem is, however, that the IBLCE CoPC REQUIRES that
permission BEFOREHAND or else you cannot do the consultation! That is
exactly what annoys me so much and is, in my view, as Nina said
paternalistic and authoritarian. This requirement prolongs undue 'power' of
certain hcp's over other health workers (even if that 'powerful' one has no
clue about breastfeeding whatsoever). Regardless of level of knowledge: it
should always be the mother or the parents who decide which hcp they want to
work with for solving *their* problem, so it needs to be *their*
choice/decision.
This request (to sign a consent)
**As stated: there is a difference between having a written consent from
another hcp before the consultation (or else you as an IBCLC are not allowed
to do the consultation!) and having a written consent from a mom to share
information after the consultation.
HOWEVER - now I think of writing the report to the doctor for a variety of
reasons (This may be US-centric, but that is where I work):
**I think you are right: sharing your information with others may be useful
for many reasons and moms can often probably be convinced of that
usefulness. Nevertheless, they need to consent to it first.
I truly believe that facilitating communication is better than avoidance in
most cases...
**Agreed, but as Rachel stated: mom should be the center of the team. And
Rachel, a trip from IBLCE into the world (hey, what is it the I stands
for...?! ;o)) seems like a good suggestion!
Best regards,
Marianne Vanderveen-Kolkena IBCLC, Netherlands
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