In response to Brenda Phipps' concerns about her supervisor @ WIC possibly
not allowing her to do LC consults in the office due to liability/not
licensed hcp, etc:

I empathize with your and your supervisor's concern about this, and since I
don't know exactly how or what kinds of consults you do at WIC, I'm sure not
the last word on the subject, but my experience at WIC has been that

1) I almost never had occasion to do consultations that involved much (any?
well, with mom's permission I would assess inside of baby's mouth digitally,
gloved of course) touching at the WIC office - in my experience, it was
rarely a good enough environment for that kind of work - privacy issues (no
matter what I did to try to maintain privacy in my office, we were NEVER
immune to the general hubbub and demands of the WIC program at large),
comfort issues, both physical & psychological (too hot, too cold, baby often
either asleep 'cause all bundled up or agitated from disruption of being
brought to WIC, not really "normal" or comfy environment/furnishings,  "my"
turf instead of mom's, etc.) Sometimes I'd take a look at mom's
breasts/nips, etc., and often I'd observe latch, nsg technique, positioning,
what babe was doing with tongue, mouth, head, hands, etc., but even then it
was not what I'd call a real good assessment. For a simple basic problem
(mom holding baby too low or too far off to the side, etc.) or basic
education, the office worked OK, but beyond that I would usually need to do
a home visit.

2) In NY, we IBCLCs were discouraged from doing the kind of extensive 1:1
work that you might do in private practice - we were not supposed to get too
in-depth with individual clients, or to be very hands-on.  A minor example -
when I first began reading about the use of hydrogel for damaged nipples, I
asked the state BFC if this was something we could suggest to clients, or if
I could buy some with WIC $$, and was told very firmly that this sort of
thing was beyond our scope, that we were not to provide treatment but should
refer to the HCP. I understand the theory here, but there's a flaw in this:
I was the appropriate HCP to deal with these things in our community. So a
certain balancing act was necessary on my part, to appropriately fill my
role at WIC and give the best care I could. Another example of this - I
never would recommend herbal treatments in my WIC role, even though I knew
of many that would have been helpful, but if a woman came to me with very
specific questions, I could help her work through references & use resources
available to me to help her find more information. Tricky - if I ran into
her at the herbal supplement section of the health food coop, was I me,
Cathy Bargar, or was I RN IBCLC, WIC Breastfeeding Coordinator? I tried to
err on the side of caution...(and you all know enough about me by now to
recognize that that wasn't my easiest task!)

3) I was told by the director of our "sponsoring agency" - Public Health
nsg. that in fact in my role at WIC I was functioning NOT as a "licensed"
RN, but as an IBCLC, by reason of job description & requirements, pay scale
(which led to union issues), etc. In other words, the opposite of what
Brenda's supervisor is telling her. Hmmm...

4) Doesn't matter whether you're a nurse, a doc, an LC or Mother Theresa
herself, you can be liable for assault and/or battery if you touch any woman
and/or baby without explicit consent or if she feels that the touching was
inappropriate or caused harm. ALWAYS explain what you need to do, and ASK
FIRST. But, when it comes down to it, I can't say that I can recall ever
touching a woman's breast in the WIC office, or even on home visits. I did
sometimes put my hands on the outside of the mother's hands to guide them in
positioning or manipulating her breast (ALWAYS and ONLY with her consent),
and never felt that I needed to do more. (I used to just get the willies
when I worked at the hospital and would see other nurses grab women's
breasts and shove babies on. They used to squoosh up the mom's breast with
one hand, grab the back of the baby's head with the other, and jam the kid
right in, nose-first, bottom way out from the mom. Yikes!)