Laurie asked about consent forms for supplementation. One of the earliest
published ones is from the Journal of Human Lactation in 1986 (2:27-28) that
was adapted from Pat Bull. While the concept of a consent form makes sense
and is a logical teaching tool for both staff and mothers, there is a
potential side effect to its use. It presumes that mothers have been told ALL
the side effects of supplementation, not just that "one bottle won't hurt".
Who informs the mothers of the side effects, who asks if there is a history
of allergies or diabetes in the family before supplementing with cow's milk
based formula? Is the mother going to pump after the feeds that are
supplemented?

A consent form essentially absolves the hospital, physician, nurse, lactation
consultant, and formula company from any responsibility for the outcome of
the use of the formula (if that is what is supplemented). If the baby has an
adverse reaction to the formula it becomes the mother's responsibility and
her fault since she consented to it! If she consents to sterile water or
sugar water what happens to her milk supply and baby's blood glucose?

Consent forms can be used by staff nurses (which I have seen) to hand to the
mother for simple convenience purposes so that they do not have to bother
bringing the baby from the nursery at night and to continue other
non-evidenced-based practices. Sometimes the use of consent forms can be a
step backwards.

Marsha Walker, RN, IBCLC
Weston, MA

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