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

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

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome