Ilene said,

<< I'm not sure it's a fair assumption that most of us work with physicians.
  I would venture that many on this list are LLLL and not "working" with a
 MD.  I don't work with a MD either and know I sometimes am on a thin line
 when I talk of diflucan and fenugreek with mothers.  We need to be very
 careful how we word things. >>

One of the standards of practice for IBCLCs is that when we work with a
mother, we send a report or somehow otherwise communicate with her physician
(or the baby's physician) -- and by physician, I mean primary health care
provider.  That is what I mean by "working with" the physician.  I consider
myself part of the mother's or infant's health care team -- and if I thought
something like APNO would help in a particular instance, I would be
communicating my recommendations to the physician.  Same w/ Diflucan.  It is
not within my RN SOP to be able to prescribe.  But there is nothing that says
I am not able to recommend a particular mode of treatment to the physician of
record.  I can't clip a frenulum either, but I can recommend that it be done.
 And that is what I mean by "working with..."  I hope that clarifies -- I've
never been a LLL Leader, so I really wasn't aware that they didn't work with
an MD or DO, or nurse practitioner or physician's assistant or certified
nurse midwife in this manner.

Sorry for the confusion.

Jan Barger, RN, MA, IBCLC

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