I would give just about anything to have someone in our community who would
come work with moms in our community. We have no LCs or LLL, and our BF
*initiation* rate in the hospital is less than 25%. (Don't even ask what it
is at 6 months.)
I certainly don't concur with denying consultations (e.g. whoever heard of a
pediatrician denying physical or speech therapy for a child? How is
breastfeeding therapy any different?) but I thought of one reason why Dr.
Trendy, and others like him/her, might have this method of practice: Money.
Managed care is becoming quite evil in some communities. Now, for some
insurance plans, the pediatrician (or PCP) is considered "responsible" for
every charge incurred on behalf of the patient, and docs who order a lot of
tests, prescribe a lot of medicines, etc. get "dinged" by insurance plans
because they are providing care that is "too expensive."
Every quarter, I get a "report card" from a VERY LARGE insurance behemoth,
errr, I mean company, that "grades" me on how I am doing as a doctor. Some
of this stuff is under my control, like how what % of prescriptions I write
are generics vs name brand. But other things are still my "responsibility"
even though I have no control over them. For example, I get graded on the
number of ER visits my patients make. Even though we have same day
appointments, an on call doctor 24/7/365, Saturday and evening appointments
available, I still have patients visit the ER at 2 pm on a Tuesday for a
cough, even though we've told them we'll see them in our office that
morning! So I am penalized for stuff like this.
So I can see how a Dr. Trendy type individual might say: If LCs start seeing
all my breast feeding patients (which hopefully, is a large number), and
start billing for their services (heaven forbid! Getting paid for work they
do!), medical costs are going to further spiral upwards, and my
reimbursements are going to go down, or at the minimum the managed care
organizations are going to want to know why this doctor has to get a consult
on a "well child issue" like breastfeeding.
Suzanne Berman, M.D., FAAP, who prays daily that she
will NEVER become a Dr. Trendy
[log in to unmask]
Date: Tue, 10 Aug 2004 07:50:16 -0400
From: "Susan E. Burger" <[log in to unmask]>
Subject: Re: Denial of access
Dear all:
It seems to me that as a user of health care, having one practitioner tell
me I cannot see another practitioner would be denying my rights to a second
opinion. From a client perspective, I would consider that unethical.
I recently had my second success on my list of three pediatricians for whom
I have made a concerted effort to win over. The first of the three was a
breeze - a few phone calls with difficult clients and he was won over. The
second said she's NEVER refer to a lactation consultant. I must have seen
about 10 clients, sent reports, sent invitations to breastfeeding
conferences, & always praised her degree of interest in breastfeeding. We
were all falling on the floor in amazement when we got a call referring a
client to us. She even admitted to the client that she never refers to LCs,
but was stumped by this particular latch on difficulty.
I was thinking that some pediatricians are just plain old lost causes and
tettering on the fence about screening and referring the clients from one
particular "TRENDY" pediatrician who puts more effort into the decor of his
office that staying up with the literature on breastfeeding. I was feeling
discouraged after spending time over the phone with a breast reduction
case, getting the health history completed & the schedule all set only to
have her cancel at the last minute after having seen Dr. Trendy (with
screaming baby in the background & only 1 meconium stool by day 6).
My thought process was that it would probably be better to just
automatically refer these clients to another LC. In addition, I've had at
least 3 women in support group or former clients sobbing over Dr. Trendy's
admonishments over sleep or other breastfeeding related advice, where he
todl them they were spoiling or going to damage their babies. The idea of
screening out clients of Dr. Trendy popped into my head because one of the
pediatricians in Manhattan will not see clients if they plan on giving
formula to their babies.
BUT then I forgot that I had just seen another client of Dr. Trendy who
probably will wean at 2 weeks of age due to a medical issue who I was able
to help go from weight loss, nipple pain & delayed lactogenesis II to full
supply, happy gaining baby, & comfortable nursing for 2 weeks. She was
thrilled. I was able to give her all the Hale information on the
medications so she and her own Dr (not Dr. Trendy) could decide what to do.
And I was able to put her in touch with another mom with the same medical
condition so she could talk over her situation. Left to Dr. Trendy alone,
my suspicion is that she would have been told "Why bother, its only 2
weeks".
So, should I keep up the good fight keep right on helping clients of Dr.
Trendy even though I lose a few? This is not the first breast reduction
client whose baby was exhibiting signs of not taking in enough and having
trouble accepting it.
Susan E. Burger, MHS, PhD, IBCLC
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Date: Tue, 10 Aug 2004 08:24:34 -0400
From: Kirsten Husband <[log in to unmask]>
Subject: 15 Minute talk --need pictures!
I am finalizing my 15 Minute Challenge presentation for our nursing staff (
dealing with the first hour after birth). Thanks to all of you who sent
encouragement and ideas. I do plan to use the self attachment video, but
would also like some pictures of NEWBORNS and their families. Babies
breastfeeding or simply snuggling on mom ( or dad!) would be perfect. I
found a wonderful website with a gallery of many, many beautiful pictures,
but was denied using them for my presentation---and I respect that and will
not do so.
So, if any of you have pictures that I MAY use I would really appreciate
it. Thanks to those of you who have already, so generously, sent some to me.
As they say, "a picture is worth a thousand words".
Kirsten RN, IBCLC in Wisconsin
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Date: Tue, 10 Aug 2004 08:29:08 -0400
From: Marguerite King <[log in to unmask]>
Subject: Re: Anticonvulsant drug Lamotrigine or Lamictal
On Mon, 9 Aug 2004 18:02:55 -0400, Catherine Watson Genna, IBCLC
<[log in to unmask]> wrote:
>You can tell her Hale, our great drug expert, classifies this drug as
>moderately safe. You can also tell her the potential problems to look
>for, and the risks of formula feeding to balance them. She is already
>on the drug during pregnancy, which exposes the baby to far higher
>levels than those in the milk.
>She may also need some information on keeping her baby safe during
>seizures. She should have a planned safe place to put the baby in every
>room - a basinette, crib, play pen, whatever, in case she feels a
>seizure coming on . This goes for whether she breastfeeds or bottle
>feeds.
>Catherine Watson Genna, IBCLC NYC
>
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I would like to add to what Catherine Watson Genna, IBCLC had to say about
safety for the infant. I know a mom who has seizures and to safe guard her
infant she placed her in a large hard plastic carry all with a handle
whenever she needed to carry her about the house (it is used for laundry or
groceries). This allowed her to carry her close to the floor incase she
fell. She also carried her on the side of her body that she was least
likely to fall towards. When other family members were not there to help
her or her husband was traveling, she slept directly on the floor with the
baby to safe guard against dropping the baby. Marguerite King, IBCLC
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------------------------------
End of LACTNET Digest - 9 Aug 2004 to 10 Aug 2004 - Special issue
(#2004-1016)
****************************************************************************
**
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