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From:
laurie wheeler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 27 Oct 2006 02:17:04 +0000
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Please allow me to clarify my position. When I gave the example that the doctor recommended supplementation but the LC did not, this would be a scenario of a baby losing weight, jaundice, etc. I have seen well-meaning LCs advise against it, yet offer no follow-up. In this scenario, the pediatrician is ultimately responsible for the medical/health care of the baby. (Well, the parents are, but they are consulting the pediatrician). Certainly, what I do in practice is assess mother and baby, assess the bf, etc. and then call the MD and discuss what I would recommend, very likely the mother could supp with her own ebm or just improve the bf. I had a baby recently, very small baby, not gaining, but took in 56 ml at the breast and my recommendation was to have the mother continue exclusive bf with the adjustments I made to latch and with breast compression and to return for a new weight check in 48 hrs. The doctor agreed with this plan.
 
For example, with tongue-tie, the LC can offer her assessments and rationale and give a recommendation to the doctor, ultimately the parents and doctor will confer and make a decision. The parents of course are free to seek another opinion. I used to be in private practice and had a lot more freedom because mothers hired me for information, assistance, and advice, but most private practice LCs have consent forms and have a stipulation that there is a primary provider in case medical intervention is needed. It is a huge responsibility to take on the complete care of the mother/infant dyad. I think some LCs function as breastfeeding advocates and deal with mostly "normal" bf situations, and I think other LCs work with vulnerable populations and premature infants and so there is more risk. I believe the IBCLC is considered an allied health professional and therefore someone who works with a "higher order" professional. Deferring to the doctor, unfortunately, seems necessary for a hospital-based LC, who is working as a consultant to a mother and baby who each are admitted to the hospital under the care of their own primary provider. Believe me, I would love to just write my own orders and have them  carried out by all, since I think I am a pretty darned good practitioner, but I don't have all the answers either.
 
While I am not necessarily satisfied with the scope of practice statement, I am trying to understand the rationale behind it. This is quite a complicated situation and I am trying to stay open minded. I still maintain that (at least in the USA, the only place I am familiar with the healthcare system) we need more MD/IBCLCs, more NNP/IBCLCs and BF medicine specialists we can confer with and refer to. I really think this should be taken up by USLCA if at all possible.
 
Respectfully to all, Laurie Wheeler, IBCLC, MN, RN Mississippi, s.e. USA 
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