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Subject:
From:
"Betsy Riedel,RNC,IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 26 Oct 2006 09:20:51 -0400
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Personally, I have found the Acacdemy's protocols to be of a tremendous 
help to me in getting policies changed and getting my physician 
colleagues "up to snuff" so to speak as far as becoming more knowledgable 
in the area of breastfeeding.I was especially pleased when I finally had 
access to the hypoglycemia protocol. Of course it was also wonderful that 
one of our local Connecticut physicians was one of the authors of that 
document (Kathleen Marinelli at Connecticut Childrens Medical Center).

Why shouldn't physicians have their own organization? If they feel more 
comfortable, get good information, and their practice changes for the 
better, who cares? It is a benefit to our mothers anad babies. As Nancy 
Wight said, breastfeeding is not just the province of IBCLC's. I am very 
pleased to have one of those physicians who practices "breastfeeding 
medicine" right here in Connecticut. I have referred to her on many 
occasions and I find her to be receptive to me as a nurse and as an IBCLC 
as well. Just because her practice is labeled as "breastfeeeding medicine" 
does NOT mean that she has medicalized breastfeeding. It means "one stop 
shopping" for someone with breastfeeding difficulties. Like it or not, 
there are many breastfeeding issues that are out of my scope of 
practice;either as an RN or an IBCLC and I am glad to have the rapport 
with physicians who will cover me and compliment my practice.

I have noticed the greatest change in the management of tongue tie. We 
always had the same ENT's here (in my 18 years at my hospital), but with 
new (pediatrician) physicians and my continued push, we are seeing a lot 
of clipping.Just the other afternoon, the ENT came to seek me out (before 
she even looked for the physician or mother/baby)to ask if I had evaluated 
the tie and what did I think? Clearly, we are making inroads.

As far as contradicting and/or questioning physicians, that is a big part 
of my role as an RN and a patient advocate as well. I do that a lot! That 
role did not change when I became an IBCLC. (I do that as a childbirth 
educator as well). If anything, it enhanced my role and gave me a leg up 
over many of the physicians. I feel that we compliment each other and I 
feel proud when the OB's call me and ask me for "that thrush protocol you 
told me about" and they then prescribe based on the information I give 
them.I am referring to Jack Newman's thrush information on prescribing.

I think much has to do with how we present ourselves and I am not foolish 
enough to think that there are not some doctors out there who are 
impossible to work with. WE all know that. There are probably some LC's 
out there as well who are difficult. There are those in every field and we 
are not going to get every physician to jump on board. We have to do the 
best we can with what we are given.

Does it bother me that there are "physician only" organizations? No, it 
does not because those speakers (for instance) that were present at the 
last ABM conference (Dr.Ruth Lawrence to be exact)have spoken at other 
lactation conferences that are open to all of us non-MD LC's. In fact, Dr. 
Lawrence will be one of the keynote speakers at the International 
Conference on the Theory and Practice of Human Research and Breastfeeding 
Management that will be held (as it always in)in Orlando in January. I'll 
be there to learn what I can regardless of who else is there and who the 
speakers are.

While I will agree that some parts of this new SOP are poorly written 
and/or vague, I think the intent was good. I am sure that the IBLCE was 
attempting to protect itself (and all of us) from incompetent 
practitioners and resulting litigations. There are incompetent 
practitioners in every field (medicine, nursing and lactation consulting 
included).

I still firmly believe (as Laurie has pointed out again)that much has to 
do with how we say what we say. I still maintain that some of us have 
advantages that others of us don't have. That probably isn't likely to 
change quickly. I am never going to have the clout a physician has(and 
frankly I don't want it)and those in lactation without the "another 
certification or licensure" may, indeed, have the hands tied. That's life.

As Dr. Wight said, we WANT physicians on our side and if the ABM can 
disseminate the proper information to doctors and educate them, then that 
is wonderful! We need more physicians who practice "breastfeeding 
medicine" as it were. If this practice leads to more babies being 
breastfed, then so much the better.I don't think the general public would 
think the term "breastfeeding medicine" meant that breastfeeding was being 
medicalized. That's just semantics and the only ones who have picked up on 
this are lactation professionals who are offended by the latest SOP.

Let's take a step back, take a deep breath, and see what comes of this and 
while we're at it, let's keep helping those mothers and babies who need us 
so much!

Betsy Riedel RNC, IBCLC (and proud of it just the same)
Connecticut

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