Dear Tamara and others,

First of: as an IBCLC we do not tell a mother what to do or not to do, but rather we discuss options and the possible positive and negative effects of all options. It is up to the mother to decide, based upon as much information as she can get, what to do and how to act. In the experience of many breastfeeding counselors, lay or professional, this is not what many HCPs do, they, instead offer one option (hopefully, but not always so, evidence based) and order the mother to do as she's told.
Example (mail, not phone, but the idea is the same): mom 9 days pp was ordered by her family physician to feed less often (no more then every 3 hours) and use a dummy in between because baby could not pass bowels without mom helping. In my answer to her I discussed briefly the different reasons for not passing bowels in a child this age (being fed not enough being one of those) and why in my opinion some of those reasons would apply most to her baby and offered for each some ways to help her baby pass her bowels. And some additional reading on thrust worthy breastfeeding internet sites.
Did I tell her her physician was probably wrong? Yes, you bet I did. Did I order her to go against his advice? No, I gave options and explained things.
In The Netherlands we finally had the start of a lawsuit against a neurologist who had been malpracticing for over 10 years because no one dared reporting him. His colleagues closed their eyes, administrators probbly didn't want to give the hospital a bad name. This should have happened and it would not have happened if anyone had dared to tell that he was doing wrong. Doctors are no saints, just people doing their jobs and if they screw up someone has to notice and do something about it.If not, they will make a bad name for the whole profession and damage the doctors who really do do a good job.

Warmly,

Gonneke, IBCLC, LLLL retires, MOM and rebel in autumn-ish southern Netherlands


--- On Wed, 9/2/09, Tamara Hawkins <[log in to unmask]> wrote:


Hello Everyone,

My post discussing my experience was found to be  offensive. Please
understand when I used the word "You" I was not referring to Lactnet as a
whole
and I was asking a rhetorical question.

I am expressing my feelings  and actual experiences and wish to get some
helpful feedback.

Here are my questions I wish to be addressed:

What is the ethical and legal implications of advising a breastfeeding
mother over the phone and telling her to do something against what her team
of care providers who are counseling her, examining her,  working with
her everyday and multiple times during day while still hospitalized?

I am baffled by this phenon I'm seeing...Where is the milk? Are there new
 trends
that are being researched?  But sadly yes, I see many many mothers 3-5 days
pp with no
clinical signs of lactogenesis. I am referring to mothers that report
absolutely no breast growth during pregnancy,

 Unfortunately, those babies need
supplementation.


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