Again, thanking all for the chance to clarify.  I find nothing wrong with
assessing and making my assessment known to the physicians I work with. A
LLLeader, with the mother's permission, can also do this by phone or note.

Communication, and dialogue of a professional nature involves sharing
information. I agree that we as Nurses, IBCLCs, or LLLeaders, cannot and
should not prescribe medication. This is the physician's job. I do think
however, that "being careful" can be a confusion phrase, and can  mean many
things.

 I do not believe that it should extend to restricting  information that is
available or to limiting discussion.   The physician and the IBCLC can
discuss, share information, and the final decisions rest with the physician.

To me, being careful means carefully assessing the client's breastfeeding
situation, at the request of the client, and  then sharing what information
I have that might be of some clinical use ..both with the client and with
the MD involved.

And, just for the record, I have never concocted a compounded medication or
suggested that a client or another IBCLC  do so without a doctor's
prescription and recommendation.  Again, this would be outside the scope of
the Nurse's Practice Act.... Many physicians we work with find professional
dialogue to be both interesting and useful since we share the goal of
helping the client.

Thanks for the chance to clarify further.

Kathleen

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
Williston, Vermont
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