What would I do in a situation like this, where the LC feels APNO would be
helpful but the primary hcp says the mother must not use it? or mom is told
she must not use a vaginal preparation while breastfeeding? Unfortunately
since the prevailing mindset in recent history has been to wean for any and
all pharmaceutical use, we will have to educate. Lucky we have the likes of
Hale and Newman and others who provide wonderful resources for us. In the
case presented, it sounds as if the mother was secure in using the vaginal
preparation but was hesitant to use the apno. You could provide her the
references, Newmans' articles online, or offer her other options (maybe she
could use gentian violet?). I find mothers are hesitant to let the baby
suckle where the cream was used. I might say that I know many doctors who
prescribe it and do not advise wiping it off, but that she could gently
rinse it if she preferred with warm water prior to feeding. If I felt it
would get me somewhere with a particular doc and I had the time, I might
call the doc, or fax over the ref to the doc as "FYI." She might also go to
a dermatologist. Since this could be considered a prescribing situation, the
LC, if not licensed to prescribe, is treading on thin ice legally, in my
interpretation. Now, when the conflict is over something like normal
physiologic jaundice in a well-feeding baby, which I encounter frequently, I
am very confident telling the mother I strongly disagree with the advice of
stopping breastfeeding, supplementing with formula, or topping off with
water, for example. I then give my rationale etc. If you are knowledgeable,
professional, and strictly state your position w/o slamming the other
professional, you should be ok. P.S. If you ask the doc for refs he may very
well be able to provide them as many of the drug literature will say don't
use while bf.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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