Christy Ann Flynn wrote:
>An LC  (RN or not) that practices independently without collaborating with
>the appropriate Primary Health Care Provider is of concern to me.
>
>Example:  Mom is seen by LC for symptoms of bilateral mastitis.  Instead of
>collaborating with Mom's CNM or MD (if there is one), she gives the Mom advice
>to treat symptoms.  Mom develops full-blown bilateral mastitis, cultures out
>Group B Strep, baby comes down with late-onset sepsis because maternal
>treatment was delayed, develops meningitis and has a poor outcome.   Who is
>responsible?
>
>Example:  LC sees Mom for latch problems at four days postpartum.   Baby is
>too sleepy and lethargic to latch.  Poor urine/stool output.  LC does not
>collaborate with a PHCP responsible for the baby, baby admitted to
>hospital on day
>five with seizures due to electrolyte imbalance and dehydration.  Who is
>responsible?

Thanks for these scenarios, Christy. Firstly, I am not a RN, so rules
for acting as one do not apply to me, nor to many other private
practice LCs. This is mainly *why* I am in private practice - I have
no other choice for using my IBCLC qualification in my area. I am an
LC, not a nurse.

In both the scenarios above, these are, as Denise so eloquently put
it, 'out of my scope of practice', ie I will certainly assist the
mother and baby to the best of my knowledge and ability to preserve
breastfeeding and resolve the problem, but I would also insist that
she consult with a doctor or go to a hospital. I know my limitations
and am very aware of the need for referrals to other HPs. I don't
think there is a necessity for *me* to collaborate with the other HP,
as long as I make sure the mother does (or at least document that I
have advised her to do this).

Just also to add to what Karen Clements wrote about child health
records in Australia, I believe that the clinic where the mother
attends also keeps a record on the mother/baby dyad (in addition to
the 'yellow book' she keeps). If the mother moves house or otherwise
wants to change clinics, her records can be sent to the new clinic.
As far as I know (as I do not work in child health), these records
are never reconciled with any medical records that the mother may
have at a medical practice. When the child reaches school age, the
school also holds a health record for each child, and there are
school nurses who visit to cover essential tests and organise
immunisations, etc.
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Australian Breastfeeding Association counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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