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Subject:
From:
"Pam Hirsch, RN, BSN, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 31 Oct 2006 15:29:58 -0500
Content-Type:
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Angela, Royce and All:  OK, I have to speak up now.  I am an RN and an LC - 
neither is separate from the other.  Lactation is my CLINICAL SPECIALTY and 
I am guilty of clinical malpractice if I have a mom/baby in my office (or 
on the phone, for that matter) and I suspect a high bili, a breast 
infection, whatever and I do NOT bring this not only to the mother's 
attention but her doctor's as well.  This is an issue that has cropped up 
periodically over the years - I have been criticized by non-licensed LCs 
for checking a baby's circ, umbilical cord, asking a mom about her lochia, 
incision, etc. while seeing a mom/baby for a lactation problem, as going 
beyond the lactation consult. What do you think would happen if I got a 
phone call from a doctor's office and the doctor is asking me why I did not 
refer his patient back to him for XYZ problem when he understands I saw her 
in my office the previous day? At the very least, I hope the only thing 
that happens is that I am embarrassed for not picking up a problem. Like 
Royce, I have many doctors owing me debts of gratitude for picking up a 
high bili, a severe mastits, etc.  Because I am hospital-based it is also 
very convenient for the mom.  I remember once calling a ped's office late 
one afternoon to let him know that I had a a pretty significantly jaundiced 
baby sitting in front of me.  Did he want me to send the baby down to the 
lab for a bili?  He asked if I could do that!  My response to him was call 
an order over to the lab and I would send the baby down, and by the way, 
did he also want to order a chem panel and a CBC while he was at it?  He 
was not offended, he was grateful.  A couple of days later I saw him on 
rounds and he thanked me, telling me I had helped this mom avoid a hospital 
admission by catching the problem early enough.  Another time I had a mom 
in the office with a chubby, happy beautifully nursing 3 week-old.  Mom was 
miserable with a temp of 105 (I took her temp in the office) and a rock 
hard red breast.  (She had wondered if her bra was too tight 3 weeks before 
when I saw her in the hospital - I had recommended that she get fitted and 
she admitted that she was continuing to wear the too small bra, leading to 
a really nice mastitis.)  She nursed the baby, we pumped the infected 
breast getting several ounces of green pus.  She was horrified that the 
baby was drinking that! but it obviously wasn't harming the baby.  Then I 
sent her next door to her doctor's office.  I saw her doc as I was 
returning from escorting her to the door and told him she was on her way 
over to his office and that he would be admitting her for IV antibiotics.  
He semi-sarcastically asked me where I got my MD from, but ended up 
apologizing to me the next day when he asked me if I could go the medical 
unit to see her, as he had indeed admitted her with the worst mastitis he 
said he had ever seen.  Another OB once told me that he was awed by my 
ability to "diagnose" mastitis over the phone.  To keep myself out of legal 
trouble, I will tell a mom to see her doctor as I suspect she might have 
XYZ going on and that her doctor needs to see her in order to diagnose and 
recommend treatment.
I have said this many, many times to many, many docs over the years.  My 
purpose in life is to help a mother meet her breastfeeding goals, not take 
over an MD's practice. I rely on the doctor for the medical diagnosis, and 
given that diagnosis, I work with the mom to develop a realistic feeding 
plan to help her achieve her breastfeeding goals within the constraints of 
the medical diagnosis.
Enough said!

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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