In trying to understand the rationale behind the scope of practice changes, I think the intent was perhaps to keep the LC from contradicting the doctor, like the doctor says to supplement and the LC says not to? Or maybe the doctor says to discontinue bf for a very high bilirubin and the LC says you don't have to??? I'm just guessing at some of the possible scenarios. I think the salient point might be that the doctor or other hcp is the primary provider and ultimately responsible for the client's care (we could argue he mother herself is ultimately responsible). I am guessing there were some bad outcomes and the LC did not provide followup care. I do think definitely this scope of practice is coming from a USA perspecitive.  If you are seeing a client and feel a certain way, send a report to the doctor with your recommendations and give a copy to the mother. The main problem I run into is tongue tie, in that I feel intervention is warranted and the doctor does not; but I must defer to the doctor, as an LC and as a nurse.
 
The LC should not prescribe nor recommend alternative therapies: I agree this is vague. I think what it might mean is for the LC to tell a mother to take xx capsules of fenugreek 4 x per day. This is a prescription. The LC could, in my interpretation, discuss various galactagogues that are used, and have the mother discuss with her hcp in case medical conditions or other meds might interfere. This is what I do, I mention to the mom some available therapies and ask her to discuss with her doctor. I also call the doctor and discuss with him/her.
 
This situation is not ever going to be resolved. I have always had a good rapport and reputation with the docs but I always have had to walk a fine line watching what I say to moms and using some semantics like someone else posted. Bottom line: What we need are ALOT more MD or other primary care practitioners that are also IBCLC so that more clinics could be available and us "regular" ibclcs could work under them and wouldn't that make all of our lives, the LCs and the moms and the babies, better. I would love to have a job like that. Is there a way we could fund this/scholarships etc to facilitate this?
 
Laurie Wheeler, IBCLC, MN, RN Mississippi, s.e. USA 
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