Help!  I have a very new, very small but lately, very BUSY, private practice.  This week I was requested by a homebirth midwife to see a baby in a crisis.  When I saw the baby she showed several signs of dehydration but was turning the corner after a traumatic birth and a rough first 36 hours.  Nursing appeared to be going well, from everyone else's perspective, but mom had a cracked nipple and baby was not stooling, besides one immediately after birth.  The midwife seemed stumped as to what to do and said she deferred to my judgment but seemed shocked when I suggested that this floppy, dry, listless, non-responsive baby see a physician!  I asked for the name of the pedi and the mom told me she had a recommendation for one that they had not yet seen.  I mentioned that there was another very breastfeeding knowledgeable pedi in the same practice (no comment on the intended choice) and mom jokingly said "Oh, then THAT'S our doctor!!"

To make a long story as short as possible, the midwife appeared quite irritated with me, questioned me several times (but she admitted she had no idea whether baby was sleepy or truly lethargic), and I think she was even briefing the father on her irritation as I wrapped up with the mother.  This is the second time in 2 weeks she and I have disagreed--the first time the baby was having black stools on day 7 and she had provided suppositories while I was harping on the need for additional nutrition!  Back to the present case--Baby ended up waking up considerably and nursing most of the night as well as receiving some formula after I left.  Things look okay now and I do not expect any further contact with them other than retreiving my video and rental pump from them soon, but I'm wondering about a report to a doctor.  CAN I/should I send a report to the intended doctor or the doctor I mentioned to her (they're in the same practice) that she wants to pursue, even though she's never seen either of them?  I don't even know if she really checked to see if they are taking new patients.  I have my own documentation of the case but would feel better if the baby's doctor, whom she may not see for an extended period of time, also had documentation.

Your suggestions??
Thanks!
Amy, IBCLC

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