Thank you so much to Liz Brooks and Dr. Nice for answering my questions about the scope of practice of IBCLC's. I did hear from an IBCLC recently that they thought this was the case that we cannot recommend any herbal treatments or OTC products, even though one might think so, since people do not need a doctor's prescription for these medications. But I don't think this information is commonly known by many of this. Thanks so much for letting us know. I guess I can see it as a liability issue. But I would think that many MD's that I know would probably be irritated to get a call from patient saying - my lactation consultant said to call and ask if I can take Tylenol. Some of this is a bit of grey area too. My other question then would be, which of these would constitute an OTC medication or treatment which we cannot directly recommend if we are not an MD or APNP?



Lanolin cream

Coconut oil

Olive oil

Lactation cookies

Brewer's yeast

Saline soaks

Epsom salt soaks

Cabbage leaf compresses

Herbal teas/fenugreek

Lecithin

Moist wound healing of damaged nipples

Warm or cold compresses



Can we directly recommend any of the above things? Or just provide them with information about them, but not recommend and tell them to check with their doctor. 



Thanks again for helping to clear this up. 



Tricia Shamblin, RN, IBCLC





Date:    Fri, 6 Jul 2018 06:18:54 -0400

From:    Elizabeth Brooks <[log in to unmask]>

Subject: Re: scope of practice



IBLCE should be issuing a revised and updated Scope of Practice any day now (July 2018) but the current version is here: https://iblce.org/wp-content/ uploads/2017/05/scope-of-practice.pdf, and the new one is not expected to change the SOP substantively.



IBLCE's 3rd (ever) Advisory Opinion, issued in 2017 and entitled Advisory

Opinion: Assessment, Diagnosis and Referral  https://iblce.org/wp-content/ uploads/2017/05/advisory-opinion-assessment-diagnosis-referral-english.pdf

(though I assert it would more appropriately be titled Assessment, NONdiagnosis, and Referral ...).



These are your authority for the notion that the IBCLC does **not** have authority to recommend specific over-the-counter (OTC) drugs, salves, ointments,etc. for a family. Their definition of medical "treatment" is very broad, and could be construed to include OTC products.



In these sorts of situations, with my private practice clients, I say something like "Check with your doctor [or other primary healthcare provider] first to make sure it is OK for you, but something like ibuprofen [or whatever] will help with that pain ..." That lets the family know what is likely to help, puts on their shoulders the responsibility of clearing it with their doctor, side-steps my "direct order" that they use the OTC, but also hints that if they already know use of that OTC would be OK (no known allergy to it, for example) then, well, their decision of what to go ahead and do is on them.



NOTE THO that the SOP also includes our ability to provide information and support to families on all manner of things, including complementary therapies (which would involve information about herbs, for example).  You can't go wrong arming families with any-and-all information, so they can make an informed decision about healthcare in consultation with the HCP.





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