Hi all,
 I am a hospital based RN IBCLC.  I work in a lactation center owned by 
the Medical Center, and I see every newborn at 7 days old, and any newborn 
that the mom, MD, or Staff feel need seen earlier.  I do document on a 
medical record for every client. But... I only send emailed or faxed 
reports to the HCP if there are medical concerns that will impact their 
care of the dyad.
 If I am providing basic guidence with latch, position, ect.. the md's 
don't want to have memos about that. They consider that the reason they 
are at the Center.  If there are weight loss issues, low supply, obvious 
jaundice, symptoms of mastitis or yeast, these things they want to know 
about and what I have advised the mom to do(and sometimes it is 
contradicting to what the HCP told the mom).
  What would be the point in generating hundreds of reports that 
read "assisted with positioning and latch on to improve comfort and milk 
transfer" ?  All 15 of our area pedi's and many of the ob's refer 
lactation concerns to us, and have often called to ask about current care 
for lactation problems or medication references .  They have learned that 
when I call or write to them about a client, it is a significant concern.  
I beleive that if I flooded them with brief reports of normal lactation 
care, they would begin to ignore the more important issues that do need 
their attention.
 It may boil down to the fact that I have worked hard over the last 14 
years to gain their respect, and demonstrate a professional ability to 
practice in my specialty. I would not really wish to devalue the 
relationship we enjoy now.

** More input from the less and less silent 3000 ****
Paula Hiett RNC, IBCLC
Good Shepherd Lactation Center
Longview, Texas

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