Well, first of all, you have addressed whatever concderns there might
be when you say that "Drs are aware of L5 status, but are allowing the
feeding."

That is your Bingo.  These doctors (thank heavens) are aware that the
best-practice, the biologic imperative, and the pubic health recommendation
is:  breastfeed the baby.

The only part of the picture that is unclear is whether the mother is also
being given additional supports that her situation calls for:  has she had a
consult with the IBCLC to discuss how drugs -- prescription and street --
pass into her milk?  Has a referral been made to social services to get her
drug rehab counseling?  Are there supports in place to assist in the care
for this baby once it is discharged?  It is probably going home to an
unstable environment, and no matter what is going into that baby's belly,
mom probably needs help.

The policies that your unit needs to have in place those that
assure evidence-based information and support are given to every
breastfeeding mother coming through the doors.  The mother should be
given individualized information about how the drugs in her system will
impact her milk, and her baby.  This mother needs to learn *how* she can
breastfeed safely.

This "we're gonna get sued" scenario is alarmist, and instead allows for
wildly inappropriate "judgment passing" about this mother and her hstory.  I
smell assumptions about how "good" a mother this is, or will be, given her
drug history.  THAT is the more troubling ethical scenario, because it means
care is being provided based on "feelings" about the mother, and not upon
evidence-based practice.  Are these same nurses, so fretful that they will
be sued for giving cocaine-laced breastmilk, equally concerned about the
drugs commonly administered during labor and delivery, and during
c-sections?  Are they fretting that a mom is going to come back and sue them
because of lactation failure due to L&D medications, which produced a floppy
sleepy baby, who could not latch and suck, and who -- in
full, self-fulfilling prophecy -- was ordered "medically indicated" formula,
so mom's milk never surged?

We take our patients as we find them.  It is not up to us -- IBCLCs, RNs,
MDS, social workers, candy-stripers -- to decide whether a patient's life
style or medical history make the provision of optimal care an option.



--
Liz Brooks JD IBCLC
Wyndmoor, PA, USA

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