>So my question is, what steps are in place to ensure that the emerging
>profession of the lactation consultant will empower women and not
>disempower women?  -  Karleen Gribble

>And speaking of malpractice, as I remember, it consists of 4 parts:
>1. departure from   "standard of care"  -  Gail Hertz

I dearly love the following description of *a consultant* - any old
kind of consultant.  I've always thought it's from a book on
consulting in general, by Hubert Bermont, though I've never been able
to find it since my first reading:

**A consultant is hired not for his education or initials but for his life
experience.  He is expected to provide ideas from outside the mainstream;
that's why he was consulted.  He offers these ideas with the understanding
that many of them will not be implemented, or will not be implemented in
the way that would make them most effective.  The client understands this
as well."**

To me, that covers *so much* of what we do!  Our initials are based far more
on our life experience (thousands of hours) than on our formal education (30
hours).  We're full of ideas like cabbage, fenugreek, and nipple confusion
that have no well-documented background.  It's the rare client who doesn't
take our ideas and modify them to fit her own reality.  And she knows, in
doing so, that she's not doing *exactly* what we suggested, and that's fine
with her.

By this definition we routinely depart from "standards of care".  Yet as far
as I know, no LC has ever been successfully sued.  And I think that's
because we don't dictate.  We spread out a smorgasbord of suggestions *and
help a mother fit it to herself*.  (Has any of us ever said, "You need to
use gentian violet"?  Or have we outline the pros and cons of various
treatments so that she can decide how she wants to proceed?)  Suing comes
from a sense of powerlessness - it's an attempt to regain control that was
lost to someone else.  ("She told me I had to use gentian violet.  I didn't
know there were other options.")  By making sure that the mother retains all
the control in our consultations - that we act as *consultants* offering
ideas - we not only honor her, we protect ourselves.  I wonder what would
happen to medical lawsuits if more doctors did the same.

Maybe I'm naive, but I've taken to carrying fenugreek and gentian violet
with me all the time.  Both are a little hard to get locally, and it saves
the mother a trip if she chooses from that part of the smorgasbord.  Am I
prescribing?  I think only to the extent that I am when I carry and suggest
nipple shields, an SNS, or anything else "weird".  If we are forced to
operate strictly "within the mainstream", then we're no longer consultants
by the above definition.  And I'm not in this to be a medical subspecialist,
prescribing this and that using on my credential-derived power.  I'm in this
to be a *consultant*.

Diane Wiessinger, MS, IBCLC  Ithaca, NY

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