From one of the usually silent 3000.  Here is the letter I sent to IBLCE last week.  Since I sent it I have become more and more concerned about the future of IBCLCs who are not nurses or physicians.  I hope that everyone will remember that this profession was originally established by LLL leaders and that many, many of the biggest contributors to this field are not nurses!  I strongly believe that the IBCLC should be a credential which stands on its own.

Dear Ms. Hewat:

As a recent 10-year recertificant I am deeply disappointed by the new Scope of 
Practice.  I have been an IBCLC in private practice for 10 years.  I practice in 
a rural area where there are no other private practice LCs, and my nearby 
hospital does not have an LC on staff.  For the past 10 years I have struggled 
to support mothers to breastfeed even though they are surrounded by an 
unsupportive and largely ignorant medical community.  I have had to contradict 
the advice of a client's healthcare provider on MANY occasions.  I have always 
handled this with tact and respect for the other provider.  This has paid off.  
Most of the physicians in this area now regularly refer to me and respect my 
treatment of their patients.  Several of the physicians I have had to contradict 
have actually thanked me for giving them better information about a topic that 
they knew little about.  I do not understand how I can practice without 
occasionally disagreeing with another health care provider.  If a
 mother asks me if it is true that she has to wean because she has a fever (true 
story), how am I supposed to respond?  The only way not to contradict her health 
care provider is for me to lie!  In the particular situation I am referring to, 
this mother was told this by a nurse in an OB's office then the doctor refused to return my calls to discuss the issue.  Does the nurse count as the health care provider?  Who exactly IS the "client's healthcare provider" 
that I cannot contradict?  Suppose she is seeing an herbalist who tells her that 
frequent emptying of the breast isn't necessary for building milk supply so long 
as she continues to take fenugreek and blessed thistle (another true story).  Is 
the herbalist the healthcare provider since that is who mother was mainly seeing for 
care before she came to me?

I also don't understand how to respond to questions about alternative therapies.  
Suppose a mother asks me if there is  any other antifungal she can use for her 
nipple thrush since the nystatin she was prescribed isn't working (a true story 
many times over!)  Do I tell her to just ask her doctor, who already said that 
is all he could give her?  Do I read to her from Hale about diflucan?  can I suggest gentian violet?  Does it make a 
difference that I co-wrote the booklet published by LLLI, Thrush and the 
Breastfeeding Family?  Can I give her the booklet even though it contradicts the physician? Some of the physicians here recommend gentian violet themselves, so is it alternative or not?

The list of questions this Scope of Practice creates is lengthy, and I'm sure 
every practicing LC can name many situations where she would have been 
contradicting another healthcare provider or recommending an alternative.  
Please re-think this document and these guidelines as soon as possible.  Our 
profession is struggling for recognition and respect.  Please don't allow the 
IBLCE to become one of the things that holds us back. 

Sincerely,

Rebecca Butler, IBCLC



 

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html