Dear Denise,

It is important that any LC program follow IBLCE and ILCAs standards of practice and ethics. These are available on their web sites.

There are many things that should be included so that your program is "professional." Such things as before making an appt, quote the fee. Take a thorough history and write it down. Have mom sign a consent form (a common one from the Lactation Institute has mom fill out basic information and then sign at the bottom with the legal wording just above where she signs). Make sure you have time to sit through an entire feeding and still have time to do a care plan with mom, answer questions (maybe 1 1/2 to 2 hours). You will need duplicate or maybe triplicate forms for hand written care plans. One copy goes to mom, one to your files, sometimes one to doctor. You will need a report form of some kind where you write out basic information like ages, weights, intake, what you did for this visit, and what you observed with baby/mom. You will need a form to fax over to the doctor to report on your visit and what you did or what needs to be addressed (done after the consult is over). You will need medical reciepts specific to lactation so mom can attempt to get insurance reimbursement. You will need to create a referral form that she can have her doctor sign to help get reimbursement.

Liability insurance is recommended -- you may already be covered under your hospitals employee plan. You will need a bag preferably with wheels to carry your scale and devices, gloves, forms, pens, handouts, bus. cards, etc.

A typical lactation consult starts with taking the history and a legal permission form being signed. Then baby is weighed on a scale like the Medela Baby Weigh. Weigh the baby naked or back off the weight of another dry diaper and clothing/blanket. Diapers should be dry. 

Ask permission before touching mom or baby. Assess baby's tongue, lips, cheeks, palate, and sucking. Assess mom's anatomy (damage, flat nipples, etc.). Wear gloves for diaper changes or putting finger in baby's mouth and touching mom if she has sore nipples or yeast.

Observe how mom normally latches baby on. Correct any areas needed. When baby finishes first side, weigh baby again. Keep written records of these weights. Assess how much baby took in and is this normal amount or poor. 

Teach mom feeding cues and satiation cues, how often and how long, active sucking vs. comfort sucking, diaper counts, etc. as you watch baby nurse.

Change diaper, burp baby, have mom latch onto second side. Observe and offer corrections. Weigh baby again when feeding is done. If feeding is adequate and baby shows signs of satiation, then you can stop. If feeding is poor or baby still hungry, do another round of feedings. 

When finished, write up an individualized care plan. Go over it with mom. Refer her to any other professional help she might need (ENT for tongue tie for example) and give her a copy of the care plan. Answer mom's questions. 

Give her handouts that pertain to her situation (how to know baby is getting enough, working and bfing information, support groups in area, etc.).

Write up medical reciept, give her a referral form to take to her doctor, and collect money.

Follow-up in person or by phone 1-2 days later, maybe 7 days later at the latest for "easy" cases. Encourage mom to call you but you will probably need to call her. 

Write up a synopsis of your visit for medical record keeping. There are already created forms available that cover this. Write up doctor's report and fax or mail it out. Keep copies of everything and put into some kind of folder (your hospital will have guidelines for this). Take care of the money.

Sincerely, Kathy Eng, BSW, IBCLC Houston, TX




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

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 mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html