Linda,

What you describe is a very difficult situation and I have some experience
with it. What I recommend is to *call it as you see it*. You are the BF
expert, you are the one who is board certified in lactation consulting. Try
to stay on good terms with the doctors. Sometimes it helps to fax a
pertinent journal article or Tom Hale citation with your report. Sometimes
it helps to call the doctor and explain your assessment further. My feeling
is if I lose referrals from that doctor, then so be it.

In fact, since July, I am not allowed to see one pediatrician group's
patients (2 doctors) per the physician's insistence, because I recommend cue
feeding, and they recommend 20 min fdg, including burping, every 4 hrs, and
intro of cereals starting at 3 wks of age, and progressing rapidly to other
foods. I am very sorry that hospital administration and the chief of OB
supports the right of this peds group to keep patients from BF services,
even if the patient asks for our assistance. Short of changing to a new
pediatrician (which is easier said than done, because other docs don't want
to take on said patient) the client cannot access LC services in hospital
nor on the phone line nor OP consults. But I will not stop doing and
recommending what, as far as I know, is current lactation science and
evidence-based practice. This kind of situation is very very frustrating for
the LC and the families. I lost a great deal of sleep, but no self respect,
over it. If I were in a private practice situation, which I once was, but am
not now, I would be even more feisty, not having several layers of hospital
management over me.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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