Carol,

> having hesitated in order to not appear to be taking any remarks
> personally,
> i would like to issue what i suppose might be called a personal
> statement of
> ethics. anyone who has IBCLC after his or her name, and lives in a country
> where there is a milk bank (or banks) should know all the details about
> recommending donor milk to a patient and implementing a plan that includes
> donor milk.

I can only take this as a personal attack on my ethics.  I considered
posting to you privately, but feel I must defend myself in the public forum.

I do not believe that any professional can know everything about every
topic, even in their field.  An example:  my sister is a physical therapist
who specializes in geriatric rehab.  I asked her a question about some back
pain and she gave me an educated opinion, but stated that her specialty was
not backs and suggested I speak with a PT who "does backs".

This is what I did with this mother who had a question about donor milk.

> 1.3.6 facilitate referral to other health professionals,
> community services,
> and support groups as needed

I guided her in the right direction, but (as Coach Smith says) it is her
baby.  I called this mother, long-distance from my home at 5:00 on a Friday
night.  She lives 150+ miles from me.  I gave her all the information I had
and offered her further support as needed.  She wasn't very interested in
the idea of donor milk and I was not going to insist that she follow through
with my suggestion.

I cannot hold every piece of information in my head about every aspect of
lactation.  My specialty is not milk banking.  Clearly it is your specialty
and you are not happy that my knowledge on milk banks is not up to your
expectations.

> 2.1 provide education to parents and families to encourage
> informed decision
> making about infant and child feeding

Did this too.

> 3.2 practice within the scope of the international code of marketing of
> breast-milk (sic) substitutes and subsequent resolutions, maintaining an
> awareness of conflict of interest when/if profiting from the
> rental or sale of breastfeeding equipment

Didn't rent her a pump, but did give her suggestions on how to facilitate
her pumping and increase her output.  Don't know who rented her the pump.

> 3.3 act as an advocate for breastfeeding women, infants, and children

I have advocated for breastfeeding couples for almost 8 years.

> 1.3.6 referral should be to milk banks when supplementation is needed

Did this (but obviously not correctly).

> 2.1 education should include risks of artificial feeding and information
> about alternatives

Mother already knows this.

> 3.3 acting as an advocate for an infant or child would appear to include
> promoting breastmilk feeding before artificial feeding

The baby's doctor was recommending rice milk.  I suggested donor milk.  Who
is promoting breastmilk feeding here?

> 4.3 informed consent would include information about risks of artificial
> feeding and availability of donor milk

I gave her the name of the milk bank in her area.  Should I have called them
myself and asked them to contact her?  I don't think that is my job.

You said:
> i can think of no adequate excuses in this day of computers, long distance
> phones, mail of all sorts, etc., for not obtaining the
> information.

Well, guess what.  I couldn't get on the computer to look up the information
for her because my son (who is autistic and had waited patiently for me to
let him use the computer) was using it and he would have been unable to cope
had I asked him to get off so I could look up the milk bank info online. I
would not have been able to help her at all if my son had had an autistic
melt-down over the computer.

> i ran into an ugly situation last week
> when an employee of a hospital forced formula, bottles and a
> pacifier on one
> of my patients, for extremely misguided reasons. i have no
> obvious recourse
> because this employee was not IBCLC. so, i like to think our code
> of ethics
> is important. and relevant.

Are you saying because I did not have instant information pouring out of my
head for this mother, that you have should have recourse?  For what?  My not
knowing every facet of milk banking is equivalent to a nurse "forcing
bottles"?

> believe me, this is much easier than describing some of the other basic
> processes that we are expected to understand. (biochemistry not
> being one of
> my easiest subjects.) i can think of several places in our ILCA code of
> ethics that might indicate a basis for my belief.

I have seen unbelievably "easy" questions asked of (gasp) IBCLCs on this
list.  Most of them are not attacked for their ignorance.  I asked a
question that you, and perhaps others, think I should already have the
answer for.  Sorry.  I do not know exactly how donors are screened and
babies are selected to receive donor milk.  I am willing to learn, which is
why I asked the question.

I received helpful, private replies and public, hurtful accusations.

I would to remind you that we are all colleagues of sorts on this list and I
would appreciate it if, in the future, you have cause to question my ethics
again, you will do the courtesy of doing so privately.  I do not appreciate
being publicly slandered.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Kathy Koch, BSEd, IBCLC
Great Mills, MD
mailto:[log in to unmask]
http://www.bftopics.org

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