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From:
laurie wheeler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 28 Oct 2006 16:43:09 +0000
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I've been thinking more about the scope of practice statement. I do practice within a medical system, I've worked in at least 6 different hospitals in the New Orleans area in my career and now I've worked one year in a rural Mississippi hospital. (I also had a private practice at one time). Working in a hospital system under the medical model  is a different situation altogether compared to bf advocacy, public policy, and other settings. Please don't misunderstand me. Don't think that I believe this is the best system or that all of us should be practicing this way. Far from it. I also have a great deal of experience collaborating with the WIC program in the USA, which is a food and nutrition program for low income women, infants, children and it provides bf education and assistance. Often mothers go to the health department with their babies and they do not have a specified doctor; they have been discharged from the hospital. In this setting,  there may be no hcp to contradict. As far as I know, in my area of Mississippi, there are about 10 counties in my WIC district with 1 or 2 IBCLCs and the other people giving bf info and advice are peer counselors and lactation specialists who are not IBCLC. I suppose they can give out information and assistance without worry.  In the hospital, however, each client is admitted under a physician's care. The mother is under the care of her OB doctor and the baby is under the care of the pediatrician, neonatologist, or family practice doctor. I sent an earlier post describing this a bit. 
 
One thing a hospital based IBCLC could do, in a consultation or followup visit, would be to report her findings, give her recommendations and send the report to the doctor with a copy given to the mother. This way the mother has the information recommended but it is not really contradicting the doctor. A private practice LC would do the same thing. However, beware! I have had the unfortunate experience to be barred from seeing one pediatrician's patients in a hospital and even after hospital discharge, because my information contradicted his. This occurred several years ago in New Orleans. The doctor in question recommended every 4 hour feedings and never sooner, and to start complementary foods at 3 weeks of age, among other things. After many meetings with the doctors and administrators, and providing AAP statements and other evidence based information, the decision was made that the doctor has the final say and so I was barred from seeing those moms. It is a very frustrating situation, and working in a an area with low bf rates, and a non-bf culture makes it all the more difficult. It was also determined that this was not malpractice on the doctor's part.
 
One more thing: I think LCs who work with sick and vulnerable infants, or those who consult with difficult or complicated bf cases, do need some background in biomedical science. I realize there are other LCs who work more with "normal" bf situations, bf advocacy, public health etc who may not need as much background as this. But if the IBCLC credential covers all areas of the blueprint, including sick and premature babies, and mothers with various health challenges, then this would be a requirement. My background before LC'ing is neonatal intensive care nursing and I'm most familiar with the USA healthcare system, so I admit I am influenced by these experiences.
Respectfully to all,
 
Laurie Wheeler, IBCLC, MN, RN Mississippi, s.e. USA 
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