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Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 31 Mar 2000 13:21:34 EST
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Dear Friends:
    Jan has initiated a great dialogue.
    My response is based upon years of reading my malpractice insurance
newsletters, plus my basic educational programs which taught me as a nurse,
to be very careful about what I say and do as a licensed professional.  And
also my state practice act, which does not permit me to prescribe. An example
is that midwives have been slapped with lawsuits for practicing medicine
without a license in many states in this country.  Another example is that
the only nurses with prescribing ability are advanced practice nurses
(nurse-practitioners, nurse-midwives, and nurse-anesthetists), all of whom
have received state permission to prescribe, and who have received training
in prescribing. Not all states endorse this, either, which makes it more
complicated.
    Again, it comes back to the public health aspect, which is to provide for
minimum safety for the majority of people. I am not trained to prescribe, so
legally I can't.
    Things will probably be alright (meaning I can get away with it)  if I
suggest to a mother that she use cabbage (which has no evidence to support
its use, and is possibly a drug delivery system, that puts "something" into
the breast via the subcutaneous route) or take "X" homeopathic remedy or take
"Z" over-the-counter preparation. But if anything goes wrong, which it can in
this country of lawsuit happy folks, I am out hanging in the breeze when an
attorney asks me if I have the legal right to recommend any substance.
    This is absolutely a conservative view. And when one reads the latest
edition of Lawrence, with its tables of possible adverse reactions to various
herbs, one must decide if prescribing or recommending or suggesting such
things is worth the risk. Especially when folks are notoriously non-compliant
with prescription medications.
    So the options are to change the practice acts, or refer to physicians or
certified herbalists or certified homeopaths and other folks who are trained
and recognized authorities in the field. Or take the risk, and hope one gets
away with it.
    Another example: as medical liaison for the local nursing mothers'
consortium, I receive phone calls from mothers wanting to know about St.
John's Wort for treating depression. They haven't a clue if their symptoms
mean  they are anemic or  hypothyroid or in a rotten relationship or being
alone most of the time with a new baby and/or small children. They often
don't like hearing me recommend seeing their healthcare provider to rule out
medical conditions which may mask as depression. I can not, as a recognized
authority, condone or encourage this behavior. If someone wants to medicate,
they need to see the person qualified to recommend that medication (and herbs
are medications).
I can't.
    What program (for LCs, lay counselors, peer counselors, LLLs, CLCs, CLEs
or anybody) offers training to provide a basis for safe recommendations of
drugs and herbs? I don't know of any. Maybe that is something the IBCLE and
other organizations need to consider. Maybe we need the ability to prescribe
as part of our practice.
    I ask you, Jan, where is  the legal support for a lactation professional
to prescribe or recommend any substance?
    Your turn....:-)
    Warmly,
Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI, CSTP
Elkins Park (a suburb of Philadelphia, Pennsylvania; northeastern USA)
supporter of the WHO Code and the Mother Friendly Childbirth Initiative

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