Jennifer said: 
"Then there is the issue that the mom doesn't know if she can believe me
when I tell her that the problem is latch--because this may mean that other
things she was told by the nurses, doctors or LC's was also wrong."

I know I've posted this before, ...but I will again because I think it is so
very important, not only for our own professionalism, but also for the
sanity of our moms...:

We CAN change/correct/improve on/add new information to the mothers we see
after others WITHOUT cutting down/criticizing/implying incompetence of those
who saw the mother before!

All we have to say is: 
...well, it seems that things have now changed  
Or
...your baby's mouth has changed/grown
Or
...your breast changes now seem to require that we try...

MOST of the time - this is true!  We are seeing DIFFERENT mothers and babies
from the mother seen at 24, 30, 36, 48, 72 hours...there are a lot of
changes occurring in that time - from mother's capacity to comprehend, mom's
ability to SIT, baby's ability to suck, swallow, breathe as well as the
breast glandular tissue changes. 

I've seen a mother 2 hours after another LC - and compared notes - you'd
think we were talking about totally different children!   

...and even if it isn't true that there have been changes - we can still
imply that there are different recommendations now, because she already
tried the set of #1 recommendations and now we go to set #2....

If you find that, in FACT (not because mother didn't hear/understand/clearly
state her problem) the previous person who saw her DID make a mistake - you
don't have to communicate that to the mother.  You can complete YOUR
evaluation, provide YOUR recommendations with rationale, and let HER decide
what recommendations work for her - without "cutting down" the previous
person.

Hopefully, you also develop a way, through a quick, informal phone call:
"you know, I just saw ____ and found that NOW I found ____." (after getting
a signed release from her, of course)  

Again, with a release, you can also communicate by a letter - but written in
such a way that it is sharing NEW information rather than implying
incompetence.

Remember for ALL situations - our criticism of others often reflects more
poorly on us than on those we criticize (how does she know you won't speak
badly of HER once she leaves?).  

Having lived in many different locations and had to prove myself competent
upon arrival AGAIN AND AGAIN I've learned that honey works better than
vinegar - and makes ME "smell" better too!

Jeanette Panchula, BSW, RN, PHN, IBCLC
California

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