new IBLCE rules restrict services LCs can provide

[mamamagnolia]

An LC I know is furious, and rightly so. Here are the new regulations, pay special attention to that which is outside the scope of practice:

http://www.iblce.org/documents/IBCLC...ice_9-2006.pdf

So an LC can now lose her license for contradicting a doctor, diagnosing a problem (HEL-lo! Isn't this what they're for?), or recommending treatment.
Crazy.
Apparently the organization has received a lot of negative feedback. Well, lets give 'em more!
http://www.iblce.org/

[kJad29]

As an IBCLC in training, I do see where some of the "scopes of practice" may be a bit sticky. Basically, we don't diagnose. We inform the doctor/midwife/pediatrician of certain things. For example, if a mother and baby have thrush we inform them that we have seen plaques on the mouth and also the signs of thrush in the mom and send the mother back to their care provider for care and medication. We never tell a woman what to do in the case of using galactagogues like fenugreek or blessed thistle, but we do let them know that it may help and if they want to use it then this is what some moms do. Also, we provide information to give to doctors/midwives about certain things. Basically we can't tell a mom to go against the doc's advice. I know it's really a pain in the butt, but it's true. Basically, we give the mother suggestions on how to present evidence based information to the doc's since for the most part, they don't know much if anything about lactation.

Basically, we do help detect the problems surrounding breastfeeding and then keeping the docs in the loop, help them give better care to their patients. It's basically when we keep them in the know about their employer (the patient), they're more open to learning about lactation and how they can help their employer be successful. Also openly contradicting the physician will put the LC in a bad light and then LC's will have less credibility in the medical community. We have to be very careful with these things because if we lose our credibility with a physician, then they will not recommend their employers (the patients) to us when they really need the help. I read it and I understand how it really stinks, but we're allied health professionals, not doctors (though there are some MD's who have their IBCLC) and some us (like me) are not nurses so we have to be very professional when dealing with the doctors and nurses.

Basically we tell the mother and inform the doctor of what we have observed like the beginnings of a mastitis infection and tell her to keep an eye on it. We advise the mother to go to her doctor for the official diagnosis and treatment. That is well within the scope of practice. It's hard to be creative in these things, but this is how I was trained and it's a great way to get around the political BS.

[clovergirl]

wow. so let's say for ha-has a pediatrician tells a mom that she shouldn't be nursing a one month old baby more then once every 3hrs, and to use a pacifier in between if baby "wants to suck". as an IBCLC you're not able to say that's a load of crap?

[sapphire_chan]

Huh, so LCs are going the way doulas went. It's long past time for doctors to stop being worried about having their "perogatives" stepped on and to start worrying about actually getting a clue.

[My4Boys]

Originally Posted by kJad29

Basically we can't tell a mom to go against the doc's advice. I know it's really a pain in the butt, but it's true. Basically, we give the mother suggestions on how to present evidence based information to the doc's since for the most part, they don't know much if anything about lactation.

I read it and I understand how it really stinks, but we're allied health professionals, not doctors (though there are some MD's who have their IBCLC) and some us (like me) are not nurses so we have to be very professional when dealing with the doctors and nurses.

Basically we tell the mother and inform the doctor of what we have observed like the beginnings of a mastitis infection and tell her to keep an eye on it. We advise the mother to go to her doctor for the official diagnosis and treatment. That is well within the scope of practice.

The problem with the new scope of practice, the way it is written now, is that if a mother calls an IBCLC and says "I think I have thrush on my nipples. I read about thrush on LLL.org and I seem to have all of the sypmtoms. My doctor says there is no such thing as nipple thrush. What do you think?" you, as an IBCLC under the S of P as it is currently written, must concur with the doctor! You, as an IBCLC under the new S of P, can not sent a report to the doctor saying mom is experiencing symptoms consistant with thrush. You can not provide that doctor with the Academy of Breastfeeding Medicines protocall for treating thrush. You can not even provide the evidence based information about thrush to the mother becuase you would be contradicting the doctor. And THAT is what needs to be changed and quickly!!

As a LLLeader, you would have the right to present the mom with evidence based info and even the thrush protocalls. As a CLC, CBE, CBC, WIC peer counselor you would be able to provide this information. As the crazy breastfeeding lady of the neighborhood you could provide this information. But, under the new S of P, as an IBCLC you can not provide this info because it contradicts what the doctor has said.

IBCLE is supposed to be reviewing the new S of P. I still think they need input from breastfeeding moms as to how they feel about the level of care they may receive if the S of P remains worded as it is currently.

[velcromom]

Wow, that would mean that a mom who came in with the concerns I had with ds would not have been able to get the help I did.

I needed help figuring out the problem (dx), recommendations on what to do, and a report on her findings to take with me to our care provider in order to carry out those recommendations. The sheet she filled out and had me take to my care provider sure looked diagnostic to me, and was totally necessary.

Not to mention once we finally got an appt with the care provider he said "Humph, that couldn't be causing breastfeeding problems" - we really needed the expertise of the IBLC for our diagnosis, because he was clueless. Our nursing relationship may not have succeeded past that point if the IBCLC had been unable to dx.

I don't know how an IBCLC can avoid contradicting drs since she may be the first to see the mom, and has no idea what a dr will say. Our appt with the LC was weeks before the clueless dr disagreed with her recommendation. Not to mention he had no bf education and was flat out wrong.

[St. Margaret]

Whoo, that's NOT good. How incredibly... Orwellian, to say they can't contradict a doctor! Hello, we're all just individual humans... obviously "can't contradict" is severely limiting in how it actually applies, according to PP.

[smeep]

What? So basically what I'm going to be doing as a CLE will be the same as an IBCLC then? Because as a CLE I can't diagnose or treat, but I can educate to no end. Hmmm.

[smeep]

Originally Posted by My4Boys

As a LLLeader, you would have the right to present the mom with evidence based info and even the thrush protocalls. As a CLC, CBE, CBC, WIC peer counselor you would be able to provide this information. As the crazy breastfeeding lady of the neighborhood you could provide this information. But, under the new S of P, as an IBCLC you can not provide this info because it contradicts what the doctor has said.

Oh, okay. So now I can do MORE than an IBCLC?

[timneh_mom]

There are HUGE discussions right now on LACTNET (a mailing list for professionals) about the new scope of practice, apparently the IBCLE is reviewing it because of all the problems IBCLC's have with it. So hopefully it will be changing and revised very soon!

[My4Boys]

Originally Posted by smeep

What? So basically what I'm going to be doing as a CLE will be the same as an IBCLC then? Because as a CLE I can't diagnose or treat, but I can educate to no end. Hmmm.

Actually, as it stands right now, you can do more than an IBCLC because if a doctor has already given bad info you can contradict it and an IBCLC can not. The powers that be are supposed to be working on this though.

[kJad29]

Hi all,

Yeah, I understand what you're saying now. I was thinking in terms of just regular stuff. As allied health professionals, it is our duty to inform the mother that the Peds is WRONG in terms of limiting feeding and using formula feeding protocols on breastfed babies. Not cool. I'll have to write IBLCE to make sure that this doesn't go into effect. Countless numbers of women will suffer because we'll have to sit on our hands while the docs give mothers terrible advice. I personally feel that all OB's or at least all Ped's should become IBCLCs or have an intense study of the breastfed infant. Anyways, I'm off to write IBLCE to protest this. I basically feel that if I get my IBCLC and then can't practice as an expert in my field that my certification would be worthless. Thanks for clarifying it for me...

[Panserbjorne]

The way I understand it you also can't refer mothers for "alternative care." So when you discover a baby with improper tongue peristalsis you CAN'T mention it, and you also can't refer to a cranio sacral therapist. If a baby has clear physical trauma preventing him/her from nursing you can't refer to say, a chirpractor. If a doc says that a mama can't nurse because she has flat nipples you can't disagree and offer alternatives.

None of my kids could have nursed under these guidelines because no IBCLC would have been able to help them.

[Meiri]

If the docs are so worried about being contradicted, maybe they should get their collective heads out of their collective kiesters and learn the facts about breastfeeding rather than what the formula companies write into the medical textbooks. Medicine is supposed to be science-based, not opinion-based.

Having experienced the opinion-based crap, we find we much prefer science. Noticeably, the science-base docs we've had have all been supportive of breastfeeding...

[bri276]

:

yk, between the tremendously difficult requirements to become an ibclc and these new rules, and the crap advice I got from one when my boob was bleeding, I'm ready for a new, real, awesome LC organization. something slightly above L&D nurse who took one course on bf'ing, but not as incredibly intimidating as IBCLCs (not that the lcs themselves are intimidating- the organization itself in many ways is).

[spughy]

My regular doctor is a registered lactation consultant (I don't know if she's a member of IBCLC or not but something like that). She is wonderful. There ought to be more of her around. And regular family physicians should be obliged to refer women to doctors with specialties in breastfeeding if a woman indicates she's having bf'ing issues, the same way you would get a referral to a cardiologist in a heartbeat (har har!) if you mentioned you were having chest pains and shortness of breath.

[NCMommax2]

Ok, so I was considering become a CLE or LC-- can't get to IBCLC anytime soon. Will these rules apply to CLEs or LCs too? Or are they under another umbrella?

I remember when my DS was having HUGE nursing issues int he first week, we hired an IBCLC. She said that my son appeared to have some birth trauma causing him not to open his mouth wide enough and referred us to a cranial sacral therapist. From what I am reading here, if these rules stand, mothers who were in my position wouldnt get that advice? How terrible!

I really want to become a lactation specialist of some sort-- but if the IBCLEs keeps the rules the way they are, I am better off staying what I am now- the crazy BFing lady on the block! :

[paquerette]

Originally Posted by Meiri

If the docs are so worried about being contradicted, maybe they should get their collective heads out of their collective kiesters and learn the facts about breastfeeding rather than what the formula companies write into the medical textbooks.

:

I guess we need to be more proactive with getting doctors charged with malpractice or professionally sanctioned when they give out false advice. What else can we do?

[smeep]

Originally Posted by Meiri

If the docs are so worried about being contradicted, maybe they should get their collective heads out of their collective kiesters and learn the facts about breastfeeding rather than what the formula companies write into the medical textbooks. Medicine is supposed to be science-based, not opinion-based.

Having experienced the opinion-based crap, we find we much prefer science. Noticeably, the science-base docs we've had have all been supportive of breastfeeding...

You mean money-based. :

[smeep]

Originally Posted by NCMommax2

Ok, so I was considering become a CLE or LC-- can't get to IBCLC anytime soon. Will these rules apply to CLEs or LCs too? Or are they under another umbrella?

I'm currently working on my certification as a CLE. We cannot diagnose or dispense treatments, and we cannot give out medical advice, but we can give lots of education and do things like give them a mothering article on treating thrush, but can't tell them to do it that way. So we can lead them in t he right direction.