Informed Consent: What is My Responsibility as a Lactation Consultant? – Reader Response

Doreen says:

August 1, 2011 at 10:35 pm (Edit)

I feel so alone in my profession and this will be a blessing! I have a question that I need help with. My manager at work, in a large hospital, told me that the nurses and physicians had a problem with “informed consent” when it came to breastfeeding. ie: we have mothers who state that they want to breast and bottle feed. I discuss the importance of getting a good milk supply started before introducing a bottle, always asking why. Most mothers state it is because they are going back to work, then I discuss this finding out when they go back, making a breastfeeding plan. The problem is that the nurses want to give bottles without informing the patients about possible consequences as they get their milk supply going for NON medical reasons ie: get sleep at night, second night feeding frenzie, etc. I feel it is my ethical responsibility as a RN and IBCLC to give “informed consent” (ie: information) because most mothers do not understand the consequences of bottles of formula in the first few days and I have made it clear that the nurses have that responsibility also. They do not like this. Any suggestions would be helpful as I have called a meeting of the managers next week. Thanks, Doreen 

Doreen, you raise an important issue for IBCLCs everywhere! 

To be clear:  the issue isn’t whether you “should” provide information and support to a breastfeeding mother, so she can make an informed decision about matters affecting her/her baby’s health.  Rather, the issue is “how” to effectively assist the mother, as her allied health care provider, in a work setting where other caregivers are offering conflicting or erroneous advice.   

ILCA’s recently-published monograph “Risks of Not Breastfeeding” concludes that “[e]xclusive breastfeeding is the normative standard for infant feeding.  Not breastfeeding increases infant and maternal acute and chronic illnesses….  The research demonstrates that there is a dose response to breastfeeding and human milk exposure for mothers and infants.  Healthcare professionals must be aware of the research and find ways to share this information with families so they can make responsible informed feeding decisions for their children.” (Spatz, D., & Lessen, R. (2011). Risks of not breastfeeding. (Monograph).  Morrisville, NC: International Lactation Consultant Association, p. 8)(emphasis added).   Your meeting with your managers is your opportunity to suggest that evidence-based practice is not being followed if non-medically-indicated use of formula is tolerated (and even promoted) by caregivers whose patients are breastfeeding mothers and babies.

You are the ideal healthcare professional to teach families (and colleagues) about human lactation. 

The IBLCE Scope of Practice, “encompassing the activities for which IBCLCs are educated and in which they are authorized to engage” (from the preamble; full IBLCE SOP at http://www.iblce.org/upload/downloads/ScopeOfPractice.pdf) anticipates that as allied health care providers we will advocate for the baby, the mother and the breastfeeding relationship.  It describes IBCLCs as having “specialized knowledge and clinical expertise in breastfeeding and human lactation.”  It describes the IBCLC duty to offer evidence-based information to help mothers meet their breastfeeding goals, and the duty to educate families and healthcare professionals about breastfeeding and human lactation.  Your ethical responsibility to inform, advocate, and educate is bolstered by the IBLCE Code of Ethics requiring, at tenet 11, that the IBCLC “provide sufficient information to enable clients to make informed decisions”  (http://www.iblce.org/upload/downloads/CodeOfEthics.pdf).

All health institutions and health care providers should support and assist breastfeeding families.  In the United States, advocating for breastfeeding as a public health imperative has received significant boosts from highly esteemed entities.  The U.S. Surgeon General’s Call to Action to Support Breastfeeding asks all health care providers, their institutions, employers, families and communities-at-large to support breastfeeding mothers.  (http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf).  This powerful document comes from the US federal government, but its call to action by the community at large is universal, and the concepts are applicable worldwide. 

The Centers for Disease Control recently issued their report concluding that US hospitals have a fairly dismal record when it comes to breastfeeding supportive practices. http://www.cdc.gov/vitalsigns/Breastfeeding/index.html.  And yet, the Joint Commission, which accredits hospitals in the US, now looks at exclusive breastmilk feeding as part of the Perinatal Care core measure set.  Because breastfeeding is the biologic norm, any (unexplained) deviation from it is seen as a deviation from best practices.  The United States Breastfeeding Committee has a toolkit to assist in the explanation and implementation of these core measures (http://www.usbreastfeeding.org/Portals/0/Publications/Implementing-TJC-Measure-EBMF-2010-USBC.pdf).

IBCLCs are specialists in a field that crosses several disciplines.  Our colleagues are not subject- matter-immersed in breastfeeding, as we are.  Use the meeting with your managers as your “toe in the door” to educate them: breastfeeding is the biologic norm and a public health imperative; hospitals can and should do a better job to support their breastfeeding patients, and this is a significant core measure that Joint Commission inspectors will be evaluating. And it is what the family wants and needs, to boot. 

Liz Brooks JD IBCLC FILCA

Liz Brooks is a lawyer, private practice lactation consultant and international speaker on legal and ethical matters affecting IBCLCs.

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5 Responses to Informed Consent: What is My Responsibility as a Lactation Consultant? – Reader Response

  1. Denise Bulpitt 16 August 2011 at 16:30 #

    Since TJC is now looking at exclusivity as a core measure, I am hoping more MCH professionals will get on board. I am currently in search of a patient handout describing WHY exclusivity is important, and written on a no more than 5th grade level. I need a handout to share with patients at a urban city hospital, most of which will be WIC users. Any help…suggestions..greatly appreciated.

  2. Liz Brooks 17 August 2011 at 11:38 #

    Denise — click the link in the original article to the US Breastfeeding Committee’s (truly excellent) Toolkit on The Joint Commission’s Perinatal Care core measure on exclusive breastfeeding. In the resources section of the Toolkit (p. 35), you can click through to the California Dept. of Public Health, which has some jaw-droppingly-good evidence-based materials on all manner of hospital-related policies and protocols for breastfeeding. Take a look at their “Sample patient handouts explaining why babies should be exclusively breastfed.” — Liz Brooks

  3. Kitty Phinney 17 August 2011 at 14:42 #

    I am so disillusioned I am not doing lactation any more. Managers telling staff that “a little bit of formula doesn’t matter” and to still report as “exclusive” for Baby Friendly discharge records. Other hospitals have policies not to teach finger feeding but remove baby from room while nurses force finger feed , giving baby no control of flow and discharging home with no knowledge of what to do. Nurses see this as a bother and don’t want assistance..

  4. Jayne Threlfall IBCLC 18 August 2011 at 10:05 #

    Dear Doreen, mangers are very concerned about patients satisfaction and letters of complaint. I am surprised that women are not complaining more when they find out that their baby has been given formula, I know I would have done. What if the baby has a cows milk allergy? the parents will have a good case to sue if they had not given informed consent.

  5. StorkStories 24 August 2011 at 13:31 #

    Thank you Liz for reminding me about the resources in that TOOLKIT! I agree Jayne about patient complaints. I think we don’t get as many because there is still a lack of education to the mainstream.

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