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Chapter 1
The Lactation
Consultant: Roles and
Responsibilities
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Elizabeth C. Brooks
GennaLLC
© Jones & Catherine
Bartlett Watson
Learning,
RebeccaOR
Mannel
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© Jones & Bartlett Learning, LLC
NOT FOR SALEAOR
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OR DISTRIBUTION
lactation consultant (LC) is a specialist trainedNOT
to FOR
Consultant
(ILCA), which publishes
focus on the needs and concerns of the breastfeeding the peer-reviewed Journal of Human Lactation and
mother–baby pair and to prevent, recognize, and other documents relating to lactation consultant
solve breastfeeding difficulties. LC services do not education and practice. In 1994, the Academy of
replace those ©
of Jones
other healthcare
workers;
instead, LLC
Breastfeeding Medicine, an©international
physician Learning, LLC
& Bartlett
Learning,
Jones & Bartlett
the LC is an NOT
extender
of maternal–child
services. organization, was formed. Its
official
journal,
BreastNOT
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OR DISTRIBUTION
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Lactation consultants work with the public in many feeding Medicine, also publishes peer-reviewed articles
settings: hospitals, clinics, private medical prac- and helpful clinical protocols. In addition, La Leche
tices, community health departments, home health League International and the Australian Breastfeedagencies, and private practices. Almost all lacta- ing Association publish professional materials that
© Jones
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LLCeducational teach and©support
Jonesthe&LC
Bartlett
Learning,
LLC
tion specialists
are women;
many have
as well as
patient/family
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and clinical backgrounds in the health professions information. This chapter traces the historical roots
or mother-to-mother support. Many are registered of lactation professionals and discusses work-related
nurses, although physicians, dietitians, speech ther- issues.
apists, and other health professionals practice as lactationLearning,
specialists asLLC
well. A growing interest in ©
theJones & Bartlett Learning, LLC
© Jones & Bartlett
History
profession is also attracting many candidates who
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study and work to enter directly into the lactation In a cultural setting in which nearly all mothers breastfed, help with breastfeeding was availconsulting field.
Lactation consulting is a rapidly growing health- able through the shared knowledge of other family
care specialty. Prior to recognition of the LC as a paid members, neighbors, and friends. As childbirth
© Jones
& Bartlett
Jones
& Bartlett
came to be managed by ©health
professionals
in Learning, LLC
specialist in 1985,
individuals
servingLearning,
breastfeed- LLC
hospital settings and formula-feeding
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OR DISTRIBUTION
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OR
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ing women did
so asFOR
volunteers
or as
unrecognized
practitioners. Over time, the lack of standardiza- cultural norm, however, knowledge of lactation—
tion of skills and minimal competencies prompted which a mother formerly shared with her daughters
formal development of the specialty practice. This or a sister with her younger siblings—was set aside
occurred&inBartlett
part through
a certification
examination or even lost.
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Learning,
LLC
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Thus, during the 1960s (at the nadir of breastadministered by the International Board of LactaNOT FOR SALE OR DISTRIBUTION
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tion Consultant Examiners (IBLCE), and through feeding) in the United States and shortly therethe establishment of the International Lactation after in other countries (such as Australia and
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3
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Bartlett Learning, LLC
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Learning,
LLC
4
Chapter
1: The
Lactation Consultant:©Roles
and
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Scandinavia), volunteer mother-to-mother breastmake a difference in breastfeeding outcomes? Ranfeeding support groups became a major source of
domized controlled trials of breastfeeding intervenassistance and information
how to Learning,
breasttions
conducted
in
© Jonesabout
& Bartlett
LLCworldwide, most of which
© were
Jones
& Bartlett
Learning, LLC
feed (Phillips, 1990). As the number of breastfeeddeveloped countries, that were published in a metaNOT FOR SALE OR DISTRIBUTION
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ing mothers increased, healthcare providers at first
analysis commissioned by the U.S. Preventive Serignored these groups; later they came to appreciate
vices Task Force (USPSTF) can be accessed at http://
them for the important role they played in helpwww.uspreventiveservicestaskforce.org/uspstf08
ing mothers and in forcing the medical profession
/breastfeeding/brfdartfig3txt.htm (USPSTF, 2008).
Joneslactation
& Bartlett
Learning,
© Jones breastfeeding
& Bartlett Learning,
to©consider
as a missing
piece LLC
of prenatal
In the meta-analysis,
promotion LLC
and
postpartum
care.
interventions NOT
significantly
increased
shortNOT FOR SALE OR DISTRIBUTION
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ORboth
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As these volunteers promoted the art of breastand long-term exclusive breastfeeding rates. In a
feeding, they also sought more knowledge of the
subgroup analysis, combining prenatal and postscience of lactation. La Leche League responded by
partum interventions had a greater effect on these
providingLearning,
research information
to its group lead- © Jones
rates, and
form of lay
or peer sup© Jones & Bartlett
LLC
& including
Bartlettsome
Learning,
LLC
ers, who serve as mother-to-mother helpers, and
port increased breastfeeding rates even more.
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by publishing a quarterly newsletter, Breastfeeding
In addition to this meta-analysis, a Cochrane
Abstracts, which focuses exclusively on the scientific
review—the “gold standard” of medical research—
literature. Through La Leche League’s professional
studied the effect of any extra support given to
liaison department, key individuals sought to culbreastfeeding women. Lay and professional support
© communication
Jones & Bartlett
LLC extended duration of ©breastfeeding,
Jones & Bartlett
Learning, LLC
tivate and maintain
links toLearning,
health
together
espeproviders in local NOT
communities.
cially that of exclusive breastfeeding
et al., OR DISTRIBUTION
NOT (Britton
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Out of this context, some experienced breastfeed2007). Face-to-face counseling (Figure 1-1) is the
ing support group members began to look beyond
most effective intervention in increasing not only
what they could accomplish as volunteers. Many of
exclusive breastfeeding rates but also the total durathese women sought to apply in a paid work setting
tion of breastfeeding (Albernaz et al., 2003; Andaya
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what they had learned from many years of helping
et al., 2012; Witt et al., 2012).
NOT
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breastfeeding mothers. In 1982, La Leche League
If the data from the randomized controlled triformed its Lactation Consultant Department. From
als included in the meta-analysis and Cochrane
this beginning grew the concept of the need for a
review were translated to healthcare costs saved by
new healthcare worker, and in 1985 the independent certification
board,LLC
IBLCE, was formed. Shortly © Jones & Bartlett Learning, LLC
© Jones & Bartlett
Learning,
1-1 Early Assistance
thereafter,
the
Journal
of Human Lactation (JHL) NOT Figure
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Promotes
Confidence.
began. Edited by Kathleen Auerbach from 1985 to
1996, by Jane Heinig from 1996 to 2012, and currently by Anne Merewood, JHL is peer reviewed,
professionally published, and cited on international
© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
indices with a competitive
Impact
Factor score
(BaiNOT FOR SALE OR DISTRIBUTION
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FOR
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OR DISTRIBUTION
ley, 2005; Journal of
Human
Lactation,
2013).
Do Lactation Consultants
Make a Difference?
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In
thisFOR
day ofSALE
cost containment
in health care,
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OR DISTRIBUTION
administrators want to know if lactation consultants are effective. Put simply, do interventions by
lactation specialists and other healthcare providers
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© United States Breastfeeding Committee
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9781449697280_CH01.indd 4
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& of
Bartlett
Learning,
© Jones & Bartlett Learning, LLC Certification: International
Board
Lactation
Consultant LLC
Examiners
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5
breastfeeding, the result would show that lactaScott and Smith assembled a small group of
tion services save the healthcare system enormous
breastfeeding experts who had come to the field
amounts of money
through
reduction
in
illnesses
in
of lactation consulting through
voluntary
service, Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
both baby and mother. When rates of breastfeeding
mostly through La Leche League. In 1984, these
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at hospital discharge were compared between faciliindividuals gathered at a conference and concluded
ties that employed certified lactation consultants
that legitimacy of the field would be heightened if
and those that did not, those having LCs had a 2.28
minimal standards of knowledge and skills were rectimes increase in the odds of breastfeeding at hospiognized through a certification examination. Subse© Jones
& Bartlett
LLCMedicaid,
Jones &panel
Bartlett
Learning,
LLC
tal discharge.
AmongLearning,
women receiving
quently, a©62-member
of experts
was recruited
there
was
a
4.13
increase
(Castrucci
et
al.,
2006).
and selected
to FOR
serve asSALE
the respondent
population
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NOT
OR DISTRIBUTION
Studies show that peer counselor interventions are
for the first practice analysis and to develop the first
also effective. Clearly, lactation services improve the
exam blueprint with the guidance of a psychomehealth of the United States, but we have yet to docutrician. The work of this expert panel represented a
mentLearning,
the extent of LLC
this effect in terms of money savbroad-based
practitioner
and professional
© Jones & Bartlett
© Jones
& Bartlett
Learning,
LLC assessment
ings. We do know the estimated cost to U.S. society
of practice in the emerging profession of lactation
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when medical recommendations for breastfeeding
consulting (Smith, personal communication, 2013).
are not met: $13.6 billion for 10 infant illnesses and
The first examination was administered in July
infections and 911 additional infant deaths per year
1985 by the IBLCE. Since 1985, a psychometri(Bartick & Reinhold, 2010). In terms of maternal
cally reviewed certification examination has been
Jones
Learning,
© Jones
& Bartlett
impact, 4981©excess
cases&ofBartlett
breast cancer,
13,946 LLC
given annually to applicants
who meet
eligibility Learning, LLC
heart attacks, NOT
and 53,847
of hypertension
are
criteria for education and clinical
training.
To date,
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OR DISTRIBUTION
FOR cases
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OR DISTRIBUTION
estimated to occur when these recommendations are
more than 26,000 candidates have been certified as
not met, compared to a cohort of 1.88 million U.S.
International Board Certified Lactation Consultants
women who optimally breastfed, leading to $17.4
(IBCLCs), the majority of whom live in Australia,
billion in costs to society resulting from premature
Canada, Japan, South Korea, and the United States.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
maternal deaths ­(Bartick et al., 2013).
Table 1-1 summarizes the number and regional
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Certification: International
Table 1-1 Number and
Board of Lactation Consultant
of IBCLCs
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Learning, LLC
© JonesDistribution
& Bartlett Learning,
LLC
Examiners
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NOT FOR SALE OR DISTRIBUTION Europe/
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© Jones & Bartlett Learning, LLC
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In 1981, experienced La Leche League leaders
Asia
Middle
JoAnne Scott and Linda Smith were asked to develop
World- Americas Pacific East
Year wide
Region
Region Region
a certification and training program for lactation
consultants. This need derived from (1) an aware2005 14,705 9305 © Jones
3184 & 2216
Jones &providers
Bartlett
Learning,
Bartlett Learning, LLC
ness that many©healthcare
discredited
the LLC
2006 15,726 9726
3083
2917
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NOT FOR
SALEbecause
OR DISTRIBUTION
value of the volunteer
counselor
she was
2007 17,026 10,229
3464
3333
unpaid, (2) a need to establish minimum standards
2008 18,032 10,554
3695
3783
for individuals who were already providing LC ser2009
21,200
11,903
4754
4543
vices for a fee, and (3) the need for a knowledgeable
2010 22,736 12,827
4843
5066
healthcare
team member
who wasLLC
responsible for
© Jones
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
2011
25,737
14,972
5076
5689
lactation
breastfeeding
care. A certification proNOT
FOR and
SALE
OR DISTRIBUTION
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2012 26,815 15,929
5047
5839
gram was viewed as a way to recognize the important role of the volunteer and to provide a credential
Data from International Board of Lactation Consultant Examiners
that identified knowledge and experience.
(IBLCE) www.iblce.org
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9781449697280_CH01.indd 5
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&Responsibilities
Bartlett Learning, LLC
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Learning,
LLC
6
Chapter
1: The
Lactation Consultant:©Roles
and
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distribution of completed IBLCE exams over 2005–
Association (ILCA) formed as the professional
2012 (IBCLE, 2013). In 2013, IBLCE administered
organization for IBCLCs and others supporting
the exam to 3660 ©
candidates
locations
across
the
member association’s mission
(ILCA,&2005).
Jonesin&945
Bartlett
Learning,
LLC
© Jones
Bartlett Learning, LLC
52 countries and territories in several languages.
ILCA has played a vital role in professional develNOT FOR SALE OR DISTRIBUTION
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Recertification as an IBCLC is required every
opment of the IBCLC and in promoting policies
5 years through the acquisition of continuing eduto protect and support breastfeeding, IBCLCs,
cation credits or reexamination, and every 10 years
and the IBCLC profession worldwide (Bailey,
by required reexamination. This dual-recertification
2005). ILCA arose primarily through the grass© Jones
& Bartlett
Learning,
LLC will
© Jones
& Bartlett
Learning,
option
increases
the likelihood
that the IBCLC
roots vision and
creativity
of its founding
mem- LLC
stay
current
in
knowledge
and
practice.
bers;
by
2013,
there
were
nearly
6000
individual
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The IBCLC is the only international certificamembers from 85 countries worldwide (Brooks,
tion in breastfeeding and human lactation, awarded
2013).
by an independently accredited organization. It
ILCA’s website is a rich and current source of
has been Learning,
accredited byLLC
the National Commission © Jones
information
and resources
of interest
to lactation
© Jones & Bartlett
& Bartlett
Learning,
LLC
for Certifying Agencies (NCCA) since 1988—a
professionals; many items are translated into sevNOT FOR SALE OR DISTRIBUTION
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mark of distinction for certification organizaeral languages. In addition, ILCA hosts an annual
tions (NCCA, 2013). IBLCE maintains a registry
international conference, serves as a nongovernmenof IBCLCs who are currently certified. Employers,
tal organization (NGO) in official relations with the
regulators, and the public, therefore, can confirm
World Health Organization (WHO), and publishes
& certified.
BartlettFor
Learning,
LLC
© JonesJournal
& Bartlett
Learning, LLC
that an individual©isJones
currently
more
the
peer-reviewed research periodical
of
information on IBCLC
go to
theDISTRIBUTION
InterHuman Lactation. Directories NOT
list IBLCE-certified
FOR SALE OR DISTRIBUTION
NOTcertification,
FOR SALE
OR
national Board of Lactation Consultant Examiners’
ILCA members who (1) provide lactation care to
website at www.iblce.org.
mothers (searchable by location, anywhere in the
Certification—a process by which an individual
world), (2) offer support to employers/workplaces
demonstrates advanced knowledge and/or experience
with breastfeeding employees, and (3) are speak© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
in a specialty—is especially popular in the United
ers/writers for educational or conference settings
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FOR
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States. More than 40 specialty certifications exist
(ILCA, home page, n.d.).
in the field of nursing alone, despite the fact that
In addition to individual members, ILCA has
affiliates organized primarily by country, focusing
­certification is a voluntary credential. Certified nurses
on IBCLC issues of particular geopolitical interest.
and healthcare workers from across a wide variety of
For example,
the United
States Lactation
specialtiesLearning,
consistently LLC
place a high value on certifi- © Jones
© Jones & Bartlett
& Bartlett
Learning,
LLC Consultant
Association
(USLCA)
is
the
professional
cation
(Niebuhr
&
Biel,
2007).
Nurses
in
the
United
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION organization for ILCA members living in the United
States and Canada who earned certification in a
States; it publishes the journal Clinical Lactation.
­specialty area report feeling more confident and experiencing fewer errors in patient care since they were
The Canadian Lactation Consultant Association
and the Lactation Consultants of Australia and New
certified; thus certification may be a marker for excelJones& &
Bartlett
Learning,Zealand
LLC represent the interests ©
Jones
& Bartlett
Learning, LLC
of ILCA
members
in
lence (Cary, 2000; ©
Raudonis
Anderson,
2002).
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those countries.
Professional Association:
International Lactation
© Jones & Bartlett
Learning, LLC
Consultant
Association
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About the same time that IBLCE certification
began, the International Lactation Consultant
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Gaining Clinical Experience
IBLCE certification
requires
a considerable
number LLC
© Jones
& Bartlett
Learning,
of clinical hours
in
direct
care
of
the
breastfeedNOT FOR SALE OR DISTRIBUTION
ing dyad: from 300 to 1000 clinical hours, preferably supervised by an experienced IBCLC. For
© Jones & Bartlett Learning, LLC
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9781449697280_CH01.indd 6
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Learning,
Gaining
Clinical LLC
Experience
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7
specific criteria on qualifying under the IBLCE
Not everyone who desires to work as a lactaPathways, go to http://iblce.org/certify/preparing
tion consultant wishes to become a nurse or other
-for-ibclc-certification/.
type of health professional.©Thus
Pathway
2 covers Learning, LLC
© Jones & Bartlett Learning, LLC
Jones
& Bartlett
A healthcare professional who needs clinical
direct-entry applicants who are in an academic lacNOT FOR SALE OR DISTRIBUTION
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hours to qualify to take the IBLCE certification
tation program that includes the required clinical
examination under Pathway 1 should seek out a
training. Pathway 3 covers direct-entry applicants
job where he or she will work with breastfeeding
who come from other backgrounds, meet the edu­mothers. Working on a mother–baby unit in a hoscational requirements, and acquire their clinical
© Jones
Learning,
LLCare examJones
& arrangement
Bartlett Learning,
pital or &
in Bartlett
a community
clinic setting
experience©in
a formal
supervised LLC
by
ples.
Other
candidates
for
Pathway
1
come
from
a
experienced
IBCLCs.
of OR
theseDISTRIBUTION
arrangements
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NOT
FOR Some
SALE
mother-to-mother support background, meet the
are available at local hospitals or community seteducation requirements, and have acquired ­clinical
tings or with IBCLCs in private practice. Box 1-1
experience through peer mentoring. Examples
provides general guidelines on mentoring lactainclude
La Leche League
tion&consultants,
available on LLC
the ILCA website
© Jones & Bartlett
Learning,
LLC leaders, Australian Breast© Jones
Bartlett Learning,
feeding Association counselors, and peer counselors
along with numerous other documents for clinical
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
in the U.S. federal Women, Infants, and Children
training programs: http://www.ilca.org/i4a/pages
(WIC) program.
/index.cfm?pageid=3488.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
NOTBox
FOR
OR DISTRIBUTION
1-1SALE
Mentoring
and Precepting Lactation Consultants
Desired Qualities of a Mentor/Preceptor
• Acts as a role model and advocate
• Has leadership experience
© Jones•&IsBartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
available and responsive
NOT FOR
SALE
OR
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
• Is willing to share expertise and insight
• Believes in the capabilities of the mentee/intern
• Motivates, supports, and enhances the mentee’s/intern’s development
• Has vision
• Is currentLLC
in the knowledge of the field© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning,
• Knows how to access professional networks
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
• Seeks to enhance political awareness
Desired Qualities of a Mentee/Intern
•
•
•
•
•
•
•
Has a desire to learn
Has©
a capacity
constructive
feedback
and coaching
Jonesto&accept
Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
HasNOT
an ability
to
identify
personal
and
professional
career
goals
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Has a willingness to take risks
Exhibits a desire for professional success
Seeks challenging assignments and new responsibilities
Actively seeks the advice and counsel of an experienced mentor/preceptor
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
Source:
Modified
from
Lauwers,
J.
Mentoring
and
Precepting
Lactation
Consultants,
International
Lactation
Consultant
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
ORAssociation:
DISTRIBUTION
http://www.ilca.org/i4a/pages/index.cfm?pageid=3488
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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9781449697280_CH01.indd 7
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Jones
&Responsibilities
Bartlett Learning, LLC
© Jones & Bartlett
Learning,
LLC
8
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
(e.g., Association of Women’s Health, Obstetric
Lactation Consultant
and Neonatal Nurses [AWHONN], 2008; also see
Education © Jones & Bartlett Learning,United
Committee
LLC States Breastfeeding ©
Jones &[USBC]
Bartlett Learning, LLC
website http://www.usbreastfeeding.org/HealthCare
Because the IBCLC
certification
is relatively
new
NOT FOR SALE OR DISTRIBUTION
NOT
FOR SALE
OR DISTRIBUTION
/TrainingforHealthCareProfessionals/tabid/96
(established in 1985), formalized lactation educa/Default.aspx for listing of several sources of healthcare
tion programs, with approved curricula offered by
professional training). Mothers will have timely access
independently accredited institutions of higher
to IBCLCs when needed—for example, in highereducation, are not yet widely available. The Lac©
Jones
&
Bartlett
Learning,
LLC
© Jones
Bartlettwill
Learning,
acuity situations
(Mannel, &
2011)—and
also have LLC
tation Education Approval and Accreditation
community
support
from
experienced
breastfeeding
NOT FOR
SALE(LEAARC)
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Review
Committee
provides approval
mothers,
such
as La Leche League leaders.
for individual short-term courses and classes on
breastfeeding management and formulates recommendations to the Commission on Accreditation of
Hospital
Lactation Programs
Allied Health
Education
Programs (CAAHEP) for © Jones
© Jones & Bartlett
Learning,
LLC
& Bartlett Learning, LLC
accreditation
of an academic program (LEAARC, NOT
A New
stateOR
law DISTRIBUTION
mandated in 1984 that any
NOT FOR SALE
OR DISTRIBUTION
FORYork
SALE
n.d.). LEAARC approval of short-term courses
institution providing care for new mothers and
serves as a “reliable indicator of educational quality
babies had to have at least one person on staff who
to employers, insurers, counselors, educators, govwas designated to serve as a resource for other staff
ernmental officials, and the public” (LEAARC, n.d.,
members and to provide breastfeeding assistance to
Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
para. 2). LEAARC©also
has developed
Standards
and
patients. The need for skilled lactation support in
NOT
FOR
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FOR
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OR
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Guidelines for the Accreditation of Lactation Education
the hospital during the perinatal
period
and SALE
for any OR DISTRIBUTION
Programs, available at www.leaarc.org.
other hospital admission of a breastfeeding mother or
Healthcare providers seeking to learn more
child has been recognized by many healthcare orgaabout supporting breastfeeding families in their
nizations including the World Health Organization
care
can
seek
out
the
many
other
short-term
courses
(2003), the U.S.
Department
of Health Learning,
and Human LLC
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© Jones
& Bartlett
in
breastfeeding
management
that
are
available.
For
Services (2011),
the European
UnionOR
(EUDISTRIBUTION
Project on
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NOT
FOR SALE
example, facilities seeking designation under the
Promotion of Breastfeeding in Europe, 2004), and
Baby-Friendly Hospital Initiative (BFHI) require
the Australian Health Ministers’ Conference (2009).
all healthcare workers in maternal–child health to
The 1990s could be characterized as the decade
take a 20-hour course in basic breastfeeding manfor widespread emergence of breastfeeding pro© Jones & Bartlett
LLC 2009). Short-term © Jones
& Bartlett
Learning,
LLC
agement Learning,
(WHO & UNICEF,
grams and
clinics (Figure
1-2). Only
a small numcourses
mayDISTRIBUTION
also be taken by those individuals seek- NOT
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OR
SALE
DISTRIBUTION
berFOR
of hospitals
in OR
the United
States had a lactation
ing to provide mother-to-mother support, such as
program in the early 1990s, but over the past two
WIC peer counselors trained by the U.S. Departdecades lactation programs have proliferated rapment of Agriculture Food and Nutrition Service’s
idly. Today, most hospitals and birth centers have
Special Supplemental
Nutrition
Program
for
© Jones & Bartlett Learning,lactation
LLC services staffed by©certified
Jones lactation
& Bartlett Learning, LLC
Women, Infants and Children (WIC) (U.S. Departspecialists,
who
have
thus
grown
in
numbers
and OR DISTRIBUTION
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ment of Agriculture, n.d.). In addition, IBCLC
visibility (Figure 1-3). Although some lactation
aspirants seeking to meet IBLCE examination
expertise has long been integrated into midwifery
requirements in lactation-specific education may
practice in countries where midwives predominate,
seek out excellent short-term courses offering eviIBCLCs are now available in many countries.
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Bartletton
Learning,
LLC
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dence-based
information
breastfeeding
support.
Ideally,
every
woman
birth will receive
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ORgiving
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Developing
a Hospital
Lactation
timely and appropriate lactation care delivered by
Service
qualified providers. Clinicians and nurses workProviding quality lactation and breastfeeding care
ing in maternal–child health will have education
is an essential part of a hospital’s maternal–newborn
and training in basic breastfeeding management
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9
a quality core measure on exclusive breastfeeding
that hospitals with greater than 1100 births per year
Figure 1-2 Breastfeeding Clinic.
will be required to report ©
beginning
(TJC, Learning, LLC
© Jones & Bartlett Learning, LLC
Jonesin&2014
Bartlett
2013). The European Union’s Blueprint for Action
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on Breastfeeding (EU Project of Promotion of Breastfeeding in Europe, 2004) expects all mothers to have
affordable access to qualified lactation consultants.
ILCA and IBLCE now award recognition to hospitals
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Bartlett
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and community-based
thatLearning,
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and provide
training
breastfeeding
management
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for other healthcare professionals. For a list of organizations that have received the IBCLC Care Award
or for more information on the criteria, go to http://
www.ibclccare.org/.
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A key element in quality hospital lactation care
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is appropriate policy development and staff training. IBCLCs are ideally suited to work with a hos© ILCA eGlobe
pital’s leadership team to develop evidence-based
policies and education for nursing staff, including
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clinical competencies. Hospitals
are&particularly
Figure 1-3 Hospital Lactation
concerned with patient safety
andFOR
risk management
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Service.
issues, both of which are increased when inadequate
lactation care is provided, especially in high-acuity
lactation situations (Table 1-2). Identifying mothers and children who are at higher risk for poor
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cate appropriate resources in a more timely fashion
(Mannel, 2011, 2013).
Department heads particularly critical to securing support for a lactation program include the
director
of maternity
nursing LLC
(who may oversee
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and
delivery,
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care, and someNOT FOR SALE OR DISTRIBUTION
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times the intensive care nursery), the director of the
pediatric unit, and the chairman or medical direc© Monkey Business Images/ShutterStock, Inc.
tor for obstetrics, pediatrics, and family medicine.
If the institution has a midwifery service, the sup© Jones Hospital
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service.The Baby-Friendly
Initiative
provides LLC
port of its director should also
be sought.
NOT figures
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NOTguidelines
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ORhospital
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the evidence-based
for ­quality
care
Physicians remain influential
in the hos(WHO, 1998), and Baby-Friendly desi­gnated hospipital, although their power has diminished since
tals demonstrate improved breast­feeding outcomes
the adoption of managed care; therefore, maintainacross all racial and ethnic groups. (DiGirolamo,
ing positive relations with physicians is critical
Grummer-Strawn,
&
Fein,
2008).
The
U.S.
Surgeon
for LCs. Even
with managed
care,Learning,
the physicianLLC
as
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© Jones
& Bartlett
General’s
Call
to
Action
to
Support
Breastfeeding
“gatekeeper”
plays
a
major
role
in
the
fiscal
health
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compels the healthcare system to ensure that materof a hospital. If the physician’s patients do not want
nity care practices are supportive of breastfeeding
to go to a particular hospital because it lacks cerand to provide access to IBCLC services. The Joint
tain amenities––such as a lactation service––the
Commission (TJC) in the United States has adopted
birthing service administrator, with the backing of
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Learning,
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10
Chapter
1: The
Lactation Consultant:©Roles
and
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Table 1-2 Lactation Acuity Levels for Determining Lactation Resources
© Level
Jones
& Bartlett
Learning,
LLC
© Jones
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I acuity
patients can
be cared for
by nursing staff who have basic
breastfeeding
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Acuity Level I NOT
knowledge
and competency.
Maternal
Characteristics
Basic breastfeeding education, routine management
Latch/milk transfer appear optimal
Maternal decision to routinely supplement
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Learning, LLC
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Maternal decision to pump and feed expressed breastmilk (EBM)
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Maternal indecision regarding breastfeeding
Mother can latch baby with minimal assistance
Multiparous mother with healthy term baby and prior breastfeeding experience
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LLC
© Jones
& Bartlett
Acuity Level
II
Level
II acuity patients should be cared
for by RLC
staff as soonLearning,
as possible, orLLC
referral made
to RLCs in the community. Early follow-up
after discharge
is critical.
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DISTRIBUTION
Maternal
Characteristics
Antenatal admission with increased risk of preterm delivery
Cesarean section delivery
Delayed breastfeeding initiation (defined as after 1 hour with routine vaginal delivery and
© after
Jones
& with
Bartlett
LLC
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2 hours
routineLearning,
cesarean section)
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Maternal acute illnesses/conditions (e.g., preeclampsia, cardiomyopathy, postpartum
depression, postpartum hemorrhage)
Maternal age (mother < 18 years or > 35 years)
Maternal chronic conditions (e.g., rheumatoid arthritis, systemic lupus erythematosus,
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LLC of gastric bypass, obesity)© Jones & Bartlett Learning, LLC
hypertension,
cancer, history
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OR DISTRIBUTION
Maternal cognitive impairment (e.g., mental retardation,
Down
syndrome,
Maternal endocrine disorders (e.g., polycystic ovary syndrome, infertility, thyroid disorders,
diabetes)
Maternal medication concerns
Maternal
palsy, visual
impairment,
psychiatric)
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& Bartlett
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Maternal readmission (breastfeedingNOT
well established/noncritical
issues)
Maternal request
Multiparous mother with history of breastfeeding difficulty
Primiparous mother or first-time breastfeeding mother with healthy term baby
©Social/cultural
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issues (e.g.,Learning,
communication
barriers, domestic/sexual abuse)
Infant
Characteristics
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Consistent LATCH score < 6 at day of discharge
Breastfeeding Assessment Score ≤ 5
Latch difficulties (e.g., pain)
Infant readmission (breastfeeding well established/noncritical issues)
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Newborn
birth
trauma
(e.g.,
cephalohematoma,
shoulder
dystocia)
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Suboptimal/inadequate milk transfer leading to medical recommendation to supplement
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Programs
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11
Table 1-2 Lactation Acuity Levels for Determining Lactation Resources
(continued
)
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
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FORIIISALE
OR DISTRIBUTION
Acuity Level NOT
III
Level
acuity patients
need to be cared for by RLC staff while in hospital.
These patients
will require in-depth assessment and ongoing management. Early follow-up after discharge is
critical.
Maternal
Abscess/mastitis
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& BartlettHigh
Learning,
LLC
Characteristics
maternal anxiety
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Induced lactation
Maternal breast conditions (e.g., breast/nipple anomalies, glandular insufficiency, history of
breast surgery)
Maternal illness/surgery
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Maternal readmission (breastfeeding not well established and/or critical issues)
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Pathologic engorgement
Infant
Characteristics
High-risk infant on mother–baby unit (e.g., late preterm, small or large for gestational age,
multiple gestation)
Hyperbilirubinemia
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NOT Hypoglycemia
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Infant admission to neonatal intensive care unit
Infant congenital anomalies
Infant illness/surgery
oral/motorLLC
dysfunction (e.g., tight frenulum,
hypotonia,&orBartlett
hypertonia)Learning, LLC
© Jones & BartlettInfant
Learning,
© Jones
Infant
readmission (breastfeeding not well established
issues)
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NOTand/or
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Infant weight loss > 7% of birth weight before discharge
Note: Acuity levels can change based upon assessment by the RLC or other healthcare team members.
Source: Modified from Mannel, R. J Hum Lact. 2011; 27, 163–170. Defining lactation acuity to improve patient safety and outcomes.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
physicians,
may
create
such
a
program
rather
than
employees,
such
a special place where employNOT FOR SALE OR DISTRIBUTION
NOT FOR
SALE
ORasDISTRIBUTION
lose patients to a competing institution. Supportees returning to work after the birth of a baby can
ive physicians are more likely to be mothers who
express milk or nurse their babies during work hours
breastfed, fathers of breastfed children, those build(Dodgson & Duckett, 1997). Many countries are now
ing a new practice, and those from countries where
requiring employers to provide support for working
©
Jones
&
Bartlett
Learning,
LLC
© JonesLabour
& Bartlett
breastfeeding is the norm.
breastfeeding mothers (International
Office, Learning, LLC
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NOT has
FOR
DISTRIBUTION
If the institution
an SALE
employeeOR
health
service
2010; U.S. Department of NOT
Labor, 2010).
or a women’s health clinic, their supervisors should
Resources
be informed of the proposal and asked for their supDetermining the resources needed for a ­
quality
port. Written proposals or documents that highlight
lactation ©program
on the
level of serhow the &
new
program Learning,
will assist andLLC
support the ser© Jones
Bartlett
Jones depends
& Bartlett
Learning,
LLC
vice
provided
by
the
hospital
in
other
areas
vices
that
are
already
being
provided
will
help
ensure
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­(Mannel & Mannel, 2006) and the goals of the lactheir acceptance. For example, the head of employee
tation services. For example, does the hospital have
health may be particularly interested in learning
a neonatal intensive care unit, provide high-risk
that the lactation program will include services to
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12
Chapter
1: The
Lactation Consultant:©Roles
and
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demand for their services, they saw each breastfeeding mother once, and again only if there was
Figure 1-4 Outpatient
referral. In an effort to meet©patient
needs,
it is
Breastfeeding
Clinic.
© Jones & Bartlett Learning,a LLC
Jones
& Bartlett
Learning, LLC
not uncommon for LCs to volunteer additional time
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for which they are unpaid. Heinig (1998) addressed
this issue as “closet consulting,” warning that when
the caseload is invisible to the employer, the LC’s
professional time is undervalued and may result in
© Jones & Bartlett Learning, LLC
further limits©
onJones
LC time.& Bartlett Learning, LLC
The two reports
reliedDISTRIBUTION
on “eduNOT FOR SALE OR DISTRIBUTION
NOT cited
FORpreviously
SALE OR
cated guesses.” Mannel and Mannel (2006) collected
data from the lactation program’s productivity reports
at a tertiary care teaching hospital (4200 births per
year). They
measured Learning,
actual hours LLC
worked by LCs
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
over a 2-year period, allocated the hours to their
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respective activities, and developed ratios for optimal
Source: © Addie Imseis
IBCLC staffing for each component of service. Optimal IBCLC staffing was calculated as follows:
• Mother–baby inpatient care requires 1 FTE
antepartum care, or have inpatient pediatric units?
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Jones
&
Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
per 783 breastfeeding couplets.
Does the hospital want a lactation service that
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OR
DISTRIBUTION
• Neonatal intensive careNOT
unit (NICU)
inpa- OR DISTRIBUTION
provides telephone follow-up, outpatient care, or
tient care requires 1 FTE per 235 infant
prenatal education (see Figure 1-4)? All of these
admissions.
services need to be factored into the equation when
• Mother–baby outpatient care requires 1 FTE
determining the necessary resources.
per 1292
couplets Learning,
discharged. LLC
Jan
Riordan
has
estimated
three
visits
(one
© Jones & Bartlett Learning, LLC
© breastfeeding
Jones & Bartlett
•
NICU
outpatient
care
requires
FTE per
20-minute
initial
visit
and
two
15-minute
followNOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR 1DISTRIBUTION
818
breastfeeding
infants
discharged.
ups) from a lactation consultant are needed, for a
• Telephone follow-up requires 1 FTE per 3915
total of 50 minutes per dyad per day. Given these
breastfeeding couplets or infants discharged.
numbers, a lactation specialist would spend at least 8
• Education requires 0.1 FTE per 1000
hours each day to see 9 dyads on a mother–baby unit.
© Jones & Bartlett
Learning,
LLC
& Bartlett Learning, LLC
This figure
does not take
into account time spent © Jonesdeliveries.
• Program
and administration
charting,
lunch, meetings, planning, and so NOT FOR
NOT FOR SALE
ORhaving
DISTRIBUTION
SALEdevelopment
OR DISTRIBUTION
requires 0.1 FTE per 1000 deliveries.
on. Daily rounds on breastfeeding women may be
• Research requires 0.1 to 0.2 FTE total.
feasible in a hospital in which the LC sees fewer than
9 patients per day; it may not be feasible if more than
Using these ratios, IBCLC staffing needs can be
9 breastfeeding mothers are housed in the maternity
calculated
© Jones & Bartlett Learning, LLC for hospital staffing according
© Jonesto&number
Bartlett Learning, LLC
unit on a given day––unless there is more than one
of deliveries (Box 1-2). All three hospitals have inpaNOT FOR SALE OR DISTRIBUTION
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specialist in the service or staff members providing
tient service, follow-up telephone service and eduother care are trained to provide optimal lactationcation, administration, and research. Table 1-3 is a
related care as well, thus reserving the LC for mothers
calculation of the staffing needs for a hospital with
and babies needing additional help and as a resource
3000 births per year using the Mannel and Mannel
© the
Jones
& Bartlett
Learning,
& Bartlett
Learning,
for
staff (Angeron
& Riordan,
2007).LLC
(2006) model.©A Jones
similar table
for hospitals
with 1000 LLC
Another
author
reported
2.6 full-time equivalent
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FOR
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NOT
FOR
OR
DISTRIBUTION
and 6000 births
per year
canSALE
be found
in their
article
(FTE) LC positions (about 90 hours) were required
in the Journal of Human Lactation. These data were
for a hospital with 1600 deliveries (Hinson, 2000).
utilized in the staffing recommendations released by
These lactation consultants saw each breastfeeding
the USLCA (2010) and the Association of Women’s
mother every day but later, to keep up with the
Health, Obstetric
and Learning,
Neonatal Nurses
(2010).
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© Jones
& Bartlett
LLC
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Programs
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13
Box 1-2 IBCLC Staffing Guidelines from the United States Lactation Consultant
Association
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LLC
© Jones & Bartlett Learning, LLC
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Hospital with Level I Neonatal Service
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The hospital with level I neonatal service would require 1.3 FTEs per 1000 deliveries per year for the
inpatient setting. To include the breastfeeding rate in this calculation, multiply the FTEs calculated
times&the
percentage
of breastfeeding
© Jones
Bartlett
Learning,
LLCmothers in that facility.© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Hospital with Level II Neonatal Service
The hospital with level II neonatal service would require 1.6 FTEs per 1000 deliveries per year for the
inpatient setting. To include the breastfeeding rate in this calculation, multiply the FTEs calculated
times the percentage of breastfeeding mothers in that facility.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
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DISTRIBUTION
NOT FOR
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Hospital with Level III (Tertiary Care) Neonatal
Service
Based on the standard of a 20% preterm delivery rate (Mannel & Mannel, 2006), the tertiary care
facility would require 1.9 FTEs per 1000 deliveries per year for the inpatient setting. To include the
breastfeeding rate in this calculation, multiply the FTEs calculated times the percentage of breast© Jones
&facility.
Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
feeding mothers
in that
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Source: Reproduced from United States Lactation Consultant Association IBCLC Staffing Recommendations.
http://www.ilca.org/files/USLCA/Resources/Publications/IBCLC_Staffing_Recommendations_July_2010.pdf
© Jones
& Bartlett
Learning, LLC
Managing
a Hospital
NOT
FOR
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OR
Lactation ServiceDISTRIBUTION
consultant
This type
of environ© (Spatz,
Jones2010).
& Bartlett
Learning,
LLC
ment is not
effective
As Spatz
(2010, p. 500)
NOT
FOReither.
SALE
OR DISTRIBUTION
said, “Educated nurses should be the first level of
intervention for all breastfeeding women and their
A quality lactation service requires dedicated posiinfants. If this occurred in all institutions, the burtions for lactation consultants to ensure timely
den on the LC would decrease, and the LC could
access to care. Some hospitals hire only IBCLCs who
© Jones & Bartlett
Learning,
LLC
© Jones
Bartlett
LLC
focus& on
complexLearning,
breastfeeding
cases. Educated
are also
RNs and plan
to use them in nursing staffNOT FOR SALEing.
ORWhen
DISTRIBUTION
NOT FOR
OR DISTRIBUTION
nursesSALE
can change
institutional and community
it is not busy in labor and delivery, then
breastfeeding cultures.”
the IBCLC/RN can “do lactation.” Unfortunately,
In 2010, Mannel described an effective lactation
this type of service leads to inconsistent access to
service where the IBCLCs make lactation rounds
care and increases risk management concerns. When
each morning to identify
high-acuity
patients, Learning, LLC
census is higher
and no &
lactation
consultants
are LLC
© Jones
Bartlett
Learning,
© Jones
& Bartlett
using a daily lactation census
and FOR
scripted
rounding
available, mothers
moreSALE
likely toOR
be discharged
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OR DISTRIBUTION
NOTareFOR
DISTRIBUTION
­questions (see Box 1-3). Low-acuity breastfeeding
with inadequate knowledge of breastfeeding mancouplets (level I) are managed by nursing staff, all
agement or even knowledge of how to identify if
of whom have training in basic breastfeeding mantheir baby is feeding adequately (Centers for Disagement. The IBCLCs are then able to focus more
ease Control and Prevention [CDC], 2011; Mar© Jones
& Bartlett
Learning,
Jones
& Bartlett
Learning,
LLC
effectively©on
higher-acuity
breastfeeding
couplets/
tens, Derksen,
& Gupta,
2004; PaulLLC
et al., 2006).
NOT In
FOR
SALE
OR DISTRIBUTION
SALE
DISTRIBUTION
patients NOT
(level IIFOR
or III).
This OR
system
represents a
other
hospitals
that have dedicated lactachange from the hospital’s previous method of relytion positions, nursing staff may stop providing
ing only on referrals from physicians, nurses, and
basic breastfeeding care based on their belief that
patients—a common practice in many hospitals.
all breastfeeding care is handled by the lactation
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Bartlett Learning, LLC
© Jones & Bartlett
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14
Chapter
1: The
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Table 1-3 Breakdown of Staffing for Hospital Lactation Program
with 3,000 ©
Births
Year Learning, LLC
Jonesper
& Bartlett
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Approx. number of births/yr = 3000 (68% initiate breastfeeding)
Approx. number of NICU admissions/yr = 400 (85% initiate breastfeeding)
One FTE =
1900 work hours (excluding vacations, sick days, etc.)
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1292 hours direct consult time
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608 hours indirect clinical time
FTE ratio is number of available direct consult work hours divided by the amount of hours per dyad.
For example, 1292 hours/FTE divided by 1.65 hrs of direct consult with each dyad = 783 dyads per LC FTE.
2040 births (68% breastfeeding of 3000) divided by 783 = the number of LC FTEs that are needed for direct
Bartlett
Learning, LLC
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consult inpatient care.
© Jones &
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Category
FTE Ratio
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Calculation
3000 × .68 = 2040
120 couples
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120 hours
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(1 hr each)
Telephone
1:3915
3000 × .60
NICU inpatient
1:235
400 × .85
85% initiate BF
©Education
Jones & Bartlett0.1:1000
Learning, LLC3000 × .68
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FOR
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Program
admin
0.1:1000
3000 × .68
Research/QA
0.2:1000
3000 × .68
Total
Inpatient
Outpatient
1:783
1:1292
Number
FTEs
2040/783 =
1292/120 =
2.6
0.1
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1800/3915 =
340/235 =
0.45
1.44
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2040/1000
0.2
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2040/1000 =
0.2
2040/1000 =
0.4
about 5.4
Source: Adapted from Mannel R, Mannel RS. Staffing for hospital lactation programs: recommendations from a tertiary care teaching hospital.
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Box 1-3 Lactation Rounding Script for the Lactation Consultant
Introduction
“Hi,
Jones, I’m
Paula, one ofLLC
the registered lactation consultants
here at & Bartlett Learning, LLC
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&Ms.
Bartlett
Learning,
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OUMC
and
I’ll
just
be
in
here
for
one
or
two
minutes.
I’m
checking
on
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FOR
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new moms to see who is breastfeeding or wanting to breastfeed and who might
need some extra help from us. Were you planning to breastfeed?” [or: “I see you’ve
been doing some breastfeeding already…”]
Mother says,
“I’m
“Well, you have
a great nurse to help you with©that.
You know,
your bodyLearning,
will
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bottle-feeding”
still make milk to feed your baby so you will have some breast fullness in 1–2
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You can apply ice packs and take acetaminophen or ibuprofen if the swelling
(i.e., exclusively
formula-feeding)
gets uncomfortable. It should get better in a couple of days. Here’s one of our
brochures in case you ever need to call us.”
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Learning,
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and Responsibilities
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Mother says, “I’m
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breastfeeding”
15
“Great, then I have just a few quick questions to help us decide who might need a
&visit
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from us Learning,
later today…” LLC
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Questions for
breastfeeding mothers
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“Is this your first baby?”
If multiparous: “Have you breastfed any of your others?”
“Have you had to give any formula?” (i.e., Has her baby been EBF so far?)
“Have youLLC
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your baby
is nursing?”Learning,
If yes, rate
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Results from rounding and identifying high-acuity
unusually sensitive. Healthcare workers assisting
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patients have improved quality of care, lactation
breastfeeding families must be especially intuitive,
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ORproductivity,
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the FOR
caringSALE
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andDISTRIBUTION
advisors. For more information
lactation team. As one IBCLC said, “Rounds make
on communication and counseling skills, see other
us more efficient … I know where to start.” This
sources such as Lauwers and Swisher’s (2010) Counmodel has been adopted by many hospital lactation
seling the Nursing Mother: A Lactation Consultant’s
Jonesin&ILCA’s
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programs. © Jones & Bartlett Learning, LLC
Guide or Lauwers’s (2012)©chapter
Core Learning, LLC
Curriculum for Lactation Consultant
Practice.
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The Unique Characteristics
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Women
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Roles and Responsibilities
The LC is responsible to the mothers she sees to pro© Jones
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ate assistance. Quality practice and service are core
There are unique aspects of working with breastresponsibilities of any profession in regard to the
feeding women that differ from other aspects of
public. ILCA standards of practice are measures or
health care. Breastfeeding is an emotion-laden
levels of quality that are models for the conduct and
subject for almost anyone who has had a child,
evaluation
of practice
(ILCA, 2013).
whether
the new mother
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LCs
report
that
the
majority
of their time is spent
Some
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remain
concerned
about
makNOT FOR SALE OR DISTRIBUTION
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in direct care of clients. The role of the LC may
ing mothers feel guilty by encouraging breastfeedclosely parallel that of the clinical nurse ­specialist,
ing, so they abdicate this important responsibility
in that it requires in-depth clinical knowledge and
completely. Others counsel mothers by relating
expertise in a particular area. Gibbins et al. (2000)
their own personal experiences, whether positive or
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information toNOT
help them
informed
decisions,
lactation
consultant
in
a
breastfeeding
clinic.
This
such as whether to breastfeed at all, or whether
advanced practice role encompasses key dimensions
to supplement with formula when the mother is
of the advanced practice model: research, leadernot sure if her baby is getting enough sustenance.
ship, education,
and clinical
practice.
Like the cliniMothers
who
do
not
reach
their
breastfeeding
goals
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cal
specialist,
the
LC
does
the
following:
tend
to
blame
themselves,
when
often
it
is
the
lack
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• Gives direct care
of timely and skilled support that made breastfeed• Teaches
ing difficult, if not impossible.
• Consults
This emotional context makes breastfeeding coun• Conducts or assists in conducting research
seling, like sex counseling or childbirth education,
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16
Chapter
1: The
Lactation Consultant:©Roles
and
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Giving breastfeeding mothers consistent breast• Proficient: Achieves the highest level of clinifeeding information is vital. Many times mothers
cal expertise, conducts or directs research
identify support received
from
healthcare Learning,
providuses&a Bartlett
holis© Jones
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Jones
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ers as the single most important intervention in
tic approach, interprets nuances
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the healthcare system in helping them breastfeed
• Expert: Global scope of practice, consults
­(Taveras et al., as cited in Shealy et al., 2005, p. 15).
widely, empowers patients and families,
The patient takes for granted that the healthcare
serves as a mentor
professional advising her is giving her accurate inforIn following Benner’s progression from novice
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mation
and “new
mothers Learning,
rarely requestLLC
care differto expert, LCs©will
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ent
from
that
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them
by
health
professionals”
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and in scholarly
workFOR
as they
gain experience
in the
(Shealy et al., 2005, p. 1). If confusion or controfield (Auerbach, Riordan, & Gross, 2000). Because
versy is found among the staff, healthcare providers
the role of the lactation consultant is relatively new,
cannot expect the patient to become knowledgeable
other health providers may be unclear about what
and
comfortable
with
learning
mother–infant
tasks.
to expect& of
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team LLC
member. Some
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Staff and clinician training in basic breastfeednursing
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as to the comNOT FOR SALE OR DISTRIBUTION
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ing management increases the likelihood that the
petency of an IBCLC versus an RN/IBCLC. All
healthcare team will provide ­consistent information.
IBCLCs should be clinically competent as outlined
A leadership function of the LC, whether based
in the IBLCE’s (2012a) Clinical Competencies for the
in a hospital or the community, is policy developPractice of International Board Certified Lactation ConJones
& Bartlett
LLC This document is suitable
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ment. Identifying©
needed
policies
related toLearning,
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the competency of any IBCLC during orientation
an important element that lays the foundation for
to a ­clinical position (available at http://iblce.org/
a breastfeeding/family-friendly environment and
resources/professional-standards/).
optimal patient care (ILCA, n. d.; WHO, 2003).
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Stages
of Role
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Lactation
Consultants in the
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Community Setting
Roles of health professionals have been extensively
studied and shown to progress through stages of
Breastfeeding is a public health imperative. It
development. For example, Benner (1984) used the
was identified by the U.S. Surgeon General in her
Dreyfus and Dreyfus (1980) model of skill acquisition
2011 Call
to Action toLearning,
Support Breastfeeding
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to describe the progression of skills and competenbest
source
of
infant
nutrition
and
immunologic
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cies of nurses in the clinical setting. This model—
protection, [providing] remarkable health benefits
which outlines a structure for the metamorphosis that
to mothers as well” (U.S. Department. of Health
occurs as nurses persevere in their practice—can also
and Human Services, 2011, p. v). The CDC’s Diviapply to lactation consultants. According to Benner
sion of Nutrition, Physical Activity, and Obesity
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(1984), there are five
stages of role
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the ultimate goal of improving the public’s health”
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petencies, develops diagnostic reasoning and
Initiative’s Ten
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Breastfeeding
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clinical
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skills,
begins
to
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Step
10
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“Foster
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establishment
of
• Competent: Expands the scope of practice,
breastfeeding support groups and refer mothers to
becomes competent in diagnostic reasoning
them on discharge from the hospital or birth cenand clinical skills, senses nuances, develops
ter” (Baby-Friendly USA, n.d.).
organizational skills
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Because of this heightened awareness of the
Medical Clinics/Offices
importance of breastfeeding support, both access
A growing number of physicians are emphasizto highly skilled
lactation
in the Learning,
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and ongoing breastfeeding support for mothers are
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among
patients
important. Women’s preventive healthcare protecin their general practice (family practice, obstetrics,
tions outlined in the 2010 Affordable Care Act are
or pediatrics) and providing staff to assist mothers
intended to provide, at no out-of-pocket expense to
to be successful. For other physicians, their genU.S. women with health insurance, “comprehensive
eral practice
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practice LLC
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other
physicians.
A
small
period, and costs for renting breastfeeding equipnumber of physicians are developing breastfeeding
ment (U.S. Department of Health and Human
and lactation specialty clinics or programs either
Services, Human Resources and Services Adminisin an academic setting or as a private practice.
tration,
n.d., para. 4).
This community-based health
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The specialty clinics serve as tertiary referral praccare differs from hospital-based care in that the
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tices for
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and baby, for conditions that require prescription
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one once described this as seeing a whole movie,
Physicians, especially pediatricians, realize the
whereas in the hospital the healthcare provider sees
value of having staff who are knowledgeable about
only one frame. Being in the family home gives
breastfeeding and can quickly and effectively
a much wider perspective on the mother’s needs
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health nurse may work with low-income mothers
making home visits, and working with the physiwho are eligible for many different programs of
cian&during
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Worksite Lactation Programs
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Corporate lactation programs pay off. Women prefer
to work at jobs where the breastfeeding woman is
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breastfeeding
moth- LLC
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ers miss less work
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Volunteer
Counselors
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Breastfeeding support does not always require
many corporate offices are becoming “breastfeeding
professional lactation care. The mother/client
friendly,” offering pumping rooms and multiuser
will obtain
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comprehensive
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pumps.
Mothers
working
full-time
spend
less
than
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IBCLCs,
volunteer
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support
counsel1
hour
over
the
course
of
one
workday
expressing
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ors, and other healthcare or program service providbreastmilk. The Business Case for Breastfeeding pubers all work together to provide support.
lished by the Office on Women’s Health (2008) is
While volunteer counselors and IBCLCs can offer
an excellent resource for employers and employees
general support to mothers, the scope of practice
and is available online.
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18
Chapter
1: The
Lactation Consultant:©Roles
and
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and clinical competencies for the IBCLC include
ILCA, 2012; Lauwers, 2007). The early pioneers in
skill at assessing both mother- and infant-related
this relatively new field are now the teachers and
lactation issues, as©well
as
an
ethical
duty
to
pro2003).
EduJones & Bartlett Learning,mentors
LLC of novice IBCLCs (Wiessinger,
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tect the breastfeeding relationship (IBLCE, 2011,
cational programs with a clinical component are rare
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2012a, 2012b). Volunteer counselors are an excelat this early stage in the evolution of LCs, and superlent source of general support for mothers, offering
vised clinical preceptorships are difficult to obtain.
preventive healthcare information pertaining to
Shadowing experienced lactation specialists in one’s
breastfeeding and lactation. They also spend more
area, however, is an excellent way to hone clinical
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mentors may NOT
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FOR
a clinic or hospital setting. It is not uncommon for a
ting of a colleague for mentoring purposes. The
mother to continue to receive assistance and caring
IBLCE defines the stages of training that a student
concern from a volunteer counselor throughout the
will achieve during supervised clinical mentoring:
entire lactation
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period. Instead, IBCLC contact may be sporadic,
Plan Approval Guide 2013, at http://www.iblce.org
initiated by the client/patient when a question or
/preparing-for-ibclc-certification#Description%20
concern requiring specific clinical skills to assess or
of%20the%20Pathways.
resolve a problem arises.
Networking, whereby members of a group
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Volunteer breastfeeding
helpers
and lactation
speexchange
in solving
probcialists can assist one
another
2000).
The
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gaining
shar- OR DISTRIBUTION
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ing expertise. When a difficult case arises, IBCLCs
home and, therefore, may be able to alert the IBCLC
can use local in-person gatherings, telephone, and
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ments of the mother’s home life that may bear on
being careful, of course, to protect client/patient
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her lactation course. The IBCLC, in turn, may serve
privacy). Networking can identify job openings,
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as a referral source for persons with complex probcolleagues who will cover for one another, and referlems. When the IBCLC works in a medical center
rals for clients needing equipment or specialized
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help. Networking also enhances advocacy efforts
helps generate new knowledge. Both the volunteer
that seek to change systems and improve methods
and the paid
IBCLC canLLC
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of providing
care.
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clients/patients.
The
volunteer
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be
sensitive
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Opportunities
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communicate
with others also
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ongoing issues that crop up after the mother has left
abound on the Internet, especially with social media
the hospital, including those that the mother may
networks, which are, in the early 21st century, a
choose not to mention to her healthcare providers.
predominant means of fact gathering and communiThe IBCLC may be aware of aspects of the healthcation. A forerunner of such interactions was LACT© Jones
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LLCa worldwide breastfeeding
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care system that influence
breastfeeding.
e-mail list
with
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nication is inexpensive and connects professionals in
Mentoring plays a major role in any clinically based
far-flung parts of the world with diverse cultural perprofession,
especially
a
new
specialty.
A
mentor
spectives. Being
able simply
to vent andLearning,
obtain sym- LLC
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(whether
serving
by
informal
or
formal
arrangepathetic
commiseration
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validation
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ment) is a trusted counselor, guide, or coach for the
hard-working but perhaps isolated practitioner. The
student/intern, and fills this role over a long period
Internet has allowed for an explosion in the availof time. Mentors nurture the novice’s growth with
ability of valuable, evidence-based practice-guiding
advice, information, and support (Altman, 2010;
websites, research articles, and other resources.
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LLC
Documentation
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19
Documentation
Health professionals use computers or smart
phones to look up medical information and to docuIt is the responsibility of the lactation specialist,
ment their interventions. ©
Free
and fee-based
soft- Learning, LLC
© Jones & Bartlett Learning, LLC
Jones
& Bartlett
regardless of where he or she practices, to chart
ware and applications (“apps”) for coding, charting,
NOT FOR SALE OR DISTRIBUTION
NOTclients
FORand
SALE
OR DISTRIBUTION
each contact with
to provide
complete
and medication information are available online.
reports to referring physicians and other healthcare
The most commonly used methods of charting are
providers (IBLCE, 2010; Williams, 1995). Almost
narrative charting and problem-oriented charting.
all record keeping involves using a computer; thus
Flow sheets and standard care plans that are indicomputer&skills
are a necessity
for healthcare
© Jones
Bartlett
Learning,
LLC work- vidualized©are
Jones
& Bartlett
Learning,
becoming
more popular,
however,LLC
as
ers.
As
in
other
healthcare
practices,
computers
can
they reduce
paperwork
and saveOR
timeDISTRIBUTION
(and money).
NOT FOR SALE OR DISTRIBUTION
NOT
FOR SALE
be used to generate records, reports, and charts that
do the following:
Narrative Charting
• Provide other health workers with valuable
Narrative documentation uses a diary or story forinformation LLC
© Jones & Bartlett Learning,
© Jones
LLCA simple paramat &
to Bartlett
document Learning,
client-care events.
• Reflect quality of care delivered (quality
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NOT FOR
SALE
OR
DISTRIBUTION
graph describes the client’s status and the care that
assurance, continuous quality improvement)
was given. Narrative notes, sometimes called prog• Highlight sometimes subtle observations or
ress notes, are used less frequently now, owing to
findings
the adoption of flow sheets and clinical care plans
• Validate health services for insurance compathat capture the routine aspects
of care.
Narrative Learning, LLC
Jonesreimbursement
& Bartlett Learning, LLC
© Jones
& Bartlett
nies to ©
determine
notes (Box 1-4) can be easily combined with flow
data that
canSALE
be usedOR
for research
• ProvideNOT
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FOR
DISTRIBUTION
sheets or any other client record.
• Serve as evidence in a legal dispute
In the hospital, the mother’s and infant’s charts are
Problem-Oriented Charting
clinical records that contain information about the
Charting©based
on &
a problem
a structured
hospital &
stayBartlett
and all contacts
with everyone
© Jones
Learning,
LLC involved
Jones
Bartlettuses
Learning,
LLC
problem
list
and
logical
format
for
each
entry in
in
their
care.
Because
the
mother
and
infant
usually
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the medical record. The format used in problemhave separate charts, it is often necessary to “double
oriented charting is called the SOAP or SOAPIE
chart.” At the same time, care plans tend to be geared
method. Each letter stands for a different phase
toward the mother, because it is she who is taught
of the process: subjective data, objective data,
and the baby who is the recipient of her learning.
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Box 1-4 An Example of a Narrative Note
Date
Time
Progress note
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& Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
05–22–03NOT 0800
InfantOR
alert.DISTRIBUTION
Rooting and suckling movements noted. Infant
latched
on SALE
breast OR DISTRIBUTION
NOT
FOR
FOR SALE
and suckled effectively until asleep. Breastfeeding assessment score 9/10.
05–22–03
1500
Discussed basic breastfeeding information including normal infant
elimination patterns to watch for after discharge. Mother given written
materials
use of breast
pump, and breastmilk
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LLCon sore nipples, engorgement,
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& Bartlett
Learning, LLC
storage.
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05–23–03
1100
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Explained that a follow-up call will be made 2 to 3 days after discharge.
Mother will have the option of a home visit.
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9781449697280_CH01.indd 19
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Bartlett Learning, LLC
© Jones & Bartlett
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LLC
20
Chapter
1: The
Lactation Consultant:©Roles
and
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Box 1-5 Example SOAP Note
© Jones
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Learning, LLC
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1. Subjective
= what mother
tells you
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NOT FOR
a. For example:
Mom SALE
c/o nippleOR
pain DISTRIBUTION
and not sure if baby is getting enough.
2. Objective = what LC saw and did, and information from medical record (e.g., interventions,
education, mother return demonstration)
a. For example: P2B2 mom, term infant <48 hrs old, output WNL to date (2 voids, 4 stools), baby is
below birthLearning,
weight. Maternal
© Jones 8%
& Bartlett
LLCpain = 8 out of 10.
© Jones & Bartlett Learning, LLC
b.
Baby
latched
with
areolar
compression,
rhythmic
sucking,
audible
swallowing.
Adjusted
positioning
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NOT
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OR
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and latch to decrease pain and increase milk removal. Mom needed moderate assistance with positioning
and latch.
c. LATCH Score = 8 (L2A2T2C1H1).
d. Breasts: full, heavy, milk easily expressed.
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e. Nipples: everted,
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FOR
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OR
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Educated re: s/s adequate infant intake, position
latch,
newborn
nutrition
in 1st 48 hrs, milk
production.
3. Assessment = identify the problem; YOUR assessment of what the situation is (a lactation
diagnosis)
a. Example
for a normal
mother–baby
couplet, LLC
IF you assessed the mother’s breasts
or baby
at
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© Jones
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Transitioning
to Lactogenesis
II. Effective breastfeeding with milk transfer.NOT FOR SALE OR DISTRIBUTION
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b. For a NICU mother: Lactogenesis I apparent, at risk for compromised milk production due to lactation risk factors: preterm delivery, PIH, GDM, late initiation of milk expression.
4. Plan = what is the goal and plan to get there
a. With a normal breastfeeding couplet with effective breastfeeding: EBF on cue of baby or at
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least 8×/day, monitor output, call (community resources) prn.
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b. For a NICU mother: Express milk 8–10×/day, use hand expression/hands-on
pumping,
monitor
milk volume collected, practice kangaroo care with baby daily as possible, acquire pump for use after
discharge, request LC support when baby ready to initiate direct breastfeeding. Call prn.
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assessment, plan, interventions, and evaluation
Electronic Health Records
of care (see Box 1-5). When the LC functions as
A patient’s lactation information is usually incora consultant, problem-oriented charting is more
porated into existing information systems (IS) in
appropriate.
©
Jones
&
Bartlett
Learning,
LLC and hospitals. Lactation©professionals
Jones & Bartlett
Learning, LLC
clinics
need
In private practice, the completeness of reports
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NOThealthcare
FOR SALE
OR
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to work closely with IS technicians
to make
sure OR DISTRIBUTION
also assists the referring
worker
to underthat
the
format
employed
for
electronic
healthcare
stand the “how” as well as the “why” of an LC’s
records accommodates breastfeeding information,
practice and methods. Reporting provides a dataespecially if mother–infant care is involved. Tranbase for all types of information (e.g., an increase in
sition to such©aJones
system takes
significant
amounts LLC
the
number
of
referrals
from
a
particular
physician’s
© Jones & Bartlett Learning, LLC
& Bartlett
Learning,
of
time
and
resources,
and
often
engenders
a great
practice).
EarlySALE
referralsOR
mayDISTRIBUTION
be for one or two comNOT FOR
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deal
of
staff
frustration.
Each
facility,
outpatient
mon problems, whereas tracking over an extended
lactation clinic, private lactation practice, meditime period may reveal that later referrals deal with
cal office, and hospital will have unique needs.
a wider variety of problems.
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LegalLLC
Concerns
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21
The Cincinnati Children’s Center for Breastis a commonly used type of care plan in hospitals.
feeding Medicine developed a lactation-friendly
These paths, which are abbreviated care plans that
­electronic health
record (EHR)
at its pediatric
facil- LLC
focus on the client’s length
stay in &
theBartlett
hospital, Learning, LLC
© Jones
& Bartlett
Learning,
©ofJones
ity, which has a breastfeeding clinic. New forms
integrate infant feeding into the overall care plan.
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specific to breastfeeding are (1) maternal history,
(2) maternal exam, (3) infant feeding history, and
Legal Concerns
(4) breastfeeding assessment. This organization’s
As credentialed allied healthcare providers, IBCLCs
computer system includes electronic prescriptions,
will take care
to use best
practices inLearning,
clinical care,LLC
to
© Jones
& Bartlett
Learning,
LLCnotes (List
© Jones
& Bartlett
printed patient
handouts,
and telephone
abide
by
the
ethical
rules
of
their
profession,
to
stay
et
al.,
2008).
LCs
will
find
the
computer
pages
and
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NOT FOR SALE OR DISTRIBUTION
within their scope of practice and clinical compedrop-down lists in this article to be helpful for
tencies as lactation professionals, and to follow the
developing their own computerized records.
legal requirements of the workplace setting. Liability may result when the mother or baby is placed
© Jones & Bartlett
Learning,
© Jones
& Bartlett Learning, LLC
Clinical
CareLLC
Plans
at risk, even if the IBCLC is following a physician’s
NOT FOR SALE OR DISTRIBUTION
NOT FOR
ORcaregiver
DISTRIBUTION
order.SALE
While no
is immune from litigaA clinical care plan provides basic information
tion (even excellent clinicians can be named in a
about client assessment, diagnosis, and planned
specious lawsuit), excellence in professional practice
interventions. It also offers a guide for care, estabis the best way to reduce such risks (Miller, 2006).
lishes continuity of care, and represents a means of
to avoid Learning, LLC
© among
Jonesall&caregivers.
Bartlett Two
Learning,
© suggest
Jonesways
& Bartlett
communication
types of LLC The following guidelines
liability:
care plans mayNOT
be created:
andDISTRIBUTION
standard.
NOT FOR SALE OR DISTRIBUTION
FOR individual
SALE OR
professional
liability
(or malpractice)
•
Carry
Individual care plans are developed “from scratch”
insurance, covering all of your practice setfor each client based on her specific needs. A stantings. If you are named in a suit, the insurdard care plan is a preprinted plan of care for a group
ance entitles you to legal counsel and advice.
of patients within the same diagnosis. Because each
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
•
Keep
up-to-date on new research findings
standard care plan must be tailored according to
NOT
FOR
SALE
OR
DISTRIBUTION
NOT
FOR SALE OR DISTRIBUTION
and clinical practices. Read current relevant
the needs of a particular client, they are designed to
articles, network with respected colleagues,
include space for adding information.
attend live or online conferences.
The Joint Commission requires a care plan for
• Use mother-centered care with all of your
each patient in the hospital as a necessity for accredmeeting LLC
each woman’s needs
itation;
however, the
plan of care can be computer
© Jones & Bartlett
Learning,
LLC
© Jones & patients/clients,
Bartlett Learning,
and
supporting
her
choice
after she has been
generated,
be
preprinted,
or
appear
in
progress
notes
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offered evidence-based information and conor standards of care (American Nurses Association,
sultation. People tend to sue healthcare pro1991). Care plans are legal requirements of practice
viders when they feel they were not treated
and may also serve as protocols or standards of care.
with respect and dignity.
Traditionally, individual care plans are divided
Jonesheadings
& Bartlett
Learning,
© Jones
& Bartlett
as close
to the Learning, LLC
into columns.©Column
change
over the LLC • Thorough documentation,
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OR DISTRIBUTION
FORinSALE
time of the intervention/assessment
as possiyears to reflectNOT
new ideas
nursing,OR
andDISTRIBUTION
some colble, will verify your excellence in care. Docuumn labels are preferred over others. In this text, for
ment development of the care plan, suggested
instance, the clinical care plans include assessment,
interventions, and the rationale for doing so.
interventions, and rationale. Other commonly
Methodically
updatesLearning,
and revisionsLLC
to
used labels
are “problem,”
“evaluation,”
© Jones
& Bartlett
Learning,
LLC “nursing
© Jones record
& Bartlett
the
plan,
based
on
follow-up
contacts
(often
diagnosis,”
“patient
outcomes,”
“nursing
action,”
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made by phone).
or simply “intervention-evaluation.” Box 1-6 pro• In the newborn period at the hospital or
vides an example of a nursing diagnosis and nursbirthing center, a latch and feed by the infant
ing care plan. The critical care path or clinical path
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Bartlett Learning, LLC
© Jones & Bartlett
Learning,
LLC
22
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Box 1-6 Nursing Interventions • Nursing Care Plan Lactation Counseling
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
Source:
Reproduced
from
Parris
KM.
Integrating
nursing
diagnosis,
interventions,
andSALE
outcomes in
public
health nursing practice. Nurs
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NOT
FOR
OR
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Diag. 1999;10:49–56.
at the breast should be assessed and documight include a daily phone call, helping the
mented before
the mother
and baby Learning,
are disvisit to the
© Jones
& Bartlett
LLCmother to schedule an early
© Jones
& baby’s
Bartlett Learning, LLC
charged. If this
has
not
occurred,
the
IBCLC
physician,
or
an
outpatient
consult
or
home OR DISTRIBUTION
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should make certain the baby’s primary
visit—or all three.
healthcare provider is apprised of the situa• Refer to someone else if the situation calls for
tion. The mother and baby may be allowed to
expertise you do not have in special situations.
stay a day or two longer; if not, the discharge
People tend
become&disenchanted
with their LLC
© Jones & Bartlett Learning, LLC
© to
Jones
Bartlett Learning,
care plan should describe how the mother
healthcare providers (and are more likely to sue) not
NOTcan
FOR
SALE
DISTRIBUTION
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know
whenOR
breastfeeding
is going well
because of clinical actions, but rather because the
and how she can access support and expert
patient/client felt uninformed, ignored, or rudely
care if she is unsure about its effectiveness.
treated. Therefore, the most effective protection
Immediate follow-up care by the IBCLC
against such actions is establishing clinical rapport
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LLCRights
Intellectual
Property
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23
and forging a mutually respectful relationship
Privacy obligations are also imposed by federal
(Miller, 2006). The lactation specialist’s pattern of
regulatory law in the United States, enforceable by
practice should
to avoid
causing Learning,
the mother, LLC
civil and criminal sanctions.
The Health
Insurance Learning, LLC
© seek
Jones
& Bartlett
© Jones
& Bartlett
the baby, or any other member of the client’s famPortability and Accountability Act (HIPAA) of
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ily any emotional distress as a result of words said,
1996, and the subsequent requirements under the
reports written, or other actions taken.
2009 Health Information Technology for Economic
A clearly written, detailed record of the healthand Clinical Health (HITECH) Act, are intended to
care provider’s actions, initial recommendations,
standardize and protect the communication of elec© Jones
& Bartlett
Learning,
© Jones
& Bartlett
Learning,
LLC
and follow-up
assistance
is one of theLLC
most effective
tronic health
information
between healthcare
providways
of
avoiding
legal
scrutiny.
Well-written,
comers
and
health
insurers.
The
regulations
are
very
clear:
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plete reports will allow the other healthcare providprotect the privacy and security of the patient/client
ers in your community to become familiar with your
(Health Insurance Portability and Accountability
standards of excellence. Information that is sent in a
Act, 2002; Omnibus Final Rule [HITECH], 2013).
timely
and professional
© Jones & Bartlett
Learning,
LLC manner may lead to future
© Jones & Bartlett Learning, LLC
client/patient referrals to the IBCLC. While charts
Intellectual
Property Rights
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and client records are considered admissible in the
The IBLCE Code of Professional Conduct (IBLCE
case of a lawsuit, clear records can also prevent cases
CPC) contains a principle specifically mandatfrom going beyond the discovery phase and into the
ing IBCLC respect for intellectual property rights
courthouse. Lawsuits often are won or lost based on
(IBLCE, 2011). While all ©
people
around
the world Learning, LLC
Jones
& or
Bartlett
LLC
Jones
& Bartlett
what appears ©
in the
written
digitizedLearning,
record.
should
respect
all
laws,
the
IBLCE
CPC
provision
The IBCLCNOT
who works
a doctor’s
clinic,
NOT FOR SALE
OR DISTRIBUTION
FORinSALE
ORoffice,
DISTRIBUTION
means
that
IBCLCs
can
be
sanctioned
under
the
disor hospital may be considered an employee who is
ciplinary procedures of their profession in addition
covered in an “umbrella” professional liability polto whatever liability they may assume under the
icy for the office/institution. The IBCLC in private
laws of their country. Intellectual property covers
practice must obtain her own insurance policy cov© Jones
& Bartlett Learning, LLC
© Jones (including
& Bartlett
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LLC
patents, trademarks
certification
marks
erage. Members of CLCA and USLCA have access
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and service marks), trade secrets, and copyright law.
to professional liability insurance coverage at a reaFor IBCLCs, copyright is the form of intellectual
sonable cost as a membership benefit. Although
property law most likely to affect professional praclegal action against an IBCLC is rare, it does occur;
tice, as these consultants typically rely heavily on
therefore, all individual practitioners need to conwritten,
audio, and
visual images
in education and
sider Learning,
how they will
protect themselves (and their
© Jones & Bartlett
LLC
© Jones
& Bartlett
Learning,
LLC
support
of
breastfeeding
families.
Unless materials
assets) against protracted litigation,
NOT FOR SALEpersonal/family
OR DISTRIBUTION
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created by others are clearly marked as available for
and even a judgment.
redistribution, permission must be sought from the
creator before the material can be reproduced, disConfidentiality
tributed, performed, displayed, licensed, communiJones & Bartlett
Learning,
Jones & Bartlett Learning, LLC
Maintaining ©
confidentiality
and protecting
the LLC
cated, or broadcast (Brooks,©2013).
privacy of theNOT
mother,
baby,
and family
is a priNote that copyright law
is not
concerned
NOT
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mary healthcare provider responsibility. It is part
assembling proper citations in professional or scholof the IBCLC’s professional conduct code, clinical
arly writing. Academic, clinical, and professional
competencies, and scope of practice (IBLCE, 2011,
rigor require appropriate attribution, in a bibli2012a,
2012b)
and
is
identified
by
the
professional
ography, ©
of Jones
any materials
used to Learning,
help inform LLC
the
© Jones & Bartlett Learning, LLC
& Bartlett
association as a standard of best practices (ILCA,
knowledge, thoughts, and conclusions of the pracNOT FOR SALE OR DISTRIBUTION
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sion of privacy and a tort (wrongful act) that occurs
creator or provider of written material, slides/phowhen information is revealed without permission to
tographs, video clips, Internet sites, blogs, illustrasomeone not entitled to know it.
tions, online courses, and other materials.
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Bartlett Learning, LLC
© Jones & Bartlett
Learning,
LLC
24
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Note, too, that the IBCLC has the additional
indented in addition to having adequate citarequirement, also unrelated to copyright law, under
tion (U.S. Copyright Office, 2012).
IBLCE CPC Principle
3.1, to&obtain
prior,Learning,
written
Legal issues for IBCLCs are©discussed
© Jones
Bartlett
LLC
Jones generally
& Bartlett Learning, LLC
consent from the mother for any photograph, recordby
Priscilla
Bornmann
(2013)
in
Core
Curriculum
for OR DISTRIBUTION
NOT FOR SALE
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ing, or taping of her or her baby. Even if the image
Lactation Consultant Practice, third edition, and by
will be stored and viewed only by the IBCLC (perElizabeth Brooks (2013) in Legal and Ethical Issues
haps to measure how interventions are helping to
for the IBCLC.
promote healing of nipple trauma), prior written
© Jones
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consent
is required.
Ethics © Jones & Bartlett Learning, LLC
The
following
basic
concepts
apply
when
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Ethical decisions are a routine, inherent part of lacusing other people’s original, copyright-protected
tation practice. Legal requirements for the IBCLC
materials:
(and all healthcare providers) may be characterized
• Seek authorization (permission) of the creas black-and-white, applicable to all practitioners
ator/source
to reproduce,
present, record, © Jones
© Jones & Bartlett
Learning,
LLC
Bartlett
Learning,
equally. &
Ethics
analysis
looks at theLLC
gray: the conbroadcast,
translate, or adapt materials pro- NOT
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FOR
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tected by copyright. A work is considered
wrong” differ with each instance, as the facts and
copyright-protected as soon as it exists in
players change (Brooks, 2013; Noel-Weiss, Cragg,
tangible form. The copyright-holder does
& Woodend, 2013). The IBLCE Code of Profesnot have to file it with the U.S. Copyright
sional
© Jones
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Jonesdescribing
& Bartlett Learning, LLC
Office (although
doing&soBartlett
fixes in time
the
mandatory
professional
behaviors
by FOR
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tices. The purpose of these documents, along with
permission to reuse another person’s materithe mandatory (“must”) IBLCE Scope of Practice
or fax may
als. A &
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letter, LLC
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Jones
& Bartlett(2012a),
Learning,
(2012b) and ©
Clinical
Competencies
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NOTbeFOR
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provide guidance
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should always keep a record of the contact.
practice. The IBLCE Code of Professional Conduct
Indicate who you are, the conditions under
is an ethical code built on the premise that it is
which reproduction is sought and will be
in the best interests of the IBCLC profession, and
used, and whether there is any commercial
serves to protect the health, welfare, and safety of
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© Jones
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aspect
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the public, to have required minimum standards
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• Users of another’s work are generally limited
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Ethical
© Jones
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making several copies even for educational,
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Practice
noncommercial purposes is not allowed.
Different personalities, ethical obligations, and
• Quote directly from the original source,
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Many times there
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course LLC
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&
Bartlett
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& Bartlett
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action
in
trying
to
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ethical
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ConNOTtution;
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a quotation
of five or fewer typesider
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written lines should be enclosed in quotation
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marks, followed by a reference. Some styles
lunch sponsored and paid for by a formula
require quotations of lengthier material to be
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25
company. Attendees may also receive other
privilege and honor to be welcomed into this close
free products.
circle of family members celebrating a birth, and
• Whether
to
distribute
free
samples
of
formula
struggling perhaps with normal
concerns
of parent- Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
or coupons to breastfeeding women who are
hood. Technologies used in lactation practice have
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being discharged from the birth setting. Do
expanded dramatically in the last quarter century.
IBCLCs employed at the facility have a right
New families need guidance, free from conflict of
to refuse to distribute these items?
interest on the part of the healthcare provider, as to
• Whether to file a complaint against a colthe appropriate use of such devices.
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who transferred
clientLLC
files out of the
health
agency
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prior
consent,
thereby
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International
Code of Marketing
failing to protect privacy and security under
of Breast-milk Substitutes
HIPAA/HITECH regulations. What are the
(“WHO Code”)
circumstances surrounding this incident?
Was it intentional?
Predating
the IBCLC
profession
and the IBLCE
© Jones & Bartlett Learning,
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of privacy regulations ? Did any harm come
examination,
WHO’s
1981 International Code of
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of the action—that is, was, in fact, any client/
Marketing of Breast-milk Substitutes, in conjunction
patient’s privacy compromised?
with the 18 relevant World Health Assembly res• How to offer evidence-based information and
olutions passed since then (WHO, n.d.; WHO &
support for the breastfeeding mother who is
UNICEF, 2009), is a model policy against preda© Jones
Bartlett
© Jones
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a smoker,
who is a &
user
of illicitLearning,
drugs, who LLC
tory marketing practices that
could reduce
optimal Learning, LLC
seeks toNOT
informally
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with her
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breastfeeding by mothers and children worldwide.
friend, or who does not want to express milk
It recognizes the public health imperative of breastfor her hospitalized, premature baby.
feeding promotion and support. It seeks to limit
• Whether to write an article with evidencecommercial marketing of infant formula, bottles,
based information about breastfeeding for
teats (called
bottle nipples
in theLearning,
United States),
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mothers that will be published in a magazine
and babyNOT
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replace breastNOT FOR
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OR
or on a website that also carries ads for forfeeding at the breast. Sales and purchases of those
mula, bottles, and teats.
products are allowed.
Ethics considerations are relevant for lactation
For the IBCLC, or any other healthcare provider,
specialists, in part because this is a relatively new
the principles of the WHO Code can be easily met
© Jones & Bartlett
Learning,
© Jones
Bartlettregardless
Learning,
profession
in healthLLC
care. As such, the public is just
and &
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of theLLC
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aware of LCs, their special knowlenactment
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The practitioner should
edge and skills, and the role they play and the
refuse any free gifts, samples, or other financial
impact they have in the maternal–child and public
inducements from product marketers. The practihealth fields (ILCA & Henderson, 2011). Our protioner should confine clinical or educational discusfessional behaviors
contribute
to
IBCLC
acceptance
sion of the use of WHO Code–covered
to Learning, LLC
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© Jones &products
Bartlett
by the public as a welcomed, respected discipline.
a one-on-one setting. The practitioner should avoid
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The nature of IBCLC practice involves assessthe professional conflict of interest inherent in the
ment of the mother (including touching her breasts)
use of pens, handouts, lanyards, tote bags, coffee
and assessment of the infant (including touching
mugs, or any other gadget bearing the logos and
the mother’s precious baby). The birth of a child
brand names of any commercial product manufac© Jones
&
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Jones &
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is a major family and life event. The circumstances
turer. The©healthcare
provider
markets
good health;
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NOTvendors
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surrounding
it willOR
be remembered
(for good or ill)
commercial
market OR
products
(Brooks,
by the mother and her family for years to come. Fur2013; International Baby Food Action Network
ther, a mother is emotionally vulnerable during and
[IBFAN] & International Code Documentation
after childbirth. The IBCLC holds a place of great
Centre, 2009).
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26
Chapter
1: The
Lactation Consultant:©Roles
and
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Moral and Ethical Dilemmas
Autonomy
The principle of personal autonomy refers to selfMoral dilemmas and ethical issues can be subtle and
governance;
it is respect for self-determination
and
©
Jones
&
Bartlett
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LLC
© Jones & Bartlett
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complex, and are intertwined in some situations.
freedom
to
make
one’s
own
decisions.
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Often they entail NOT
simplyFOR
a feeling
thatOR
something
is not quite right about a situation, and this uneasy
Example. Autonomy includes the mother’s right
feeling lasts for a long time. Most of us remember
to choose whether to follow a treatment suggesan incident in our childhood where a parent made
tion, or to refuse treatment or care plan options.
it©very
clear &
that
we were Learning,
doing the wrong
Jones
Bartlett
LLCthing.
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Autonomy fits
well with
caring for Learning,
breastfeed- LLC
Although
it
was
painful
at
the
time,
our
parents
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ing families because
we know
so much
about the
inculcated a moral sense that gave us a behavior
advantages of breastfeeding that it is difficult for
compass so that we headed in the right direction as
us sometimes to stand back and accept the wellwe grew up (Noel-Weiss et al., 2013; Noel-Weiss
informed mother who decides to supplement her
& Walters, 2006).
baby when
she goes back
to work even
after we sug© Jones & Bartlett
LLCworkers do when their © Jones
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What Learning,
should healthcare
gestFOR
ways SALE
that she OR
can exclusively
breastfeed in this
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job responsibilities
conflict with their ethics—for NOT
A
­
utonomy
for
the
patient
requires the
situation.
example, when they are asked by a supervisor to disIBCLC
to
recognize
and
appreciate
the
client and
tribute free samples of formula to a breastfeeding
family’s
value
choices.
mother? When lactation specialists feel that they
are being asked to©doJones
something
outside their
pro& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
Beneficence
fessional ethical code, an analysis can be conducted
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by looking at legal and ethical obligations, and
Beneficence is the principle of the duty to do good.
flexibility within the workplace to explore other
It may ask the IBCLC to prevent or remove harm.
options. Sometimes the IBCLC will not be able to
Beneficence is just what it sounds like: being kind,
change the outcome of the situation at hand but can
merciful, and caring about the welfare of others. It
© Jones
& Bartlett
LLC
© Jones
Bartlett
initiate
a review
of policyLearning,
and procedure
to form
involves promoting
the &
interests
andLearning,
well-being LLC
NOToptions
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better
for future
mothers
(and colleagues).
of others in one’s sphere, including colleagues and
Most hospitals and large clinics have an ethclients/patients.
ics or risk assessment committee to help in sorting
out these types of issues. The committee may hold a
Example. Maintain nurturing relationships with
forum for interdisciplinary review where discussion of
your
colleagues
and your
clients/patients.
© Jones & Bartlett
Learning, LLC
© Jones
& Bartlett
Learning,
LLC That inthe dilemma and answers to questions are addressed.
cludes those providers who are in training to beNOT FOR SALE OR DISTRIBUTION
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come an IBCLC. Critical comments and gossip
Principles of Bioethics
about other colleagues’ skills do not promote a
spirit of collaborative care by the healthcare team.
Ethics is the branch of philosophy that structures
Such behavior can undermine the confidence of the
morality; morality concerns choosing actions per©
Jones
&
Bartlett
Learning,
LLC if she thinks the IBCLC©has
Jones
& in
Bartlett
Learning, LLC
mother
no trust
the
ceived to be right or wrong, and bioethics is the
FOR (Noel-Weiss
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abilities of other caregivers. NOT FOR SALE OR DISTRIBUTION
study of ethics inNOT
healthcare
et al.,
2013). Major principles of bioethics include the folNonmaleficence
lowing (Paola, Walker, & Nixon, 2010):
Nonmaleficence is the duty to do no harm, and
• Autonomy
underlies the©medical
“AboveLearning,
all, first do LLC
• Beneficence
© Jones
& Bartlett Learning, LLC
Jonesmaxim
& Bartlett
no
harm”
(Paola
et
al.,
2010,
p.
52).
It
must
be bal•
Nonmaleficence
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anced with the principles of beneficence.
• Justice
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Reimbursement
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Example. Giving an injection to a patient causes
the harm of pain, but if it delivers medicine to cure
disease, then ©
it isJones
justifiable.
The rare mother
who LLC
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must take a powerful medication that is contrain•
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dicated during lactation can be counseled by the
IBCLC about preventing harm to the baby through
her breastmilk, or by discussing options to maintain lactation until the medication is no longer in
© Jones
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the mother’s
bloodstream.
27
her name and IBCLC certification. This was
substantiated, but there were mitigating circumstances. Private©
reprimand
given. Learning, LLC
Jones was
& Bartlett
IBCLC certification was revoked for proof of
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theft of products while at a conference, and
for making copies of the IBLCE certification exam in violation of testing protocols
(IBLCE, 2010).
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Reimbursement
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Justice
In most countries, lactation services are a part of
the national healthcare system, and reimbursement for these services occurs mainly through sala© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
Example. Is the need for skilled expertise of an afried positions paid for by government programs.
NOT FOR SALEfluent
OR breastfeeding
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mother who can access private,
In theSALE
UnitedOR
States,
reimbursement for lactation
individualized care because she can afford to pay the
services is extremely complex and depends on the
IBCLC on an out-of-pocket basis, without regard to
setting where the services are provided, the educaher health insurance coverage, any greater than that
tional qualifications of the provider, and the type
of the mother©who
must &
rely
solely onLearning,
her health LLC
of insurance. Reimbursement
has also&been
made Learning, LLC
Jones
Bartlett
© Jones
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insurance benefits?
the SALE
mother OR
withDISTRIBUTION
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NOT Or
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ance at all?
requiring increased access to preventive care services; among those services listed for women are
access to skilled lactation care and equipment to
IBLCE Ethics and Discipline
support breastfeeding (U.S. Department of Health
Committee
© Jones
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© Jones & Bartlett Learning, LLC
and Human Services, Human Resources and SerNOT
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IBLCE has established an enforcement and sancvices Administration,
tions procedure for its mandatory IBLCE Code of
Lactation specialists who work in a birthing cenProfessional Conduct, which is triggered by the
ter, hospital, or medical office are usually salaried
filing of a complaint with the IBLCE Ethics and
employees reimbursed with a set hourly or weekly
Discipline
Committee
(IBLCE,
2011).
Once
such
wage.
include
lactation services
© Jones & Bartlett Learning, LLC
© Jones
& Hospitals
Bartlett usually
Learning,
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a complaint is filed, a hearing process commences
as
part
of
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“packNOT FOR SALE OR DISTRIBUTION
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to review the allegations, with an opportunity for
age.” The cost package is an agreement between
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the insurance company and the hospital to charge a
can range from dismissal of the complaint to public
certain amount of money for healthcare coverage for
censure and revocation of the IBCLC certification.
each birth—a reimbursement mechanism known
© Jones
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© Jones
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Examples of matters
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before IBLCE
include LLC
as capitation. Managed care
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the following:NOT FOR SALE OR DISTRIBUTION
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through price bids to winNOT
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• An IBCLC was accused of contradicting a
If postpartum home visits are part of a materphysician’s order. There was not clear evinity insurance package, breastfeeding assistance is
dence to prove the accusation. The case was
given as ©
part
of a routine
postpartum
visit to LLC
the
because
it was unsubstantiated.
© Jonesdismissed
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Jones
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home visits
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practice in a published article, which carried
Justice speaks to the principles of fairness, and how
social benefits and burdens should be distributed.
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Jones
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Bartlett Learning, LLC
© Jones & Bartlett
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28
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
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company. Services above and beyond the packaged
from her insurance company and provides the
IBCLC services are paid for either by a separate
third-party payer with the information it needs,
insurance claim or©byJones
the family
themselves.Learning,perhaps
the IBCLC
for
& Bartlett
LLC using forms supplied©by
Jones
& Bartlett
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For the IBCLC in private practice, cash paysending to the insurer in the hope of being reimNOT FOR SALE OR DISTRIBUTION
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ment for services rendered or for equipment may
bursed. Such a lactation consult bill with paybe requested from the client at the time of the serment- and assessment-related codes is displayed in
vice. The client, in turn, may seek reimbursement
Box 1-7.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
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Box 1-7 Lactation Services Bill
OU PHYSICIANS FOR WOMEN’S HEALTH
© Jones & Bartlett
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Department
of Obstetrics
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ORN.E.
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10th Street, Suite 3300
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(405) 271-9494 Scheduling (405)
271-5293 Billing
© Jones & Bartlett
TAX ID# 73-1477155
Patient Name
Patient SSN
© Jones
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Patient &
DOB
NOTDate
FOR
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Insurance
MRN#
Learning, LLC
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Prenatal
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LACTATIONNOT
CONSULTANT:
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(PRINT NAME)
SERVICE PROVIDED
Supplies to Be Charged for
© Jones & Bartlett
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LLCLactation Consultation © Jones & Bartlett Learning, LLC
S9443
NOT FOR SALES9445
OR DISTRIBUTION
Follow-up Lactation ConsultationNOT FOR SALE OR DISTRIBUTION
MATERNAL DIAGNOSIS
- PRIMARY
CHILD DIAGNOSIS
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675.14
Abscess, Breast
783.2X
© Jones
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676.44
Agalactia& Bartlett Learning,796.1
FORofSALE
DISTRIBUTION
676.34, 757.6 NOT
Anomaly
Breast orOR
Nipple
750.1
(Includes Breast Surgery)
676.34, 757.6 Axillary Breast Tissue
767.9
649.24
Bariatric Surgery (Status Post)
774.39
Complicating
Puerperium
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676.34
Pain
771.7
NOT
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648.04
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775.5
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Ecchymosis of Breast or Nipple
783.41
783.3
© Jones
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Engorgement of Breast
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757.6
675.94
779.3
780.91
779.89
Lactation Care / Exam
Follow-up Exam (When the
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Bartlett
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resolved)
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676.04
Inverted Nipple(s)
315.4
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&
Bartlett
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675.24
Mastitis - Non-purulent
750.0
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FOR
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(Interstitial)
675.14
Mastitis - Purulent (Infective)
649.1,
Obesity
278.00
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676.84
Breastfeeding
Difficulty
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Painful Nipple (No Apparent
Trauma)
676.84
Plugged Duct
676.84
Polygalactia
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676.54
Suppressed
NOT FOR SALE OR DISTRIBUTION Lactation
676.34
Trauma to Nipple
649.0
Tobacco Use Complicating
Puerperium
676.34
Ulceration of Nipple
29
478.29
775.6
764.90
774.6
766.1
GE Reflux
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High Arched Palate
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Hyperactive Gag Reflex
Hypoglycemia 775.0 - (IDM)
Intrauterine Growth Retardation
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Jaundice/Hyperbillirubinemia
Large for Gestational Age
(continues)
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Bartlett Learning, LLC
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30
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
(Continued)
©
Jones &DIAGNOSIS
Bartlett Learning,
LLC Micrognathia
MATERNAL
524.00
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FOR SALE OR DISTRIBUTION
- SECONDARY
304.90
244.90
761.5
Jones
642.44
Drug Dependency
Hypothyroidism (Unspecified)
Multiple Birth
©
& Bartlett
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Pre-eclampsia
(Mild or LLC
unspecified)
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V10.3
Unilateral Mastectomy
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315.9
769
764.00
520.7
Motor Retardation
Respiratory Distress Syndrome
Small for Gestational Age
© Jones
Teething
syndrome& Bartlett
528.9
528.2
Ulceration of Oral Mucosa - Traumatic
Ulceration of Oral Mucosa - Nontraumatic
Learning, LLC
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Diagnosis Codes:
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2.
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3.
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Return
Days:
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& Bartlett Learning,
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Months:
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LACTATION CONSULTANT
SIGNATURE
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© Jones & Bartlett Learning, LLC
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TIME SPENT
© Jones
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Form 2008-G
Revised
10’08
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Source: Reproduced from Oklahoma University Department of Obstetrics and Gynecology.
Insurance and Third-Party Payment
one-third of U.S. births are paid for under Medicaid. Medicaid
reimbursement
for health
© Jones & Bartlett
LLCpayment for lactation © Jones
& Bartlett
Learning,
LLCcare is furInsuranceLearning,
and third-party
therFOR
complicated
fact that some Medicaid
NOT FOR SALE
OR
SALE by
ORthe
DISTRIBUTION
services
is aDISTRIBUTION
complex issue. Third-party payment— NOT
recipients are also enrolled in managed care plans.
insurance or payment by another entity besides the
These plans’ policies on reimbursement differ from
patient––varies according to the state (and country)
the state and federal rules governing reimbursement
where the services were given. In the United States,
when the patient is not enrolled in managed care.
third-party payers©can
be divided
into two Learning,
general
Jones
& Bartlett
LLC requires a practitioner©toJones
& Bartlett
Learning, LLC
Medicaid
be licensed
to be
categories: government
or
public
health
insurance
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eligible for reimbursement; noNOT
U.S. FOR
state licensed
(Medicare, Medicaid) and managed care organizaIBCLCs in 2013.
tions (MCOs).
Insurance policies usually spell out by title who
Medicare applies to individuals older than age 65
may be reimbursed with third-party payment. Physiand is not applicable for breastfeeding except that
providers
such as nurse
practitio- LLC
© Jonescompanies
& Bartlett
Learning,
LLC rules cians and midlevel
© Jones
& Bartlett
Learning,
insurance
usually
follow Medicare
ners,
certified
nurse
midwives,
and
physician
assistants
NOT
FOR Medicaid
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DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
for
payment.
is a federal
program adminare recognized by third-party payers as providers who
istered by the states, and state regulations apply to
can receive direct payment for their services.
mothers and children who qualify on the basis of low
To receive reimbursement from Medicaid, the
income. The regulations in various states may diflactation consultant must be accepted as a Medicaid
fer in billing
rules andLLC
regulations. Approximately © Jones & Bartlett Learning, LLC
© Jones & Bartlett
Learning,
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9781449697280_CH01.indd 30
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© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning,
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Reimbursement
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31
provider by his or her state Medicaid agency to be
the claim form for an “incident to” service be filled
admitted to the provider panel of an MCO. Generout with the physician’s name and provider number.
ally, providers©areJones
accepted
on
the
basis
of
having
a
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
medical or medically related degree, state licensure,
Rejection
of
Billing
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and national certification. Lactation consultants
If the company rejects a bill, the HCFA 1500 form
can receive direct reimbursement if they are also a
is returned with a short explanation about why it
licensed care provider (physician, nurse practitioner
is being rejected. Sometimes several letters back
[NP], or certified nurse–midwife) who has graduand forth are necessary before the bill will be paid.
© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learning, LLC
ated from
an accredited
educational
program, is
Persistence is the key, as many claims may not be
licensed,
and
is
certified
nationally
in
a
specialty.
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paid on the first submission. Anyone in a mediPhysicians or nurse practitioners can apply for a
cally related practice quickly learns from trial and
provider number through the state Medicaid agency
error how to best file third-party insurance claims
by filing a provider application. If accepted as a proto maximize the number of paid claims.
vider,Learning,
they can billLLC
the state Medicaid agency on©anJones & Bartlett Learning, LLC
© Jones & Bartlett
Payers may require documentation to validate that
HCFA 1500 form using the patient’s name and identhe care
was given,
site of the care, and the mediNOT FOR SALE OR DISTRIBUTION
NOT FOR
SALE
OR the
DISTRIBUTION
tifying information, the ICD-10 code, the Current
cal necessity and appropriateness of services provided.
Procedural Terminology (CPT) code, the charge,
Fees for care of breastfeeding women on Medicaid are
and the provider’s name, number, and location for
based on number and type of services provided using
services. Fees for CPT codes vary according to locathe CPT, published in the tenth edition of Interna© Jones
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
tions and providers.
For example,
in many
states to LLC
tional Classification of Diseases (ICD10) (see Box 1-8).
receive third-party
LC services
must be
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NOT payment,
FOR SALE
OR DISTRIBUTION
Major barriers to third-party reimbursement for
provided in collaboration with a physician. A book
nonphysician healthcare workers such as lactation
by Carolyn Buppert (2008), Nurse-Practitioner’s
consultants have been lack of state licensure for
Business Practice and Legal Guide, third edition, is an
IBCLCs, opposition by other medical professions,
excellent resource for learning about reimbursement.
© Jones
& Bartlett Learning, LLC
© Jones
& Bartlett
Learning,
LLC
and third-party
payers
that fear expansion
of proThe USLCA also has a section on reimbursement on
vider eligibility.
The 1997
passage
of a provision
NOT
FOR
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OR
DISTRIBUTION
NOT
FOR
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OR
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its website, available at http://uslca.org/resources.
in the budget bill Public Law 105-33 to expand
In addition, the U.S. Breastfeeding Committee has
Medicare reimbursement for NPs allows for reimpublished a document giving guidance for thirdbursement of NP services including lactation serparty payers on implementing the lactation care
vices; however, each state has the option of covering
provisions
in the Affordable
Care Act; this docu© Jones & Bartlett
Learning,
LLC
© Jones
Bartlett
NP &
services.
SinceLearning,
the law wasLLC
passed, these nonment
is
available
at
http://www.usbreastfeeding.org
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OR
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physician providers have continued to encounter
/NewsInfo/NewsRoom/201307ModelPayerPolicy
difficulties in getting third-party payment.
/tabid/345/Default.aspx.
Physicians in the United States are able to obtain
reimbursement by using established ICD-10 medi“Incident ©to”
Billing
cal codes for breastfeeding diagnoses,
for both Learning, LLC
Jones & Bartlett Learning, LLC
© Jonesbilling
& Bartlett
Lactation services
that
fall
under
the
category
“incimother
and
baby
as
indicated,
and
submitting
NOT FOR SALEbills
OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
dent to” can be billed if they are an integral but
for insurance coverage. This type of reimbursement
incidental part of a physician’s professional services;
often falls under the constraints of contracted fees,
however, the physician must personally treat the climanaged care, and/or HMO contracts. The Amerient on the first visit to the practice and be on site when
can Academy of Pediatrics’ section on breastfeeding
© Jones
& is
Bartlett
LLC is a nurse published© Breastfeeding
Jones & Bartlett
Learning,
LLC
the service
rendered.Learning,
Thus, if the IBCLC
and Lactation:
The PediaNOT
FOR SALE
ORinDISTRIBUTION
NOTGuide
FORtoSALE
DISTRIBUTION
practitioner
working
a medical office, he or she
trician’s Pocket
Coding OR
in 2006.
However,
can bill for services to the breastfeeding dyad offered
owing to the time-consuming nature of fully evalu“incident to” the physician also seeing the mother and
ating the breastfeeding dyad and observing a feedbaby, and also being on-site. Medicare requires that
ing, the physician’s time will rarely be adequately
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32
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
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Box 1-8 ICD-10 Lactation Diagnosis Codes
Maternal
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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091.21 Non-purulent mastitis associated with pregnancy
091.22 Non-purulent mastitis associated with puerperium
091.23 Non-purulent mastitis associated with lactation
091.11 Purulent mastitis; mammary abscess during pregnancy
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& Bartlett
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LLC
© Jones & Bartlett Learning, LLC
091.12 Mastitis
associated
with puerperium
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FOR
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091.13
Mastitis
associated
with lactation
091.03 Infected nipple associated with lactation
092.03 Retracted nipple associated with lactation
092.13 Cracked nipple associated with lactation
© Jones & Bartlett
LLC
© Jones & Bartlett Learning, LLC
092.3Learning,
Complete failure
of lactation
NOT FOR SALE092.4
OR Partial
DISTRIBUTION
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failure of lactation
092.5 Suppressed lactation
092.79 Other disorders of lactation
Q83.3 Supernumerary nipple
©nipple
Jones
& Bartlett Learning,
© Jones & Bartlett Learning, LLC
Q89.9 Breast or
deformity/anomaly,
congenital LLC
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NOT
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N64.82 Hypoplasia of breast
N64.89 Subinvolution (postlactational or postpuerperium); galactocele
L24.4 Irritant contact dermatitis due to skin contact with drugs (see list of drugs for fifth and sixth digits)
Infant
© Jones
& Bartlett
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P92.5 Neonatal
difficulty
feeding at breast
P74.1
Dehydration
of newborn
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FOR
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P37.5 Neonatal candida
M26.06 Microgenia (hypoplasia of chin)
M26.04 Micrognathia (hypoplasia of mandible)
M26.11
Maxillary asymmetry
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M26.19
Retrognathia
(other
specified
anomalies
of
jaw–cranial
baseSALE
relationship)
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Q35 Isolated cleft palate (.1 hard palate, .3 soft palate, .5 hard and soft palate, .7 cleft uvula, .9 unspecified
cleft palate)
Q36 Isolated cleft lip (.0 bilateral, .1 median, .9 unilateral)
Q37 Cleft palate with either bilateral (even fourth digit)/unilateral (odd fourth digit) cleft lip (.0/.1 cleft
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Jones
& Bartlett
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hard palate, .2/.3
soft palate,
.4/.5 cleftLearning,
hard and softLLC
palate)
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Q 90.9 Down syndrome
Q38.1 Ankyloglossia (tongue-tie)
Q38.2 Macroglossia
R 13.10 Dysphagia (.11 oral phase, .12 oropharyngeal phase, .13 pharyngeal phase;)
© Jones
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P92.6 Failure
to thrive Learning,
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R62.51
to thrive
in child (older than 28 days)
R68.12 Fussy infant (irritable infant)
Source: Reproduced with permission from ICD-10 Lactation Diagnosis Codes. ICD10Data.com.
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Private
Practice
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33
compensated in full. Creative use of staff is often feaPayment and Fees
tured in the physician-led lactation clinic to allow
Most clients pay for their lactation consultation sereffective time©
management
the physician.
Jones &for
Bartlett
Learning, LLC
Jones &can
Bartlett
vices at the time of service.©
Practitioners
elect to Learning, LLC
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OR DISTRIBUTION
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waive or reduce their fees inNOT
light FOR
of exigent
circumCoding
stances of mothers, but the IBCLC’s professional
Accurate and complete coding for services and supresponsibilities remain unchanged. Setting fees is
plies is vital to the financial success of a lactation
an important part of establishing a thriving pracprogram or service. Several resources related to codtice, taking
account
what the market
will bear
© Jones & Bartlett Learning, LLC
© into
Jones
& Bartlett
Learning,
LLC
ing, billing, and reimbursement, specific to skilled
for
the
location
of
the
IBCLC
practice
as
well
as
the
NOT
FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
lactation care and frequently updated in light of
IBCLC’s particular level of experience and expertise.
fast-changing regulations in this area, are available
The prospective private-practice IBCLC can invesfrom the United States Lactation Consultant Assotigate the fees charged by comparable professionals
ciation (USLCA, n.d.)
in his or her community. Other factors to consider
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett
LLC
in setting
fees areLearning,
the anticipated
length of visits,
NOT FOR SALEPrivate
OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
costs and time to travel and park, and providing sinPractice
gle-user breastfeeding supplies during the consult.
The need to provide continuity of care in commuWhile visits to a physician’s office may last only 15
nity-based settings has led to a rise in the number of
to 20 minutes, a thorough IBCLC consult (involvprivate practitioners offering skilled care. Some phying assessment of the mother,
the baby,
and a full Learning, LLC
© Jones
Bartlett
Learning,
© Jones
& Bartlett
sicians have built
practices&that
specialize
in breast- LLC
breastfeeding session) may run 60 to 120 minutes.
NOT FOR SALE OR DISTRIBUTION
NOTothers
FORareSALE
OR
DISTRIBUTION
feeding medicine;
making
IBCLC
care a
Phone consultations may also be considered in
regular part of their practice. Lactation consultants
establishing IBCLC services. The risk in “answering
in private practice may have full- or part-time praca few questions” for the mother who calls is that the
tices; they may partner with other IBCLCs or align
formalities of establishing a professional relationthemselves
formally orLearning,
informally with
other health© Jones
& Bartlett
LLC
© Jones
Bartlett
LLC
ship are not
evident.&No
consent Learning,
forms have been
careFOR
practices
(such
as DISTRIBUTION
obstetricians or midwives,
NOT
SALE
OR
FOR
SALE
OR DISTRIBUTION
signed, noNOT
histories
have
been taken
or assessments
childbirth educators, pediatricians, chiropractors,
noted, and no individualized care plan has been creand complementary or holistic practitioners). Some
ated with follow-up built in. This is bad for busiIBCLCs also offer a retail side to the business—­ ness, and bad for excellent clinical care. IBCLCs in
perhaps renting breastfeeding equipment or offerprivate practice are most successful when they have
© Jones & Bartlett
Learning,
© Jones
& Bartlett Learning, LLC
ing classes.
IBCLCsLLC
may do home visits (handling
ongoing, mutually respectful relationships with
clinical
contact in the mother’s home), have
a FOR
NOT FOR SALEallOR
DISTRIBUTION
NOT
ORproviders
DISTRIBUTION
other SALE
healthcare
in the community, who
home-based office, or rent or share office space.
refer clients to them.
Private practice is clearly not for every lactation
The Business of Doing Business
consultant. However, those who choose this practice model enjoy rewards not
in other
practice Learning, LLC
© Jones
& Bartlett
Learning,
© found
Jones
& Bartlett
A private practice
is a small
business, and
there are LLC
settings.
The
independence
also
offers
an
opportuimportant legal
andFOR
business
considerations
that
NOT FOR SALE OR DISTRIBUTION
NOT
SALE
OR DISTRIBUTION
nity to flexibly structure the workday, offering betany IBCLC must take into account before deciding
ter work–life balance for some LCs. Linda Smith’s
to open a practice. Each IBCLC must choose which
(2003) book, The Lactation Consultant in Private
business form the practice will take, run the pracPractice: The ABCs of Getting Started, is a valuable
tice, market it, and report income (and pay taxes)
© Jones
& Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
resource for the IBCLC thinking of opening a prifor fees earned as part of the practice. The IBCLC’s
NOT
FOR SALE OR DISTRIBUTION
NOTBox
FOR
SALE
vate practice.
1-9 lists
someOR
dos DISTRIBUTION
and don’ts suginsurance should cover business and professional
gested by IBCLCs in private practice––either when
liability contingencies, and consider the locations
establishing a private practice or when initiating an
where the IBCLC conducts his or her clinical work
office-, clinic-, or hospital-based lactation service.
(Smith, 2003).
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
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9781449697280_CH01.indd 33
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Bartlett Learning, LLC
© Jones & Bartlett
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34
Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Box 1-9 Dos and Don’ts of Lactation Consulting
DO . . .
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
• Insist on gaining credibility for the profession by passing the IBLCE examination. Ensure
that people know this is the minimum credential for any person practicing as an LC in the
community.
•
From
very firstLearning,
client, behave
with the utmost professionalism.
© Jones & the
Bartlett
LLC
© Jones & Bartlett Learning, LLC
•
Charge
what
you
are
worth;
do
not
apologize
for
your
fees.
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NOT FOR SALE OR DISTRIBUTION
• Set limits immediately, so that people know the boundaries of your availability.
• Establish your own knowledge and skills boundaries. Do not be afraid to ask for help.
• Develop a network of LCs in the community; they can serve as a sounding board for problems
and as back-up when you are not available.
© Jones & Bartlett
Learning,
LLC
© Jonesby&learning
Bartlett
Learning,
LLCexperi• Avoid
repeating
problems other LCs have experienced
from
those with more
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DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
than you have.
• Know what you are doing if you rent or sell equipment. Learn how the equipment works, and
who should and should not use it. Be aware that its availability from you may influence what
you tell a client to do.
• Use a computer
to maintain
a database
of clientsLLC
and practice documents and©for
maintaining
© Jones
& Bartlett
Learning,
Jones
& Bartlett Learning, LLC
your business.
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NOT FOR SALE OR DISTRIBUTION
• Learn as much as possible about running a business. It can take years to break even.
• Get a competent business advisor for accounting, marketing, and taxes. Ensure that those advisors understand exactly what you are trying to do.
• Bill the client directly for the service. The client then files a claim to her insurance company.
© Jones
Bartlett
Learning,
© use
Jones
&insurance
Bartlettcoverage.
Learning, LLC
Use&standard
forms
for billingLLC
and a letter that the client can
to seek
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OR
DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
Develop a specialization within the field and make your work visible to others through
good
care (Brimdyr, 2002).
• Document what you have done and send the original to the primary care provider, whether or
not this individual made the initial referral.
• Recognize that this business is a labor of love. Do not expect to get rich.
© Jones & Bartlett Learning, LLC
NOT FOR SALE
OR DISTRIBUTION
DON’T
...
© Jones & Bartlett Learning, LLC
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• Don’t get heavily involved in phone consultations, paid or unpaid, without having seen the
mother and baby. An overall assessment is needed.
• Don’t give away your time without reimbursement.
© Jones
& Bartlett
LLC Advertise judiciously
© and
Jones
& Bartlett Learning, LLC
your money
on a lot ofLearning,
expensive advertising.
be patient.
• Don’t waste
NOTbeFOR
SALE OR DISTRIBUTION
FORelse’s
SALE
ORasDISTRIBUTION
• Don’t useNOT
someone
opinion
a reason for doing something. Experiment;
creative.
What works in one practice may not work in another one.
• Don’t get too many partners at the beginning. Knowing how each partner works as an individual will not necessarily predict how each works as part of a group. The more partners one
has,&the
greater the
number ofLLC
problems that can arise.
© Jones
Bartlett
Learning,
© Jones & Bartlett Learning, LLC
•
Never
forget
that
a
happy
mother
and
thriving
baby
are
your
best advertisements.
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NOT
FOR SALE OR DISTRIBUTION
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© Jones & Bartlett Learning, LLC
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Key
Concepts
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35
Acknowledgments
to healthcare costs, these studies show that
IBCLC services save the healthcare system
The authors of this first chapter of the fifth edition
reduc- Learning, LLC
© and
Jones
& Lactation
Bartlettacknowledge,
Learning, LLC enormous amounts of
© money
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learned from
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Summary
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an allied healthcare
specialty.
Most hospitals
now LLC • Most hospitals have©lactation
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which can be split into part-time positions.
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vate practices. IBCLCs usually have educaaccording to experience, as follows: novice,
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health
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and
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clinical care plans are popular methods to
Provides professional liability insurance and
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professional development opportunities.
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New
skills are mandatory.
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LEAARC
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recognition is a formal, nongovernmenthe United States, IBCLCs are increasingly
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evaluation. Approved/accredited programs
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(U.S.) health by working collaboratively to
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wide organization of physicians dedicated to
Hale
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b
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lactation consulting.
breastfeeding
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References
Includes a worldwide registry of IBCLCs.
www.iblce.org
Albernaz E, Victora CG, Haisma H, et al. Lactation counselInternational Lactation Consultant Association
ing increases breast-feeding duration but not breast
milk intake as measured by isotopic methods. J Nutr.
(ILCA):
Educational,
conference,
and
profes© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
2003;133:205–209.
sional
development
resources
including
the
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
ORourDISTRIBUTION
Altman, D. Clinics
in human
lactation:
mentoring
future.
Journal of Human Lactation. www.ilca.org
Amarillo, TX: Hale Publishing; 2010.
Canadian Lactation Consultant AssociaAmerican Nurses Association (ANA). Has JCAHO eliminated
care plans? Am Nurse. June 1991:6.
tion (CLCA): National Canadian affiliate.
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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References
NOT FOR SALE OR DISTRIBUTION
37
Andaya E, Bonuck K, Barnett J, Lischewski-Goel J. PercepCary AH. International survey of certified nurses in the U.S. and
tions of primary care-based breastfeeding promotion
Canada. Washington, DC: Nursing Credentialing
interventions: qualitative analysis of randomized
Center; 2000.
controlled©
trial
participant
Med.
Castrucci BC, Hoover K, Lim S,©
et al.
A comparison
of breast- Learning, LLC
Jones
& interviews.
BartlettBreastfeed
Learning,
LLC
Jones
& Bartlett
2012; 7(6):417–422. doi: 10.1089/bfm.2011.0151.
feeding rates in an urban birth cohort among women
NOT
FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION delivering infants at hospitals
Angeron J, Riordan J. Staffing for a lactation program [Unpubthat employ and do not
lished manuscript]. Wichita, KS: Via Christi Medical
employ lactation consultants. J Pub Health Manage
Center; 2007.
Pract. 2006;12:577–585.
Association of Women’s Health, Obstetric and Neonatal
Centers for Disease Control and Prevention. Breastfeeding.
Nurses (AWHONN). Position statement: breastfeedn.d. Available at: http://www.cdc.gov/breastfeeding
ing.&
2008.
AvailableLearning,
at: http://www.awhonn.org
/index.htm.
Accessed
2, 2014.
© Jones
Bartlett
LLC
© Jones
& January
Bartlett
Learning, LLC
/awhonn/content.do?name=07_PressRoom%2F07
Centers
for
Disease
Control
and
Prevention.
Vital Signs:
NOT FOR
SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
_PositionStatements.htm.
Accessed May 14,
Hospital Practices to Support Breastfeeding—United
2014.
States, 2007 and 2009. Morbidity and Mortality Weekly
Association of Women’s Health, Obstetric and Neonatal
Report. 2011;60(30):1020–1025.
Nurses (AWHONN). Guidelines for professional registered
Cohen R, Mrtek MB, Mrtek RG. Comparison of maternal
nurse staffing for perinatal units. Washington, DC:
­absenteeism and infant illness rates among breast-feed­Author; 2010. LLC
© Jones & Bartlett Learning,
© Jones &ing
Bartlett
Learning,
and formula-feeding
womenLLC
in two corporations.
KG, Riordan J, Gross A. The lactation consultant:
J Health
Promotion.
1995;10:148–153.
NOT FOR SALEAuerbach
OR DISTRIBUTION
NOT FOR Am
SALE
OR
DISTRIBUTION
an increasingly visible health care role. Mother Baby J.
DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of
2000;5(1):41–46.
maternity-care practices on breastfeeding. Pediatrics.
Australian Health Ministers’ Conference. The Australian
2008;122(suppl 2):S43–S49. doi: 10.1542/peds.2008National Breastfeeding strategy 2010–2015. Canberra,
1315e.
Australia: Australian Government Department of
Dodgson JE, Duckett L. Breastfeeding in the workplace:
©Ageing;
Jones
& Bartlett Learning, LLC building a support program
© for
Jones
& Bartlett Learning, LLC
Health and
2009.
nursing mothers.
Baby-Friendly USA.
Ten FOR
steps to SALE
successful OR
breastfeeding.
n.d.
NOT FOR SALE OR DISTRIBUTION
NOT
DISTRIBUTION
AAOHN J. 1997;45:290–298.
Available at: http://www.babyfriendlyusa.org/about-us
Dreyfus SE, Dreyfus HO. A five-stage model of the mental activi/baby-friendly-hospital-initiative/the-ten-steps. Acties involved in directed skill acquisition (USAF Contract
cessed June 9, 2013
No. F49620–79–C–0063). Berkeley, CA: University of
Bailey D. ILCA: 20 years of building a profession. J Hum Lact.
California; 1980.
2005;21(3):239–242.
EU
Project
on Jones
Promotion&
of Breastfeeding
in Europe. Pro- LLC
© Jones
Bartlett
Learning,
LLC breast©
Bartlett Learning,
Bartick M,&Reinhold
A. The
burden of suboptimal
tection, promotion and support of breastfeeding in
feeding
in the United
States: a pediatric cost analysis.
NOT FOR
SALE
OR DISTRIBUTION
NOT
FOR for
SALE
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Europe:
a blueprint
action. European
Commission,
Pediatrics. 2010;125:e1048–e1056.
Directorate Public Health and Risk Assessment, LuxBartick MC, Steube AM, Schwarz EB, et al. Cost analysis of
embourg, 2004. Available at: http://ec.europa
maternal disease associated with suboptimal breastfeed.eu/health/ph_projects/2002/promotion/fp_promotion
ing. Obstet Gynecol. 2013;122(1):111–119.
_2002_frep_18_en.pdf. Accessed May 14, 2014.
Benner P. From novice to expert: excellence and power in clinical
Gibbins S, Green PE, Scott PA, et al. The role of the clinical
© Jones & Bartlett Learning,
LLCPark, CA: Addison-Wesley; © Jones &nurse
Bartlett
Learning,
LLC
­nursing practice. Menlo
specialist/neonatal
nurse practitioner
in a breast1984.
model of advanced practice. Clin Nurse
NOT FOR SALE OR DISTRIBUTION
NOT FOR feeding
SALEclinic:
ORa DISTRIBUTION
Special. 2000;14:56–59.
Bornmann P. A legal primer for lactation consultants. In:
International Lactation Consultant Association, Mannel
Health Insurance Portability and Accountability Act (HIPAA)
R, Marten PJ, Walker M, eds. Core curriculum for lactaof 1996, 45 C.F.R. 160, 162, 164 (2002).
tion consultant practice (3rd ed.). Burlington, MA: Jones
Heinig MJ. Closet consulting and other enabling behaviors.
& Bartlett Learning; 2013:215–242.
© Jones & Bartlett Learning, LLC J Hum Lact. 1998;14:181–182.
© Jones & Bartlett Learning, LLC
Brimdyr K. Lactation management: a community of practice.
Hinson P. The business of clinical practice. In: Auerbach KG,
SALE OR DISTRIBUTION
NOT
SALE
OR DISTRIBUTION
In: Cadwell
K, ed.FOR
Reclaiming
Breastfeeding
for the
ed. Current issues in clinicalNOT
lactationFOR
2000. Sudbury,
United States. Sudbury, Mass: Jones and Bartlett;
MA: Jones and Bartlett; 2000:43–47.
2002:51–63.
International Baby Food Action Network, International Code
Britton C, McCormick FM, Renfrew MJ, et al. Support of
Documentation Centre. Code essentials 3: responsibilities
breastfeeding mothers [Review]. Cochrane Collaboraof health workers under the international code of marketing
tion. Available at: http://www.thecochranelibrary.com.
of breastmilk
substitutes
and subsequentLearning,
WHA resolutionsLLC
© Jones
&
Bartlett
Learning,
LLC
© Jones
& Bartlett
Accessed July 28, 2007.
(Report No. 3). Penang, Malaysia: Author; 2009.
NOT
FOR
SALE
ORissues
DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Brooks
E. Legal
and ethical
for the IBCLC. Burlington,
International Board of Lactation Consultant Examiners
MA: Jones & Bartlett Learning; 2013.
(IBLCE). Sanctions list. April 2010. Available at:
Buppert C. Nurse practitioner’s business practice and legal guide
http://iblce.org/wp-content/uploads/2013/08/sanctions
(3rd ed.). Sudbury, MA: Jones and Bartlett; 2008.
-list.pdf. Accessed May 14, 2014.
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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Chapter
1: The
Lactation Consultant:©Roles
and
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
at: http://www.leaarc.org/index.html. Accessed July 13,
International Board of Lactation Consultant Examiners
2013.
(IBLCE). Code of professional conduct for IBCLCs.
November 1, 2011. Available at: http://iblce.org/wp
Lauwers J. Mentoring and precepting lactation consultants.
-content/uploads/2013/08/code-of-professional-conduct
© Jones & Bartlett Learning, LLCJ Hum Lact. 2007;23:10–11. © Jones & Bartlett Learning, LLC
.pdf. Accessed May, 14, 2014.
Lauwers J. Communication and counseling
In: Mannel
NOTskills.
FOR
SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
International Board of Lactation Consultant Examiners
R, Martens P, Walker M, eds. ILCA core curriculum for
(IBLCE). Examination data. Provided by IBLCE Execulactation consultant practice (3rd ed.). Burlington, MA:
tive Director, August 2013.
Jones & Bartlett Learning; 2012:53–64.
International Board of Lactation Consultant Examiners
Lauwers J, Swisher A. Counseling the nursing mother: a lactation
(IBLCE). Clinical competencies for the practice of
consultant’s guide (5th ed.). Sudbury, MA: Jones and
© Jones
& Bartlett
Learning,
LLC (IB© Jones & Bartlett Learning, LLC
international
board certified
lactation consultants
Bartlett; 2010.
CLCs).
September
15,
2012a.
Available
at:
http://iblce
List
BA,
Ballard
JL, Langworthy
KS, et al. Electronic
health
NOT.org/wp-content/uploads/2013/08/clinical
FOR SALE OR DISTRIBUTION
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records in an outpatient breastfeeding medicine clinic.
-competencies.pdf. Accessed May 14, 2014.
J Hum Lact. 2008;24:58–68.
International Board of Lactation Consultant Examiners
Mannel R. Lactation rounds: a system to improve hospital
(IBLCE). Scope of practice for international board
productivity. J Hum Lact.2010;26:393–398.
­certified lactation consultant (IBCLC) certificants.
Mannel
lactation
acuity to improve
patient safety
© Jones & Bartlett
Learning,
LLC
© JonesR.&Defining
Bartlett
Learning,
LLC
­September
15, 2012b.
Available at: http://iblce.org
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/wp-content/uploads/2013/08/scope-of-practice.pdf.
NOT FOR SALE Accessed
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Mannel
R. Developing
and managing
a hospital lactation
May 14, 2014.
service.
In:
International
Lactation
Consultant AssociaInternational Labour Office, Conditions of Work and Employtion; Mannel R, Marten PJ, Walker M, eds. Core curment Programme. Maternity at work: a review of
riculum for lactation consultant practice (3rd ed.). Burlingnational legislation. 2010. Available at: www.ilo.org
ton, MA: Jones & Bartlett Learning; 2013:243–255.
/wcmsp5/groups/public/@dgreports/@dcomm/@publ
Mannel
lactation&pro© Jones & BartlettAccessed
Learning, LLCR, Mannel RS. Staffing for hospital
© Jones
Bartlett Learning, LLC
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grams: recommendations from a tertiary care teaching
July 13, 2013. NOT FOR SALE OR DISTRIBUTION
NOT
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hospital. J Hum Lact. 2006;22:409–417.
International Lactation Consultant Association (ILCA). Home
Martens PJ, Derksen S, Gupta S. Predictors of hospital readpage. n.d. Available at: http://www.ilca.org/i4a/pages
mission of Manitoba newborns within six weeks post/index.cfm?pageid=1. Accessed June 9, 2013.
birth discharge: a population-based study. Pediatrics.
International Lactation Consultant Association (ILCA). Lacta2004;14(3):708–713.
tion consulting: the first twenty years a history. ILCA: 1985© Jones
Bartlett
Learning,
LLC
Jones
& Bartlett
Learning,
LLC
Miller RD. Civil©
liability.
In: Miller
RD. Problems
in health
2005 the&
birth
of a profession
and an association,
Lauwers
care law (9th
ed.). FOR
Sudbury,SALE
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andDISTRIBUTION
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ed. Raleigh,
NC: Author;
2005.
NOTJ, FOR
SALE
OR DISTRIBUTION
NOT
OR
2006:587–681.
International Lactation Consultant Association (ILCA), HenNational
Commission for Certifying Agencies Standards
derson S. Position paper on the role and impact of the
(NCCA). Available at: http://www.credentialingexcelIBCLC. 2011. Available at: http://www.ilca.org/files
lence.org/p/cm/ld/fid=66. Accessed July 13, 2013.
/resources/ilca_publications/Role%20%20Impact%20
Niebuhr B, Biel M. The value of specialty certification. Nurs
of%20the%20IBCLC-webFINAL_08-15-11.pdf. Ac© Jones & Bartlett
Learning,
© Jones
& Bartlett
Learning, LLC
Outlook.
2007;55:176–181.
cessed
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Noel-Weiss
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AK. Exploring how
International
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BMC Med Ethic. 2013;13(18):1–8. Available at:
Kombol P, Kutner L, Barger J, comps.; Lauwers J, ed.
http://www.biomedcentral.com/1472-6939/13/18.
Amarillo, TX: Hale Publishing; 2012.
Noel-Weiss J, Walters GJ. Ethics and lactation consultants:
International Lactation Consultant Association (ILCA).
developing knowledge, skills and tools. J Hum Lact.
Standards of practice for International Board Certified
© Jones
Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
2006;22(2):203–212.
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Office on Women’s Health, U.S. Department
HealthSALE
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Human Services. Business case for breastfeeding. 2008.
Available at: https://www.womenshealth.gov
The Joint Commission (TJC). Specifications manual for
/breastfeeding/government-in-action/business-case
­national Joint Commission quality core measures.
.html. Accessed May 14, 2014.
2013. Available at: http://manual.jointcommission.org
/releases/TJC2013B/.
Accessed
July
13,
2013.
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Final Rule,
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Information
Technol- LLC
© Jones & Bartlett Learning, LLC
© Jones
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5566
(January
25, 2013).
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JulyOR
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Paola
FA,
Walker
R,
Nixon
LL.
Medical
ethics
and humanities.
Lactation Education Approval and Accreditation Review
Sudbury, MA: Jones and Bartlett; 2010.
Committee (LEAARC). Home page. n.d. Available
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NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
References
NOT FOR SALE OR DISTRIBUTION
39
U.S. Department of Labor, Wage and Hour Division. Fact
Parris KM. Integrating nursing diagnosis, interventions, and
sheet #73: break time for nursing mothers under the
outcomes in public health nursing practice. Nurs Diag.
FLSA. 2010. Available at: http://www.dol.gov/whd/regs
1999;10:49–56.
July
2013.
Jones
& Bartlett
Learning,
LLC /compliance/whdfs73.htm.©Accessed
Jones
&13,
Bartlett
Learning, LLC
Paul IM, Lehman©EB,
Hollenbeak
CS, Maisels MJ.
PreventU.S.
Lactation
Consultant
Association
(USLCA).
Licensure
able newborn
readmissions
since
passage
of
the
NewFOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION and reimbursement. n.d. NOT
Available at: http://www.ilca.
borns’ and Mothers’ Health Protection Act. Pediatrics.
org/i4a/pages/index.cfm?pageid=4126. Accessed June
2006;118(6):2349–2358.
10, 2013.
Phillips V. The Nursing Mother’s Association of Australia as
U.S. Lactation Consultant Association (USLCA). International
a self-help organization. In: Katz AH, Bender EL, eds.
Board Certified Lactation Consultant staffing recomHelping one another: self-help groups in a changing world.
© Jones
& Bartlett
LLC
© Jones
Bartlett
Learning,
mendations
for the&
inpatient
setting.
2010. AvailableLLC
Oakland,
CA: ThirdLearning,
Party Publishing;
1990.
at:
http://uslca.org/resources/publications.
Accessed
Raudonis
BM,
Anderson
CM.
A
theoretical
framework
for
NOT FOR SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
July 13, 2013.
specialty certification in nursing practice. Nurs Outlook.
U.S. Preventive Services Task Force (USPSTF). Primary care
2002;50:247–252.
interventions to promote breastfeeding: an evidence
Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM. The
­review for the U.S. Preventive Services Task Force.
CDC guide to breastfeeding interventions. Atlanta, GA:
2008. Available at: http://www.uspreventiveservices
U.S. Department of Health and Human Services, Cen© Jones & Bartlett Learning,
LLC and Prevention; 2005. Avail© Jones &taskforce.org/uspstf08/breastfeeding/brfdartfig3txt
Bartlett Learning, LLC
ters for Disease Control
Accessed
20, 2013.
at: http://www.cdc.gov/breastfeeding/resources/NOT FOR .htm.
NOT FOR SALE ORable
DISTRIBUTION
SALE
OR July
DISTRIBUTION
Wiessinger D. Professional responsibility revisited. In: Smith
guide.htm. Accessed July 13, 2013.
L, ed. The lactation consultant in private practice. Sudbury,
Smith L. The lactation consultant in private practice: the ABCs of
MA: Jones and Bartlett; 2003:214–226.
getting started. Sudbury, MA: Jones and Bartlett; 2003.
Williams
EL. Increasing your credibility with physicians:
Spatz D. The critical role of nurses in lactation support.
strategies for lactation consultants [editorial]. J Hum
JOGNN. 2010;39:499–500.
© Jones & Bartlett Learning, LLC Lact. 1995;11:3–4.
© Jones & Bartlett Learning, LLC
Thorley V. Complementary and competing roles of volunteers
NOT
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NOT
FOR
SALE
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Witt
AM,
Smith
S,
Mason
MJ,
et
al. Integrating
routine OR DISTRIBUTION
and professionals in the breastfeeding field. Int Self Help
lactation consultant support in to a pediatric practice.
Self Care. 2000;1(2):171–179.
Breastfeed Med. 2012;7:38–42.
U.S. Copyright Office. Copyright basics (Report No. CircuWorld
Health Organization (WHO). The full code and subselar 1). Washington, DC: U.S. Copyright Office; 2012.
quent WHA resolutions. n.d. Available at InternationAvailable at: http://www.copyright.gov/circs/circ01
al Baby Food Action Network website: http://www
.pdf.
February
19, 2014. LLC
© Jones
&Accessed
Bartlett
Learning,
© Jones & Bartlett Learning, LLC
.ibfan.org/issue-international_code-full.html. Accessed
U.S. Department of Agriculture. WIC works resource system
NOT
FOR
SALE
OR
DISTRIBUTION
NOT
FOR SALE OR DISTRIBUTION
June
10, 2013.
(Loving Support WIC peer counselor training). n.d.
World
Health
Organization,
Division of Child Health and
Available at: http://wicworks.nal.usda.gov/. Accessed
Development. Evidence for the ten steps to successful breastJune 7, 2013.
feeding. Geneva, Switzerland: Author; 1998. Available
U.S. Department of Health and Human Services, Human Reat: http://whqlibdoc.who.int/publications/2004
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tive
services:
required
health
plan
coverage
guidelines.
© Jones & Bartlett Learning, LLC
© Jones
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Learning, LLC
World
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NOT FOR infant
SALE
DISTRIBUTION
and OR
young child
feeding. Geneva, Switzerland:
Accessed June 9, 2013.
Author; 2003.
U.S. Department of Health and Human Services. The Surgeon
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