is this lact consultant ethical?

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We have a lactation consultant who is no longer an employee of our hospital. She works for the ob/gyn (we'll call him DrX)and sees his patients postpartum. All of our other doc's pts are seen by another lactation consultant from the health dept (who is an employee of the hospital). The problem is, we are not allowed to give breastpumps, shields, anything to those moms of DrX. We are to call his lc if they need anything...but not in the middle of the night, etc. I know there are a lot of differing opinions on shields, pumps, etc- but the bottom line is the bottom line. For instance an evening nurse called her wanting a pump for a mom whose baby was in the nicu and the lc said she'd just see her in the morning, let her rest tonite. She wants them to come to her office and buy the pumps from her, which they could get free from the health dept.

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We have a lactation consultant who is no longer an employee of our hospital. She works for the ob/gyn (we'll call him DrX)and sees his patients postpartum. All of our other doc's pts are seen by another lactation consultant from the health dept (who is an employee of the hospital). The problem is, we are not allowed to give breastpumps, shields, anything to those moms of DrX. We are to call his lc if they need anything...but not in the middle of the night, etc. I know there are a lot of differing opinions on shields, pumps, etc- but the bottom line is the bottom line. For instance an evening nurse called her wanting a pump for a mom whose baby was in the nicu and the lc said she'd just see her in the morning, let her rest tonite. She wants them to come to her office and buy the pumps from her, which they could get free from the health dept.

Sounds fishy to me. Are the pumps from Dr X lc the same as the ones from the health dept? Is Dr X lc worried that the ones from the health dept. aren't as good as hers?

I couldn't imagine a health dept. offering defective pumps, so it sounds like the lc wants money. What would happen if you went behind Dr X's back and went straight to the health dept?

I would bring this up to the nurse manager. Dr. X and his lc should be worried about patient care and not the money.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I don't like it. Any way this subject can be brought up to your Perinatal/Ped Committees?

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That doesn't sound at all ethical. You can't even get "her" patients started pumping with a hospital pump? Who does that benefit, besides this outside LC's pocketbook? I don't like it at all.

If it is a question of health dept pumps being of lesser quality, maybe I can see that, but... around here, WIC will provide brestfeeding moms with a mini-electric pump. But if they have a documented need (NICU baby, history of breast surgery, etc) for a high grade pump, the lc or peds can write a prescription for & WIC will provide for the rental of a hospital-grade double pump.

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I don't think it's ethical. I also don't think a doctor should be able to say you can't give breastfeeding advice or give out pumps or shields.

Breastfeeding is not a medical intervention. We have lactation consultants to help us with it but it is still something that falls under the realm of nursing. Because it's a nursing responsibility I don't think that a doctor should be able to stop you from doing it. It would be one thing if the lac consultant were willing to come in when patients needed her but she isn't. Its not okay for the patient to suffer threw the night just because of this exclusive agreement.

If it were me I would call the lac consultant and tell her that the patient needed to see her. If she could come in and do her job within the time frame the patient needed then I would just let her handle it. If she couldn't get in on time then I'd let her know that I would do the teaching and give the patient a breast pump. I'd explain that the patient needed the interventions now and not in the A.M. but that she would be welcome to see the patient and add anything I missed once she found it convenient to come in and see the patient.

This is a political situation so you have to be prepared for political repercussions for anything you do. Still the larger issue is that mom's and babies need care and regardless of weather or not the doc has a private lac consultant you are still ultimately responsible for that care.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Sounds as if Dr. X has a plan for a windfall. Swaying these moms his way to profit.

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Specializes in Psych, Med/Surg, LTC.

I don't think its ethical. But whats worse than that, is that some moms will get very frustrated and give up on breastfeeding all together. If she has the baby at say 5pm, and has no help until 9am, thats about 16 hours that she would be tired and struggling and worried about the baby's lack of eating. She may ask for formula and just completly give up by then. Then the baby won't be getting ideal nutrition, and mom may be left feeling like she is a bad mom. (Even though she is doing the best thing she can do, feeding a hungry baby) And its sad that this could have possibly been prevented if mom didn't have to wait for help.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

The more I think about this, the more it really, really bothers me. It needs to be elevated and discussed at your perinatal committee meetings. If you don't have *immediately available* 24/7 LC services, all nurses who work with new moms/breastfeeding babies *MUST* be trained and stand ready to help w/special situations and problems, and that would very much include the immediate availability and use of devices like breastpumps SNS systems, shields and other necessary aids. THIS IS WRONG, WRONG, WRONG here. VERY wrong.

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Specializes in Perinatal, Education.

This is wrong on many levels. What happens to the mom who gives birth to the preemie or sick baby who gets sent to NICU--or even another hospital at 7pm??? As a lactation consultant, she should know that that mom needs to start pumping within 6-12 hours of delivery to start to establish her milk supply. This is even more important for a preemie/sick baby as they need that breast milk!!! What happens on the weekends?? I agree with other posters that ALL nurses who work with moms and babies need to have good training in breastfeeding and the theories/studies behind the practices. She sounds like the patients aren't her top priority!!

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Specializes in Pediatrics.
The problem is, we are not allowed to give breastpumps, shields, anything to those moms of DrX. We are to call his lc if they need anything...but not in the middle of the night, etc.

Who set that policy (as you say this situation is in the past, lc no longer there)? The mother gets to decide what practitioners she uses! If the mother wants a pump in the middle of the night from the hospital, she can request it and get it! She doesn't have to go with a certain doc's lc! I'm sure that doctor's patients would be pissed if they knew what was being done to them!

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