The steady diet of ethics that I feed attendees of 90-credit Comprehensive Lactation Course surprises some. I am by no means the be-all and end-all of ethical issues and answers, but I do enjoy the challenge of a good question from participants. Therefore, I found this question about what IBCLCs are able to say about prescription medications intriguing.
I currently work with three IBCLCs at my facility and we have had some discussion about how much advice we can give about medications. The discussion has been sparked by our understanding of the Code of Professional Conduct (CPC).
Two of the four of us say that it is acceptable to print out information from credible sources or give the manufacturer’s package insert that accompanies the drug. However, our newest IBCLC says that we may give the information to the physician, and then it’s up to the physician to tell the patient whether the drug is compatible with or contraindicated while breastfeeding. Can you help to clarify this?
With the above scenario in mind, I have read two documents from the IBLCE® several times. I urge you to read and re-read the documents, too. I cannot see where there is any directive to prohibit the IBCLC from giving information to the mother. Here are the relevant passages:
Scope of Practice
IBLCE’s Scope of Practice (December 2018) says, “IBCLC certificants have the duty to provide competent services for clients and families by providing evidence-based information regarding use, during breastfeeding and human lactation, of medications (over-the-counter and prescription), alcohol, tobacco and addictive drugs, and herbs or supplements, and their potential impact on milk production and child safety.
Code of Professional Conduct
The text of the Code of Professional Conduct (Nov. 2011, updated September 2015) has a similar statement in Principle 1: “Every IBCLC shall: … Supply sufficient and accurate information to enable clients to make informed decisions … [and] Convey accurate, complete and objective information about commercial products.”
To me, these passages say that not only is the IBCLC allowed to give such information to the mother, she has a duty to do so!
Of course, a newly-minted IBCLC colleague may have the right intentions when talking about what an IBCLC can say about prescription medications. The colleague may be trying to provide the doctor with information prior to providing the client with the information. That’s just good manners. (If I were the doctor, I would not want the IBCLC to go around telling patients information that I was unaware of, or information that might change my clinical recommendation.)
Similarly, we all need to avoid the situation of making doctors look dumb or feel as though they have been blindsided. Creating an adversarial situation with doctors doesn’t accomplish anything, and is just plain rude.
There is also the case of the package insert. Even if the IBCLC withholds this information, the client can get it from the the pharmacist, or from the Internet. Had the client filled a prescription at a pharmacy, an insert, or very similar materials, would have come with the medication. Anyone who looks up the information on the Internet can see the manufacturer’s package insert information.
In short, if clients really want that information, they can get it! It seems pointless for us to withhold easily-obtained information on prescription medication.
Information versus advice
As I’ve written before, there is, however, a clear distinction between giving INFORMATION and giving ADVICE. I am not an attorney, but it is my clear understanding that the person who has prescriptive privileges and manages the care of that patient has the legal right to advise about the risk-benefit decision. The rest of us cannot interpret, summarize, paraphrase, or otherwise alter the information. We may quote the source verbatim, or simply supply the client with the published material.
Let me add that ultimately, it’s the client who will make the final decision about the risk-benefit. The client cannot do that without having adequate information.
In summary, this comes down to a duty to provide evidence-based information to the client and a commitment to good manners. Finally, the client, IBCLC, and physician need to understand that giving information is very different from giving advice about the risk-benefit of any medication, including prescription medications. According to IBLCE, IBCLCs are ethically bound to provide the former, but the latter is outside of the IBCLC’s Scope of Practice.
Although I feel confident in my interpretations of these documents, I will say what I always preach in class: Never hesitate to go to the primary source! If you have questions, please contact the IBLCE directly.
What are your thoughts on what an IBCLC can say about prescription medications? Let me know in the comments below!