People who take to my 95-credit Lactation Education Course are sometimes surprised by the amount of ethics content in the course. Perhaps that’s why I receive some very interesting ethics questions from course participants months (years even!) afterward. I admit it: I am not the be-all and end-all of ethical issues and answers, but I do enjoy the challenge of a good question, including this one from a past course participant. Here’s what she asked about IBCLCs talking about prescription meds.
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 most recent IBCLC 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 according to the CPC, 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 the IBLCE’s Scope of Practice and Code of Professional Conduct several times, and I urge you to read and re-read the documents, too. I cannot see where there is any directive to prohibit an IBCLC from giving information to the client or family.
Let’s review the relevant passages. From the Scope of Practice:
“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 . . .”
To me, that statement says that not only are IBCLCs ALLOWED to give such information to the mother, they have a DUTY to do so!
The text of the Code of Professional Conduct concurs, stating: “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.”
Of course, newly-minted IBCLC colleagues may have the right intentions. They may be trying to provide the doctor with information prior to providing a client with the information. 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 management. We all want to avoid the situations of making the doctor look dumb or feel as though he has been blindsided. Certainly, we all need to approach colleagues in a respectful, helpful manner before giving the patient information that makes them look good and makes the doctor look bad. Creating an adversarial situation with the doctor doesn’t accomplish anything, and is just plain rude, so this is an understandable goal.
There is also the case of the package insert. If clients have a prescription for the drug filled at a pharmacy, they would have received the insert, or very similar materials, with the prescription. If they have looked up the information on the internet, they could have seen the manufacturer’s package insert information. Whether clients get it from the IBCLC, the pharmacist, or from the internet seems unimportant. If they really want that information, they can and do get it! And, if they want to find the information in a book or in a journal, they can do that, too. Why should we withhold information they could easily obtain?
There is, however, a clear distinction between giving INFORMATION and giving ADVICE.
IBCLCs cannot give risk-benefit advice, since that requires holding a state license that allows them to do so. They cannot interpret, summarize, paraphrase, or otherwise alter the information. IBCLCs may quote the source verbatim, or simply supply the client with the published material. They may also confirm if they agree that that the advice about taking a medication is sound. (Example: “Yes, it’s okay to take your prescribed ibuprofen.”)
Perhaps the new IBCLC is confusing “information” with “advice.” IBCLCs are not qualified to give advice; I’m not an attorney, but I think most authorities would agree that giving advice about whether or not the drug is safe for the breastfeeding infant is tantamount to practicing medicine without a license. Otherwise stated, the IBCLC can’t say “don’t take this medication your primary care provider has prescribed.” The person who has prescriptive privileges and manages the care of that patient has the legal right to make risk-benefit decision. The IBCLC may provide information but not pronounce the risk-benefit or make such a decision.
In summary, this comes down to a duty to provide evidence-based information to clients, a commitment to good manners, and the recognition that information about medication is very different from advice about medication risk-benefit. According to IBLCE, we are ethically bound to provide the former — but providing the latter is outside of our scope of practice.
Although I feel confident in my interpretations of these documents, I will say what I always preach in my courses: Never hesitate to go to the primary source! If you have questions, please contact the IBLCE directly.