Liz Brooks, JD, IBCLC, FILCA

Is my public health objective more important than yours?  Experts agree: exclusive breastfeeding should occur for at least six months, and continue while complementary foods are introduced.  Breastfeeding is dose-dependent (the more, the better), so mothers and babies have improved health outcomes, throughout their lifetimes, when there is breastfeeding.  This includes a protective effect against obesity for both mother and child; it also has a protective effect against other morbidities associated with overweight (diabetes and cardiovascular disease). And yet: messaging from other important public health campaigns may be at odds with messaging designed to increase breastfeeding initiation, exclusivity and duration.  Examples: suggestion to use pacifiers (dummies) "to prevent SIDS" (reduces breastfeeding opportunities; reduces milk supply) and back-to-sleep (or) no-co-bedding campaigns "to prevent SIDS" (reduces feeding opportunities; reduces milk supply; discounts evidence-based protective effect against SIDS of exclusive breastfeeding).  Mothers who are given conflicting information and messages (i.e. "breastfeed upon demand, even at night ... but never sleep with your baby in your bed") are frustrated with inconsistent breastfeeding advice, and  may engage in the least-healthy behaviors (i.e. sleeping in recliner chair with an infant, rather than a safe proximal sleeping arrangement).  Learn how to identify and re-frame public health objectives, so that all campaign messaging is consistent.   

Mom tested positive for drugs when she arrived to deliver, and now wants to breastfeed. Mom hands you a print-out from a social networking site, and asks if you agree with the customer ratings given for breastfeeding supplies. Low-supply NICU mom wants to know if she can bring in expressed breastmilk from her best friend, who is still breastfeeding a toddler. OB orders a hormonal contraceptive injection on Day 2 for an exclusively breastfeeding mother, and you are concerned the progestin will affect her milk supply. Yikes! Who knew the road to safe, natural, biologic-norm breastfeeding had so many legal and ethical potholes? At the end of this session, participants will be able to: (1) Describe the difference between a legal and an ethical responsibility as a health care provider; (2) Define a professional conflict of interest for the medical professional serving clients/patients; (3) Identify three reliable on-line, evidence-based lactation resources for parents, and for health care providers; (4) Implement immediate changes in record-keeping to conform with ethical benchmarks for lactation consultation

Deal or No Deal? What if determining the IBCLC's correct course of action, when faced with a moral, legal or ethical dilemma, was as fun as being a game show contestant? This session will review the ILCA Standards of Practice, and IBLCE Code of Professional Conduct, the IBLCE Scope of Practice for IBCLCs, and other authorities affecting our professional work (i.e. licensing and scope of practice). Look for humor, prizes and even buzzers to make this analysis of IBCLC ethics memorable -- and fun. We'll cover common everyday problems (what if your boss requires you to hand out a formula discharge bag?) and more theoretical ones (can anyone own a patent on human milk components?) An opportunity for audience members to pose hypothetical situations will provide take-home-and-use answers: a prize for everyone! Objectives: The IBCLC will be able to: 1. describe the differences between the ILCA Standards of Practice, the IBLCE Code of Professional Conduct and the IBLCE Scope of Practice for IBCLCs 2. implement immediate changes in record-keeping to conform with ethical benchmarks for lactation consultation 3. identify (and avoid) real and perceived conflicts of interest in lactation consultation practice 4. describe the influence of marketing of breastmilk substitutes in the workplace, so as to avoid becoming an unwitting salesperson for formula 5. change at least three elements in her day-to-day practice to protect a mother's confidential information

The 2011 IBLCE Code of Professional Conduct (IBLCE CPC), describing mandatory ethical behaviors for IBCLCs, states at Principle 2.5 "Respect intellectual property rights."  Intellectual property includes copyrights (which apply to written material, photographs, slides, illustrations, etc.), trademarks, service marks, and patents.  As an IBCLC, you are required to follow the IBLCE CPC. But what if you find the patenting of human milk components objectionable, on legal or moral grounds? Did you know that trademark law for baby food manufacturers "trumps" the protections that the International Code of Marketing of Breast-milk Substitutes is designed to offer? While these legal issues provide for stimulating discussion, most IBCLCs simply want to know: where can I get my hands on some good, free hand-outs? So we'll cover it all. In addition to a review of the legal issues, the participant will leave with a long list of sources for fabulous materials, that can be immediately used and adapted, in clinical lactation practice. Objectives: 1. Define the four areas of intellectual property (IP) law that might affect an IBCLC 2. Describe the rationale for IBLCE CPC Principle 2.5, requiring IBCLCs to respect IP laws 3. Describe procedures to obtain permission to use IP materials from others 4. Learn how to protect your own materials from unauthorized use 5. Identify several sources for permission-granted lactation materials, that are immediately available for use

Imagine parents in a bitter custody dispute: dad wants overnight visitation; baby is still nursing at night, mom wants you to testify on her behalf. Does the IBCLC represent the Mom? The baby? Or the profession of lactation consultation? What if dad wants you to testify? Is it unethical to be paid to prepare and practice your testimony? Or, imagine the breastfed baby who was born at 37 weeks, left the hospital poorly-feeding, got hyperbilirubinemia, and whose parents have now sued everyone connected with his care (including the IBCLC) for malpractice. Who defends the IBCLC? Who pays the lawyer? Can you continue to work? As our profession grows, more IBCLCs are finding themselves being called to court – sometimes as a willing expert; sometimes as a reluctant witness. This session will examine the IBCLC’s legal and ethical responsibility if called to court. Liz's expertise is in American law, but many of the concepts are universal, and she can adapt her presentation to suit the intended audience. Objectives and Content Describe the process to be qualified as an expert witness on lactation in a courtroom 1. Jurisdiction of family law courts 2. Role of expert vis-à-vis the court, and the parties 3. Preparing your resume and curriculum vitae 4. Describing for the record the international certification to earn IBCLC credential 5. Taking it on the chin: cross-examination Describe the IBCLC’s responsibilities if sued as part of her work 1. Ethical and legal practices for documentation 2. Professional liability insurance primer 3. Protecting your records during “discovery” 4. Finding allies; avoiding enemies 5. Keeping your focus during the rest of your work

Bias, confusion, tension, conflicts-of-interest (COI): is this the inevitable result when healthcare providers (HCPs) rub elbows with commercial interests like pharmaceutical and medical device manufacturers? Such COIs threaten the integrity of research, the objectivity of professional education, and ultimately the patient's trust. This session explores how HCPs in research, clinical care and public health can avoid being pulled -- knowingly or not -- into situations where their judgment becomes (or is seen as) biased. At the end of this session, participants will be able to: 1. Identify three voluntary practice-guiding ethics documents covering health care provider relationships with commercial interests. 2. Identify three mandatory practice-guiding documents covering health care provider relationships with commercial interests. 3. Describe the difference between a "professional" and a "personal" conflict of interest in a health care setting. 4. Define "reciprocity" in the context of healthcare providers accepting gifts from commercial interests. 5. Implement three practices, today, to reduce real or imagined commercial conflicts of interest (COI).

Participants will be able to define at least five sources of formal legal authority, and five sources of informal legal authority, over a health care provider (HCP) like an IBCLC. Participants will be able to define and describe five different scenarios in the workplace where ethical and legal issues arise for the HCP assisting a breastfeeding mother and baby. Participants will be able to describe five techniques to prepare for an appearance in court as an expert, witness or defendant, in a case involving a breastfeeding mother.

There is a lot of confusion about what the International [WHO] Code means, and how to support it, in a world full of marketing. Do you violate the Int'l [WHO] Code if you work for a hospital that distributes formula discharge bags? Can you use glossy handouts from bottle manufacturers? The IBLCE Code of Profesional Conduct encourages IBCLCs to adhere to the WHO Code. This session will use real-life case studies to discuss challenges faced by IBCLCs, asking: a) does the Int’l Code apply; (b) are other options available to curtail marketing influences in the healthcare workplace; and (c) what are the consequences when there is a violation of the Int’l Code? At the end of this session, the participants will be able to: 1. Describe the legislative history of the International Code of Marketing of Breast-milk Substitutes, and why IBCLCs need to support its principles. 2. Identify geopolitical areas that have enacted enforcement procedures for the International Code, and those that do not have an offical support mechanism for this global initiative. 3. Identify three or more areas of commerce and marketing, not envisioned when the Code was drafted in 1981, that affect today's commercial messages about breastfeeding. 4. Describe the mechanism for reporting International Code violations, and identify reliable means to determine if a marketer is in compliance with the International Code 5. Implement five or more immediate changes in professional practice to show IBCLC support for the International Code.

Your client just called at 3 a.m., for the third night in a row, for more "hand-holding" about babies that want to breastfeed at night. The mother you saw in the hospital is threatening to write a nasty letter to the administrators because you urged breastfeeding-on-demand, which is not what she learned in her faith-based parenting class. Your client of a 36-weeker, discharged home at 38 weeks, refuses to pump because she "has no time," but she cut your session short so she could go get a pedicure. Can an IBCLC ever fire a mom? Sometimes the "chemistry" just isn't there, and you think a mother may be better served by other IBCLCs you can suggest. Sometimes your client/patient is volatile or even dangerous. Sometimes you Just Don't Like this mom. This session will discuss when, and how, an IBCLC may end her professional relationship with a mother. After this session, the participant will be able to identify: (1) Sections of the IBLCE Code of Professional Conduct, IBLCE Scope of Practice for IBCLCs, and ILCA Standards of Practice that govern how an IBCLC may end a professional relationship with a mother; (2) Three annoying habits of mothers that are not grounds to "fire" her as a client/patient; (3) Three surprising habits by mothers that will permit you to sever your professional ties; (4) At least six verbal and written steps needed to ethically and legally terminate the professional lactation consultation relationship.

The American government is built upon the notion of a balance of power: inherent tensions between the governing authorities in our lives require a system of checks-and-balances. Is the field of lactation consultation any different? As a young allied health care profession, lactation consultation must fit inside (or alongside) pre-existing systems of support and health care for the breastfeeding dayd. This creates tensions between the IBCLC and others serving a mother and baby. So what is the IBCLC to do when s/he identifies a problem with the advice mom is getting elsewhere? How does s/he professionally, ethically, and legally express a difference of opinion? Do we even put our certification at risk by discussing with mother the non-evidence-based information she has received? The ILCA Standards of Practice, the IBLCE Code of Professional Conduct and the IBLCE Scope of Practice for IBCLCs do offer guidance on how an IBCLC is to handle conflict and debate ... but this session goes beyond: to describe techniques for discussing your difference of opinion with colleagues, without being ignored or patronized. Objectives: Identify sections of the ILCA Standards of Practice, IBLCE Code of Professional Condcut, and IBLCE Scope of Practice for IBCLCs governing an IBCLC's obligations to: 1. act as an advocate for breastfeeding women, providing sufficient information to permit informed decisions 2. base clinical practice on well-designed research 3. work within the legal framework of her/his institution and community 4. share evidence-based information and clinical skills with other health care providers 5. conduct oneself with honesty, integrity and fairness 6. recognize the limits of one's personal competence, making referrals as necessary

You are a private practice lactation consultant. If you're doing your job well, you "get rid of your client": your care plan and follow-up phone calls address the lactation issue at hand, and your client doesn't need to see you again. So how does a lactation consultant stay afloat in this profession? It's not realistic to wait for your satisfied clients to have more children. This session explores marketing and case management techniques -- all of them ethical and legal -- from which your consult today can draw business to you tomorrow. While your own "best practices" are the best advertisement of your professionalism, every private practitioner can use some fresh ideas to keep her business growing. After this session the participant will be able to: (1) Implement five or more changes in paperwork management to enhance marketing of the private practice (2) Evaluate whether the stressed mother has found the consultation effective (3) Increase contacts (and referrals) within the local medical community (4) Explain which sections of the ILCA Standards of Practice, IBLCE Code of Professional Conduct and IBLCE Scope of Practice for IBCLCs cover ethical marketing practices for the IBCLC (5) Design effective marketing materials targetted for those in contact with the mother