Liz Brooks, JD, IBCLC, FILCA

In a paper-only world, breastfeeding charting presented several issues. Was lactation something that happens to the mother, or the baby ... or both? How could the healthcare team best learn about the consultation and care plan the IBCLC had offered? But computer-based charting brings more challenges: How do we translate what we see-and-feel into tick boxes on the new Electronic Health Records (EHR) system? How can we easily access history that "is in there somewhere" without spending our consultation time in front of the computer, rather than face-to-face with the patient? And what about the privacy laws that require confidentiality, if reports are to be sent to healthcare providers with no access to our system?  This session will describe different charting rationales, the evidence-base for assessment of breastfeeding, and tips-and-tricks for accurately recording a clinical visit no matter what the set-up or system.

At the end of this presentation, the learner will be able to: (1) Define one rationale each for charting breastfeeding under baby, mother, or both; (2) Describe one evidence-based breastfeeding assessment tool; (3) Provide two examples of objective charting when recording mother's subjective statement  "My nipples hurt"; (4) Identify which element of the IBLCE Scope of Practice for IBCLCs covers charting and documentation.

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.  Can an IBCLC testify in court in this dispute? What if the Dad wants the IBCLC to testify?  Can IBCLC be paid for her time to prepare for court; what happens if the case gets settled at the last minute?  Does the IBCLC need a lawyer herself?  As our profession grows, more IBCLCs are finding themselves being asked to share their professional and clinical expertise in court cases. This session will examine the IBCLC’s legal and ethical responsibilities if asked to participate in a lawsuit involving lactation or a breastfeeding woman's rights. This one is for everyone: While Liz's expertise is in American law, the concepts are universal, and the IBCLC practice-guiding documents are international in scope. 

At the conclusion of this session, attendees will be able to (1) Identify the IBCLC's four practice-guiding documents describing legal and ethical obligations to a lactation patient/client; (2) Describe the difference between a fact witness and an expert witness in a legal case; (3) Understand factors preventing an IBCLC from serving as an expert witness in a lawsuit; and (4) Explain why it is not a conflict of interest for an expert witness to be compensated for working on a case

You are the IBCLC on the postpartum ward, and the mother who is happily breastfeeding just told you she smoked a little marijuana yesterday to ease labor.  Her chart indicates an injection of hormonal contraceptive has been ordered before her discharge.  Your colleague handed her a sample of free formula "just in case."  The baby's mother has a partner who is also lactating, and she is demanding to cross-nurse the infant.  The baby's biological father wants overnight visitation, starting next week.  You just assessed short frenulum and diminished tongue function in the infant, but your facility has no practitioners who diagnose and divide tongue-tie. You know mom needs a pump, and you happen to rent them on the side.  What could, should or must the IBCLC say or do?  

This talk is a first of its kind: an examination of legal and ethical tensions unique to the IBCLC.  Regardless of one's other professional licenses or credentials, there are four primary practice-guiding documents for the IBCLC (The IBLCE Code of Professional Conduct, the IBLCE Scope of Practice for IBCLCs, the ILCA Standards of Practice, and the [WHO] International Code of Marketing of Breastmilk Substitutes).  After a review of those "rules of the road," we'll navigate a simple algorithm the IBCLC can use to determine what she could, should or must do, in any situation that sets off ethical red flags in the IBCLC's mind.

Then, we'll hit highlights of legal and ethical issues for the IBCLC:  certification vs. licensure vs. certificates-for-classes-and-courses; who is the patient/client?; the IBCLC on the Internet; conflicts of interest (and tensions from "wearing many hats"); intellectual property law; the WHO Code; the IBCLC in the courtroom (as expert or witness);  the IBCLC on the Internet; the IBCLC as breastfeeding advocate, and its corollary: the IBCLC as advocate for a breastfeeding mother. 

It costs money for practitioners to obtain continuing education, yet all healthcare professions require them.  It costs money to host an educational training session, yet all healthcare professions encourage such learning opportunities.  Most of us work in healthcare to provide healthcare, not to seek out speakers and set up in-services.  So what is the harm in finding a commercial sponsor to help cut the costs?  Isn't it especially smart when a company says it can even provide the expert speaker, and the refreshments, for free?  This session will describe the history and magnitude of commercial influences on education (before entry into the healthcare rofession), and post-training tensions in medical research, continuing education, and in the clinical setting.  Suggestions for immediate changes in clinical practice and education will be offered, to reduce inappropriate commercial influence.  

Hospitals and birthing centers are proud to offer specialized breastfeeding care to mothers in the immediate postpartum period. But what happens after those mothers are discharged ... and breastfeeding hasn't quite sorted itself out yet? Even when the teaching immediately after birth is spot-on and evidence-based ... it often doesn't "translate well" into conditions when mother and baby return home. Hear funny, poignant and thought-provoking case studies from an IBCLC who does home visits. If you work with mothers in the first few days of life, this session will offer insight into hospital-based practices and teaching styles that "stick" with the mother and baby long after discharge. It will offer suggestions to improve post-discharge outcomes. If you work with mothers who are back home with new babies, this session will offer suggestions for adapting the original care plan using collaborative (rather than contradictory) language.

After this session the attendee will be able to: 1. Describe at least three clinical breastfeeding situations, in the immediate postpartum period, that rarely persist after hospital discharge; 2. Provide a discharge plan for lactation that considers conditions when mother gets home, and incorporates contingencies for changing circumstances; 3. Learn three key phrases to use in discharge teaching at the hospital, and during community-based care, to assist the mother who is home with her baby; 4. Learn five reliable web-based resources for parents to use after discharge for assistance with breastfeeding issues.

Liz's game show approach to IBCLC ethics is so popular that a second version has been added! All new questions -- all new quandries -- but every scenario describes realistic issues an IBCLC might face in day-to-day work. Learn law and ethics the fun way: by earning prizes!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

Conflicts of interest: Are you a little bit unsure that you'd recognize one? The IBLCE Code of Professional Conduct, IBLCE Scope of Practice for IBCLCs and ILCA Standards of Practice are all quite clear: IBCLCs should avoid conflicts of interest. This session provides a can't-fail way to remember how to recognize a conflict of interest in your lactation work -- and how to avoid (or cure) it! At the end of this session, the participant will be able to: 1. define a conflict of interest for a health care professional 2. describe the difference between a true, and a perceived, conflict of interest. 3. identify three common, everyday situations where true conflicts of interest can arise in lactation clinical practice 4. describe how to disclose a conflict of interest 5. identify when a conflict of interest requires an IBCLC to step back, and refer the mother elsewhere.

Lots of people help breastfeeding families: IBCLCs, WIC Peer Counselors, doctors, nurses, dietitians, midwives, mother-to-mother counselors, childbirth educators. Different legal and ethical responsibilities apply to each of these helper groups. And there are responsiblities that everyone must meet, no matter what the job title or work setting. This is a lively session to teach you how to follow the law, and meet high ethical and professional standards, all while serving breastfeeding mothers and children. Participants will be able to: (1) Identify differences in the scopes of practice for various professions serving breastfeeding dyads (2) Describe the difference between a professional “scope of practice” and a work place “conflict of interest” (3) Identify different ethical expectations for various professions serving a breastfeeding dyad

There is a lot of confusion about what the International Code of Marketing of Breast-milk Substitutes (International Code) means, and how to support it, in a world full of marketing. Do you violate the International Code if you work for a hospital that distributes formula discharge bags? Can you use glossy handouts from bottle manufacturers?  Does it matter if your facility is seeking Baby-Friendly status? The IBLCE Code of Professional Conduct encourages IBCLCs to adhere to the International Code. This session will use real-life case studies to discuss challenges faced by IBCLCs, asking: a) does the International 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 International 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 should support its principles. 2. Define how the International Code aligns with designation under the Baby-Friendly Hospital Initiative. 3. Identify three areas of commerce and marketing, not envisioned when the International 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

Principle 2.5 of the IBLCE Code of Professional Conduct (IBLCE CPC) states: "Respect intellectual property rights."  What are they, and how does the IBCLC do it?  "Intellectual property" (IP) includes copyrights (covering written material, photographs, slides, illustrations, etc.), patents (covering inventions) and trademarks/service marks (used by companies to protect their brands).  Most IBCLCs simply want to know: where can I get my hands on some good, free photos and hand-outs? This session provides an overview of IP law.  The legal concepts are similar around the world; this session will interest an international audience.  Then we'll get right to the good parts:  the participant will leave with a long list of sources for fabulous materials, that can be immediately used and adapted, in clinical lactation practice.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to improve access to and continuity of health insurance. Privacy protection is one of HIPAA’s most far-reaching sections. The IBCLC's work with a breastfeeding dyad must be kept confidential. While lactation consultants have long had the responsibility to respect a mother's privacy, HIPAA imposes new responsibilities. The IBCLC must now: * tell mother she is entitled to privacy ... * prove that she has done so ... * make sure that others she works with also protect mother’s privacy ... * produce paperwork to meet all of HIPAA’s requirements. Because HIPAA provides civil and criminal liabilities for failure to comply, it can be frightening to think you don't know your privacy rules. Liz will take the extraordinarily cumbersome and confusing HIPAA regulations, and explain them in plain language: so that the IBCLC understands the law, and can explain it to her clients! Objectives: 1. Describe the legislative history of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 2. Describe the privacy protections afforded by HIPAA to patients in the health care system 3. Describe five scenarios where an IBCLC may share a mother’s protected health information with others 4. Compare the privacy protections of HIPAA with those of the ILCA Standards of Practice and the IBLCE Code of Professional Conduct 5. Compare HIPAA compliance for the hospital-based IBCLC vs. the private practice IBCLC