The Lactation Consultant’s Clinical Practice Manual

First Edition*

Marie Davis, RN, IBCLC

^{*Electronic format includes some revisions}

TABLE OF CONTENTS

PART I The Lactation Consultant In Practice

Chapter 1 Practice Issues

Before You Begin ................................................................................................................................................. 3

Continuing Your Education......................................................................................................................... 3

Practice Issues ........................................................................................................................................................ 3

Scope of Practice .................................................................................................................................................. 4

Setting Practice Guidelines........................................................................................................................... 5

Legal Issues In Practice................................................................................................................................... 6

Practice Options..................................................................................................................................................... 7

Physician’s Office......................................................................................................................................... 7

Obstetrician............................................................................................................................................. .8

General Practice (Or Family Practice).............................................................................. 8

Pediatrician.............................................................................................................................................. 8

Hospital Based Practice.......................................................................................................................... 8

Private Practice ......................................................................................................................................... 10

Collaborative Lactation Practice ................................................................................................ 10

Proposals ................................................................................................................................................................. 11

Contracts .................................................................................................................................................................. 12

Public Relations................................................................................................................................................... 12

References......................................................................................................................................................... 13

Chapter 2 Managing An Office

Setting up the office ...................................................................................................................................... 15

Baby Scale ............................................................................................................................................................... 15

Breast Pumps and Other Breastfeeding Aids.......................................................................... 15

Business Hours.................................................................................................................................................... 16

Business License ............................................................................................................................................... 16

Card File..................................................................................................................................................................... 16

Communications................................................................................................................................................. 16

Computer ................................................................................................................................................................ 17

Insurance ................................................................................................................................................................ 17

Planner/Appointment Book ................................................................................................................... 17

Stationery ................................................................................................................................................................ 17

Housekeeping....................................................................................................................................................... 17

Hand washing....................................................................................................................................................... 17

Universal Precautions................................................................................................................................... 17

Record Keeping................................................................................................................................................... 18

Taxes .......................................................................................................................................................................... 19

Billing for lactation services..................................................................................................................... 19

References......................................................................................................................................................... 21

Chapter 3 The Lactation Consultation

Office Visits.............................................................................................................................................................. 22

Return Consultation ...................................................................................................................................... 22

Suckling Assessment ..................................................................................................................................... 23

Oral Motor Function ...................................................................................................................................... 27

Neuro-Motor Development...................................................................................................................... 27

Oral-Motor Dysfunction/Disorganization.................................................................................... 29

Examination Of The Breasts.................................................................................................................... 30

Insufficient Glandular Development Of The Breast................................................. 31

Breast Surgery............................................................................................................................................ 31

Breast Pain..................................................................................................................................................... 32

Milk Ejection Reflex......................................................................................................................................... 33

Breastfeeding Observation....................................................................................................................... 33

Assessment Of Feeding Components.............................................................................................. 34

Documentation.................................................................................................................................................... 35

Telephone Contacts......................................................................................................................................... 36

Calls To The Medical Provider............................................................................................................... 37

What If The Provider Is Not Supportive?.................................................................................... 38

Giving Instructions To Adults................................................................................................................. 39

References......................................................................................................................................................... 40

PART II Policies and Protocols for Lactation Consultant Practice

Policy Manual

Billing ........................................................................................................................................................................ 44

Birth Control For The Lactating Woman..................................................................................... 46

Breast Creams...................................................................................................................................................... 48

Charting..................................................................................................................................................................... 50

Communicable Illness................................................................................................................................... 52

Devices:

Devices: Breast Pumps....................................................................................................................... 54

Devices: Breast Shells........................................................................................................................... 57

Devices: Nipple Shields....................................................................................................................... 61

Devices, Feeding Tube......................................................................................................................... 62

Diet, Maternal Breastfeeding.................................................................................................................. 63

Employee Health................................................................................................................................................ 64

Fee Schedule.......................................................................................................................................................... 65

Jaundice, Normal Newborn...................................................................................................................... 66

Maternal Illness.................................................................................................................................................. 71

Medications............................................................................................................................................................. 72

Non-Nurser: Galactostasis........................................................................................................................ 74

Provider Contact................................................................................................................................................ 75

Substance Abuse.............................................................................................................................................. 77

Supplements........................................................................................................................................................ 78

Protocol Manual

Standard Rationale In Lactation Practice.................................................................................... 81

Breast Abscess.................................................................................................................................................... 89

Breast Lump......................................................................................................................................................... 91

Engorgement......................................................................................................................................................... 94

Failure To Thrive............................................................................................................................................... 99

Fussy Baby / Colic......................................................................................................................................... 107

Hospital Rounds.............................................................................................................................................. 112

Latch-On Techniques................................................................................................................................. 115

Low Milk Supply.............................................................................................................................................. 120

Mastitis...............................................................................................................................................................................

Milk Collection And Storage.................................................................................................................. 136

Nipple Thrush / Oral Thrush............................................................................................................. 141

Oral-Motor Dysfunction (O.M.D.)..................................................................................................... 148

Oversupply (Overactive Let-Down) Syndrome................................................................ 154

Plugged Duct(s).............................................................................................................................................. 161

Pre-Term Infants.......................................................................................................................................... 165

Sleepy Baby......................................................................................................................................................... 173

Slow Weight Gain/Dehydration........................................................................................................ 179

Sore Nipples........................................................................................................................................................ 188

Weaning................................................................................................................................................................. 194

Weight Check..................................................................................................................................................... 196

Working And Nursing................................................................................................................................ 200

PART III Support Documents

Professional Guidelines............................................................................................................................ 205

Baby-Friendly Hospital ............................................................................................................................ 208

Business Forms

Proposal for On Staff Lactation Consultant................................................................... 214

Job Description for Lactation Consultant........................................................................ 216

Contract for Physician’s Office.................................................................................................. 217

Letter to the Medical Provider.................................................................................................. 219

Lactation Clinic Supply List.......................................................................................................... 210

Finances

Income Spreadsheet ......................................................................................................................... 221

Expenses Spreadsheet..................................................................................................................... 222

Cash Paid Out Receipt...................................................................................................................... 223

Receipts Envelope ............................................................................................................................... 224

Vehicle Expense Record ................................................................................................................ 225

Billing for Services

Superbill........................................................................................................................................................ 226

Fee Schedule ............................................................................................................................................ 227

Diagnosis Codes (CPT/ICD)_..................................................................................................... 228

Maternal

Infant

Evaluation and Management (EM) Codes ................................................................... 231

Clinical Reference Charts

Physical Assessment Guide ......................................................................................................... 236

Reflexes.......................................................................................................................................................... 255

Additional Neonatal Concerns................................................................................................... 256

Maternal Post-Partum Concerns............................................................................................ 257

Perinatal (Labor) Medications.................................................................................................. 259

Conversion Tables

Weight Conversion.............................................................................................................................. 261

10% Weight Loss Tables................................................................................................................ 267

Required Intake Calculations ................................................................................................... 275

Required Breastmilk Intake By Weight................................................................... 279

Required Calories Table........................................................................................................ 281

Part IV Charting and Documentation (forms also provided in Microsoft ™ Word ^®)

Consent Forms

Consent For Treatment.......................................................................................................... 283

Consent For Nipple Shield................................................................................................... 284

Consent To Photograph......................................................................................................... 285

Chart Forms

Information (Intake) Form................................................................................................. 286

Consultation Initial Visit......................................................................................................... 287

Consultation Return Visit...................................................................................................... 290

Telephone Conference............................................................................................................ 293

Assessment Oversupply Syndrome............................................................................. 294

Treatment Evaluation Tool Oversupply Syndrome...................................... 297

Pre-Adoption/Induced Lactation.................................................................................. 298

Prenatal Profile.............................................................................................................................. 299

Client Handouts

Client Instructions....................................................................................................................... 302

Intake and Output Record................................................................................................... 305

Engorgement: The Cabbage Cure................................................................................ 306

Thrush Self-Care Instructions.......................................................................................... 307

Pumping and Breastmilk Storage Guide................................................................. 309

Differential Plugged Ducts, Mastitis, Abscess..................................................... 310

Part V Appendices

A. Glossary.................................................................................................................................................... 313

B. Miscellaneous Documentation ........................................................................................... 322

C. Additional Works Cited ............................................................................................................ 323

D. About The Author.......................................................................................................................... 323