Facebook in its mysterious wisdom has re-surfaced a thread that appeared several years ago. Private practice IBCLCs were discussing what items they routinely carry in their home visit bags, so they’d have at-their-fingertips whatever might be required for the family being seen. Great discussion! And then … there was the suggestion that a well-prepared IBCLC will have a bottle or two of ready-to-eat infant formula. You know, for those scary, waaaaaay underweight babies we sometimes see in our work. Here’s what I had to say then, with some updated links, and the advice still stands:
It’s all about conflict of interest (COI), and avoiding the appearance of one. The IBLCE Code of Professional Conduct (CPC) at Principle 5 specifically says COIs are a No-No, but it does not list out all the examples by which COI is made manifest. The CPC also strongly encourages, but does not mandate, IBCLC support for the International Code of Marketing of Breastmilk Substitutes (International Code). Y’all have heard me say it before, and I’ll say it again: Code analysis is nothing more than a subset of COI analysis. So even if the IBLCE CPC doesn’t require IBCLC support for the International Code, the over-arching commandment mandating avoidance of conflicts of interest is a back door way to say: Oh by the way, you DO have to support the International Code.
An IBCLC toting around formula in their private practice bag is no different than a pediatrician having formula samples out and visible in the office, or pharmaceutical samples in their top drawer. The International Code, and COI literature, generally, says healthcare providers (HCPs) should NOT be giving out samples and other freebies to the families they see in clinical care. Yup, that’s right. No samples. Period. The giving out to or use of freebies with a patient or client by HCPs is what “bathes the product with the respectability of the profession,” as I like to put it. That is why the formula companies love it when HCPs hand out formula discharge bags, or samples of their brands, or coupons for their products. It says to the family, “This product is A-OK because your trusted HCP is giving it to you.”
If a pediatric practice purchases some formula for later dispensing, this keeps the International Code folks happy. But there is still an implied endorsement of the product. That’s the be-deviling part of COI: appearances and impressions matter, more so than your good intent. One pediatric practice had a great system. They purchased formula and kept it stored away from patient view. During lactation consults (yup; IBCLCs are on staff) where supplementation was medically indicated, they first asked the families if they had any formula with them. Many who are having concerns about supply DO. If the family hadn’t brought their own expressed breastmilk or formula, then the HCP would go to the closet for some infant formula.
Formula is ridiculously easy to buy here in the USA. It may well be that non-human-milk supplements will be a part of a care plan being crafted by an IBCLC during a home visit. And families need to learn how to safely prepare it, and clean up afterwards. So send someone out to get it, if there is need.
If any child is in such desperate need for sustenance that we think we should be whipping out some formula (STAT! We gotta save the baby!), my advice is instead to pull out your phone and call the pediatrician and 911, cuz that kid needs to go to a hospital for a full head-to-toe assessment.