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Guidelines for Active Leaders Who Also Work As Paid Lactation Consultants

Sally Tobin
From: LEAVEN, Vol. 26 No. 3, May-June 1990, pp. 39-41

In the 1980s the role of the La Leche League Leader was rapidly expanding. Leaders were being asked to work as paid breastfeeding consultants in clinics, hospitals, or with local physicians or public health units. La Leche League International, in an effort to provide support and encouragement for these Leaders and others who wished to expand their role in the community, established the Lactation Consultant Department. In 1983 JoAnne Scott was named the first Director of the department. As Director, JoAnne was the LLLI representative during the formation of the International Board of Lactation Consultant Examiners. The IBLCE is a free standing organization comprised of representatives from La Leche League and many other disciplines, which, in 1985, offered the first IBLCE Examination. The IBLCE program was approved in 1988 by the National Commission for Health Certifying Agencies, Washington DC. This examination remains the only certification process of its kind for lactation consultants in the world. In 1989 the Lactation Consultant Department was retitled to better reflect its purpose and is currently the Lactation Specialist Education Department. LLLI is pleased to see Leaders able to expand their volunteer role into a career and proud to be part of this new allied health care field.

As the number of Leaders who also served as lactation consultants grew, the Division Directors and LLLI received more and more letters asking how to keep their roles as Leaders and lactation consultants separate and work effectively and ethically in both capacities. While Leaders who worked as lactation consultants in structured settings often found their roles defined by the institution for which they worked, the lactation consultant who began a private practice found she often needed to define her own role. These Leaders expressed increasing frustration with the lack of role definition for their lactation consulting business and for the conflicting messages they received regarding how to best fulfill their role as an LLL Leader. How could they keep these roles separate? What was the best way of helping mothers in an increasingly complex situation?

In response to these requests and after careful study of the issues, the LLLI Board of Directors passed the following guidelines for Leaders who are lactation consultants in October 1989. The numbered items [in bold in the original LEAVEN text] are the actual guidelines. Each guideline is followed by questions [marked with *] pertaining to these guidelines.

It is important to note that LLLI has no authority to define what lactation consultants can or cannot do in their lactation consultant role. It is, however, equally important to remember that only LLLI can define what the limits and expectations are of the active LLL Leader. If you have additional questions after reading this article, please send them to Betty Wagner, c/o LLLI Headquarters.

1. An active Leader who is also a lactation consultant cannot make referrals to herself for pay.

* What if I'm the only lactation consultant in my community?

When you accept an LLL referred phone call you are expected to help the mother to your fullest capability without charge. This means that when you receive a League call, that mother is entitled to all the help you can give her without cost. After a Leader receives the call, she may not begin to charge the mother later because the call requires more time or extra care.

If you are a Leader and a lactation consultant who receives referrals from professionals in your community as a lactation consultant, it can be difficult to decide if a call is an LLL call or a lactation consultant call. In this case you may want to: 1) install a second phone line for business calls; 2) refrain from accepting LLL phone calls; or 3) spend time at the beginning of the conversation determining in which capacity the contact was made, and then help the mother to the best of your ability in that role.

* What if the mother needs to be seen in person or needs extended help beyond the usual telephone help I give as an LLL Leader?

When you receive an LLL phone call, you are expected to help the mother to your fullest capability. This may mean seeing a mother in person or becoming involved in a series of helping calls and follow-ups. LLL Leaders have always been free to visit a mother at home or in the hospital as their time and circumstances allow. If a Leader does not wish to help mothers in person, she may refer the mother to a Leader who does in-person help. It is not appropriate, however, to offer LLL phone help to a mother and then charge her as a lactation consultant for a visit.

* What if a contact/call made to me as a Leader is taking too much time?

Regardless of whether the call is handled as a Leader or lactation consultant, there will be times when your family needs you. A call takes no more or less time because it is an LLL call than if it were a lactation-consultant call. If a call is going to take more time than you as a Leader can spare at the moment, you can call the mother back or refer her to another Leader in the area, and of course encourage her to attend Group meetings.

* What if a mother, referred to me as an LLL Leader, needs the services of my breast pump rental station?

The mother can expect to pay the required rental fees, regardless of where she rents the breast pump. Because the call was received as an LLL referral, the counseling help offered with the pump rental will be given as a volunteer.

* I've been an active Leader for several years. During this time LLLI has encouraged me to learn more and enhance my skills. Doesn't LLLI owe me the right to profit from those skills?

LLLI applauds Leaders who desire to continue learning skills beyond basic breastfeeding management. LLLI appreciates the active interest of those Leaders who further choose to pursue a career in the field of lactation. LLLI's primary responsibility is to give volunteer help to the women who request it and to maintain its reputation as a volunteer organization. In return LLL offers Leaders educational opportunities, improved counseling skills, and increased self-esteem. The La Leche League Leader is vital to her family and her community.

2. An active Leader who is also a lactation consultant cannot advertise herself as a lactation consultant on LLL phone recordings or at LLLI Group meetings.

* What constitutes an LLL phone?

An LLL phone is defined as any phone that is listed in the phone directory under La Leche League or paid for by LLL funds, or a residential phone that a Leader uses for helping calls and whose number is given out for this purpose.

* Is it necessary to have two phone lines?

It is not necessary, but you may find it helpful. It is important to remember that the purpose of LLL phone recordings and Group meetings is to provide volunteer support and information for the community.

* What if I only have one phone line?

According to telephone company sources it may be illegal to advertise a business on a residential phone line, depending on the area in which you live. If you are using one phone line for both LLL calls and lactation-consultant calls, it is important to spend time at the beginning of each call determining in what capacity the mother has called. You might ask "Are you calling LLL for breastfeeding help?" or "From whom did you get my phone number for breastfeeding help?"

* Clarify how this applies to messages on my home answering machine.

Mothers seeking LLL help or assistance may not be referred to telephone lines answered by phone answering machines that advertise lactation-consultant services.

* Can I have my lactation-consultant brochure or business card on the display table at our meetings, but not overtly advertise my services?

LLL Policy does not allow the advertising of individual businesses or services at LLL meetings. By placing a brochure or business card out at LLL meetings, it may confuse mothers, and they may not understand LLL's long-standing policy of providing services at no cost.

3. The Leader discount on purchasing materials from LLLI is intended to produce revenue for the local Group or Area. The Leader who is also a lactation consultant is expected to return such profits to LLLI, her Group, or her Area. However, she may purchase materials at a commercial bulk rate and retain the profit as any business may do.

* Can I use the Leader discount on materials I give away to my clients?

No, because the purchase of these materials is intended for business purposes and because they are directly or indirectly paid for by your paying clients, your Leader discount does not apply.

* If I need to use an information sheet from my Leader file, how do I determine the profits from these sales so I can share them with LLLI, the Area, or the Group?

The difference between the cost of materials at commercial bulk rate and Leader rate would be the amount contributed to LLL. Items used for paying clients should either be repaid in this manner or a replacement provided for your Leader files by your business.

* How do I go about ordering at commercial bulk rate?

Purchases can be made from the LLLI Catalogue. This Catalogue contains a bulk price list. Another alternative is for the Leader who is a lactation consultant to become a Breastfeeding Resource Center (BRC). By becoming a BRC, lactation consultants receive a 15% discount instead of the 10% member discount. Additional information on becoming a BRC can be obtained by writing to BRC Director, LLLI.

* As a Leader who is also a lactation consultant, can I still take part in the Medela Breastfeeding-Aid Sales program?

Yes, as long as any sales from the program are managed according to the sales program contract. In this program the profits are divided between the Group, the Area, and LLLI so that every level of our organization benefits.

4. Leaders who are also lactation consultants using LLLI materials and resources to help a paying client are expected to reimburse LLLI for the cost of those materials or resources or to make a donation to LLLI, her Group, or her Area.

* What if I need to access the Center for Breastfeeding Information for one of my clients?

The Center for Breastfeeding Information (CBI) is a service provided by LLLI, which allows Leaders, lactation consultants, health-care providers and others to access current breastfeeding information for a fee. The Professional Liaison (PL) network through the Divisional PL Administrators may access the CBI for information at no charge, although there may be a fee for bibliographic listings or specific research studies. Lactation consultants are expected to pay the CBI fee and will be charged by the CBI. Additional information on the CBI can be obtained by writing to the CBI at LLLI Headquarters.

* Can I access the Professional Liaison resource network for one of my clients? How do I determine the cost of such resources?

Professional Liaison Leaders are Leaders who have been appointed, within their Areas, to provide additional resources and expertise on breastfeeding to Leaders. This network has been developed to help the volunteer Leader and, unfortunately, these Leaders are often overworked in this capacity. At this time, they are not able to provide this same resource network for lactation consultants or their clients. Lactation consultants are encouraged to access the Center for Breastfeeding Information for their resource needs.

* As a Professional Liaison Leader and lactation consultant, can I charge another Professional Liaison Leader who calls me for help for an LLL mother in her Area?

Just as the Leader is expected to handle LLL calls to her fullest ability so, too, the PL Leader is expected to complete LLL calls to her fullest ability without charge. If a PL Leader is receiving a large number of calls from her fellow PL Leaders, she needs to discuss the situation with her Divisional PL Administrator and/or her Area Coordinator of Leaders.

5. Lactation consultants may advertise in written LLL materials or exhibit at LLL functions to the same extent as other individuals and organizations that promote breastfeeding and offer breastfeeding information and support. Free exchange of information promotes cooperation and harmony and benefits everyone in the long run. Exclusion promotes lack of cooperation.

* Can I be listed as a lactation consultant in my Area's Leader Directory?

Area Directories will not carry a separate listing of Leaders who are also lactation consultants.

* How will LLLI's Advertising and Exhibit guidelines apply to me?

The LLLI Advertising and Exhibit guidelines will apply to the lactation consultant in the same way they apply to other advertisers or exhibitors. For current information on advertising or exhibiting please contact your Area Coordinator of Leaders.

Other frequently asked questions:

* How does my Leader insurance apply to my work as a lactation consultant?

It does not. Your Leader insurance only covers the work you do as a volunteer. Separate insurance is needed to cover your lactation-consultant practice. One reason for being especially careful to separate your roles as Leader and lactation consultant is because if a call is started as an LLL Leader and completed as a lactation consultant, and should a malpractice claim be filed against you, both your volunteer insurance and your business insurance may hesitate to represent you, believing it is the other company's responsibility.

* Is it necessary to keep my Leader logs separate from my lactation-consultant notes?

Yes. Because both are legal documents, it is important that you maintain your LLL logs in the way recommended by LLLI and your lactation-consultant notes in the way recommended by the lactation-consultant organizations.

* What is the difference between a Leader's and lactation-consultant's role in the community?

Both Leaders and lactation consultants help mothers breastfeed. The LLL Leader does this as a volunteer and official representative of LLLI. The lactation consultant does this on a fee-for-service basis in her community through a clinic, hospital, or private practice.

* When is it appropriate for a Leader to refer a mother to a lactation consultant?

A Leader can help mothers through most breastfeeding difficulties either by phone or in person. Before referring a mother to a lactation consultant, it is important that a Leader exhaust her La Leche League resources first. In addition to her own personal knowledge, a Leader has access to the collective knowledge of the experienced Leaders in her Area, LLL publications, the PL network, LLLI, and the Professional Advisory Board. If a Leader refers a mother to a lactation consultant, it is also important that the Leader be certain the lactation consultant will be able to give the mother the time, encouragement, and high-quality information she needs. It is also important to remind the mother that a fee for services will be charged.

The role of the La Leche League Leader has always been and will continue to be to provide support, encouragement, and information for the breastfeeding mother. She does this voluntarily, to the fullest extent of her capabilities and utilizing the fullest expertise of the international League network. When Leaders who are lactation consultants understand how to best keep their roles separated, they will be better able to function both as Leaders and as lactation consultants. This will benefit them, the mothers they serve, and La Leche League.

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