Professional Practice, Ethics, and Research
The Professional Practice, Ethics, and Research domain tests safe, ethical lactation care and the ability to appraise evidence. It combines scope of practice, the WHO Code, confidentiality, and basic research methods.
Practice and ethics
- Lactation consultant scope is clinical lactation assessment, education, counseling, and management within competence. It does not include medical diagnosis, prescribing, or independent surgical decisions; refer when findings exceed scope.
- Ethical practice requires informed consent, confidentiality, professional boundaries, and attention to equity, culture, language, and implicit bias.
- Document objectively and promptly: history, observation, assessment, plan, and referral, using secure systems. Share information only with consent or as legally required.
- The WHO International Code of Marketing of Breast-milk Substitutes restricts promotion of breast-milk substitutes, bottles, and teats. Health workers should not accept samples, gifts, or inducements that create conflicts of interest.
- Collaborate with obstetric, pediatric, midwifery, and mental health colleagues. Recognize perinatal mood and anxiety disorders and refer appropriately.
Research literacy
- Evidence hierarchy: systematic reviews and meta-analyses of randomized controlled trials, then individual RCTs, cohort studies, case-control studies, cross-sectional studies, case reports, and expert opinion.
- Use PICO to frame a question: population, intervention, comparison, outcome. Appraise selection bias, measurement bias, confounding, attrition, blinding, and intention-to-treat analysis.
- Effect size and confidence intervals matter more than a p-value alone. Sensitivity is the proportion of true cases identified; specificity is the proportion of non-cases correctly excluded. Positive predictive value depends on prevalence.
- Apply evidence to the individual dyad through shared decision-making, not by applying group averages blindly.
Worked example
A formula company offers a lactation clinic free diapers and staff lunches if the clinic displays its logo. The reasoning: this is a marketing inducement linked to breast-milk substitutes. Accepting it creates a conflict of interest and may violate the WHO Code. The clinic should decline the offer, document the decision, and seek unrestricted funding that carries no marketing conditions.
Traps that cost marks
- Claiming a lactation consultant can prescribe medication or diagnose a maternal condition.
- Breaking confidentiality because a family member asks.
- Treating a case report as proof of causation.
- Assuming the WHO Code bans all formula rather than regulating its marketing.
- Equating statistical significance with clinical importance.