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Lactation Consultation Confidentiality & Consent

Confidentiality

By reading and acknowledging this agreement, I give permission for my lactation consultant to make and keep notes about me, including any personal information I may disclose, information regarding my health, medical history, pregnancy, birth and postpartum, breastfeeding habits, as well as any information about my family. I consent to my lactation consultant sharing my basic information:

  • with my and/or my baby's primary healthcare provider and our referring health or support specialist
  • for statistical or educational purposes, and that my lactation consultant may use non-identifying information for research, learning, and improvement
  • to provide me, the client, with a summary of my support services

I understand that in all other ways, my information will remain confidential. My information will be securely held by my lactation consultant for one year after the completion of my support services.


Consent

I give my consent for the lactation consultant to work with me and my baby during this consultation for my breastfeeding problem/concern. This consent is for visits, phone conversations, and information sent by e-mail, text, or any other means, and includes appropriate follow-up.


I understand that a lactation consultation may involve visual and physical assessment of my breast and of my baby's mouth and feeding habits, physical contact with both my baby and my breast for the purpose of offering suggestions and assistance, analysis of records related to the breastfeeding situation, demonstration of breastfeeding techniques, and may include the use of breastfeeding equipment. I consent to my lactation consultant:


  • observing a breastfeeding session
  • touching my breasts and body for the purposes of assessment
  • assessing my baby's sucking patterns with a gloved finger
  • helping me achieve optimal breastfeeding habits by touching or gently guiding me or my baby during a feeding session
  • demonstrating the use of techniques, supplies, or tools that may help me
  • weighing my baby to monitor weight gain and intake amounts


I understand that I may, at any time, decline any and all specific techniques, breastfeeding equipment, and any and all recommendations provided. Alternatives will be offered upon request.


I understand that lactation consultation does not substitute for medical care, and that medical care can only be provided by a physician. Any advice given in the course of this consultation cannot replace medical advice received from a primary care provider. I understand that it is my responsibility to discuss any change in my care plan with my primary care provider.


I understand that I am responsible for informing the lactation consultant of changes I feel are relevant to the care path at the time of the visit or during any follow-up communications. I understand it is my responsibility to contact the lactation consultant with progress reports, questions or concerns per the contact method provided to me.


Last updated on 4 Feburary 2025. Manna Milk reserves the right to update this consent form without any prior notice.