I am trying to figure out why it would even be necessary to include in the
scope of practice anything about the fact that passing the IBLCE exam does
not confer prescriptive authority.

Are we not, as IBCLCs, expected to obey the local laws about practicing?  If
someone who isn't authorized to write prescriptions for substances requiring
prescription before they can be dispensed, they will be getting themselves
in trouble with the law in most places.  An IBCLC who breaks the law would
be at risk for losing her or his credential after being reported to the
ethics committee of IBLCE.  Is it really necessary to write it this way,
unless IBLCE thinks we are incredibly dense?  

I have no problem with being reminded not to ignore the advice of one of a
mother's or baby's other health care providers.  Really, half of what I do
is clear up misconceptions conveyed to the mother in bad advice from other
HCPs, and certainly not just docs.  Public health nurses are the group in
most contact with mothers where I live.  Consequently, dealing with advice,
good and bad, from them is a big feature in my practice.  IBCLCs are also
health care providers in the truest sense of the word.  Most docs
concentrate on sickness care, at least where I live; most nurses too, for
that matter.  Our well child care system makes it clear that you must never
ever bring your child to the well child clinic when it is ill.  For that,
you go to your family doctor.  When we first moved here, I really missed the
one-stop service I had in Seattle, with a family practice doc and nurse
practitioners in women's health and pediatrics, who met virtually all of my
health and sickness care needs.  They didn't give out formula samples to new
mothers either, and absolutely all the care I got when having my baby was
evidence based and would have satisfied the requirements for
Baby-Friendliness today.    

Another thing that concerns me very much in the document is the lack of any
serious mention of the hands-on nature of IBCLC work.  I am a clinical
breastfeeding specialist, for want of a less medical sounding word.  I am
competent to assess the effectiveness of a baby's feeding at the breast, to
calculate how much that baby may need to be supplemented in addition to what
baby is able to transfer at the breast, to support normal growth, to
recognize signs and symptoms of various physical and mental conditions that
may threaten breastfeeding, all because of the knowledge I have had to
acquire in over 20 years of experience giving guidance to breastfeeding
mothers, to pass the IBLCE's own exam.  While some IBCLCs are currently
operating in administrative or educational roles, there can't be many who
have never in their careers sat down with a mother and baby and observed
carefully what is going on while baby feeds.  

Someone who isn't familiar with what IBCLCs do could read this document and
never get a clue about what it looks like when we're working.  We are
interacting with mothers and babies, first and foremost, in a consultative
way that resembles very much what happens when you see a physical therapist
or a midwife or an optometrist or an acupuncturist or a counselor - or a
physician.  I'm trying to say that our work, like the work of all these
groups, is PRACTICAL.  Our strategies for solving problems are based on
solid theory, but the way we implement them looks a lot like the way these
and many others work.  It also resembles the way my hairdresser works, and
my mechanic, for that matter, but that may be less important in this
context.

I think this discussion could be one of the more meaningful ones we've had
on Lactnet, ever.  Without Lactnet it would not have been possible to
mobilize so many diverse voices, with running input from our friends outside
the pale of holding the actual credential, and the reaction time would have
been dangerously long.  As it is, ILCA is already alerted and is being made
aware of how much this affects you all.

Rachel Myr, still proud to be an IBCLC and a midwife too, in
Kristiansand, Norway

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