First, since quite a few folks have asked--APPPAH is the Association  
of Pre and Perinatal Psychology and Health and I think we should be  
aligning with them and their work as a profession, since their focus  
is normal human physiology and health. Without their research applied  
to our field, we are missing out on a lot of what keeps us in the  
realm of normal and out of the realm of medicalized. Human infants  
are born physiologically competent, not culturally competent-- 
shouldn't that be our universal and unifying foundation as a profession?

http://www.birthpsychology.com/apppah/


Onto the SOP:
Upon reflection, I do think that the only underlying cause for such a  
ridiculous document is fear tied to money. Perhaps fear of  
litigation, although I believe we are far more at risk of litigation  
now than we have ever been before, b/c we are far more capable of  
doing harm through our inaction than even the most inept LC might  
have done through incorrect application of an "alternative therapy"  
or by daring to contradict an inept HCP.

It also occurred to me just how many times I inadvertently contradict  
a doc, just by giving accurate info. For example, the other day, I  
was speaking with a mom about normal frequency of feeding for a 4  
week old baby. While she went to tend to a phone call, I picked up  
her ped's info booklet and read the section on bf. He wrote that if  
newborns feed more often than every 2 hours, offer them a bottle of  
AIM as this is too often!!! So, there, I had done it already. Now, I  
can imagine the scenario going something like this. I tell the mom  
how often babies tend to feed and then she tells me what she has read  
in her booklet or what the doc has said. I now have to say to her,  
"Oh, wait a minute, I am in error. Of course, your doc is right about  
that--you go ahead and give that bottle of AIM. That's what I meant  
to say, just lost my wits for a moment." Sound absurd? Well, applied  
as it is written, that is what the SOP  would have me do.The rest of  
the booklet just got worse! Pretty much everything is a reason to  
give AIM. As the current SOP reads, I have to answer to this doctor  
in some way--as if he has some authority over my practice? Frankly,  
he should have to answer to his own profession for putting the health  
of women and children at risk. But, there sin;t even a method of  
accountability for such awful practice. It cannot be my imagination  
that all  of the doctors out there working their butts off to take  
good care of babies are not a lot more concerned about their own  
colleagues than they are about IBCLCs!

I did have an epiphany about this SOP, though,. If the ACOG and  
similar organizations in other countries adopted it as their own, we  
could all retire. Pretty much, we cannot touch mothers and babies and  
really just have to stand at a distance and give them encouragement.  
Now, this actually should be all that women need, but b/c birth is so  
brutal and damaging, we have a lot of repair work to do (granted, the  
fact that western women tend to be so malnourished and our bodies are  
exposed to such high levels of toxins would also need to be  
addressed, but that gives midwives and nutritionists something to  
do). If ACOG adopted our SOP,  and they just stood away from birthing  
women and offered encouragement from a distance, birth would be, as  
Sara Buckley has said it is designed to be--"undisturbed" and we  
would have no repair work to do. So, I am thinking that perhaps this  
is really a brilliant document, simply applied to the wrong profession.

If, OTOH, money and fear are not the guiding force,  then we are at a  
real crossroads and I think the recent posts reflect the decision  
that must be made. In truth, it is no surprise to me, given my past  
experiences with ILCA that this has happened (as others have said,  
the "writing was on the wall for a long time").

I think Betsy's posts are a true reflection of the thinking of many  
who are not posting here who would like IBCLC to be just another set  
of initials added to their primary credential, such as MD or RN,  
eliminating especially non-RN IBCLCs. This new SOP, in effect,  
creates just that. I don't know what I was thinking when I believed  
that IBCLC was an independent profession, b/c what we have here is a  
an adjunct "helper" who really has nothing much to offer.

As an independent profession, we bring to the table whatever training  
we have and IMO that has always been our greatest asset. We are free  
to speak our minds, to be creative, to diaolgue as colleagues, to  
function as if human feeding is a normal part of life and not a  
medical event. Frankly, it would become a medical event less often if  
IBCLCs were the primary educators after birth and if we stopped  
looking to other professions to approve of us and approve of our  
methods and give us permission to practice.

I do think we need to clean up our profession, but not by using the  
medical profession as our compass. As the docs on this board have  
said (and my own personal friends who are docs as well), we are not a  
threat to them. We are not taking away the job of a ped or family  
practitioner when we help a mother bf (although we do create fewer  
sick visits, but I have more respect for peds than to imagine they  
want to see their patients be sick). So, where is the fear coming  
from and why are we willing to react to it, or perhaps even create it  
ourselves? Why are we behaving as if the physician is the compass or  
frame of reference for our profession? Our frame of reference should  
be normal human physiology. Our guiding principles should be written  
by the likes of Michel Odent and Sara Buckley and Nils Bergman and  
Ray Castellino. Health, not illness should be our compass. We have  
utterly and completely medicalized breastfeeding with this SOP. I  
wonder how many of us are willing to allow it to happen? This is a  
defining incident for us and allows us to decide who we really are.  
Are we willing to accept this edict just to exist as a false,  
impotent profession or are we willing to be real advocates for  
mothers and infants and for ourselves as unique in the world of  
health care?

I am mow viewing this whole situation as quite an opportunity for us.  
We have been moving very slowly and somewhat silently toward  
eradication of non-MD/RN IBCLCs, by making our skills less relevant  
and making it so ridiculously easy for a candidate to sit and pass  
the exam purely based on knowledge as an MD/RN. This way, it is out  
in the open and we can decide honestly who we are. I am not attached  
to being an IBCLC--I am very attached to my own integrity, however  
and to the right of the human infant to its true nature. I think it  
is time we looked to the ecology--the nature of the infant at breast,  
as our compass and foundation and design the scope of our profession  
accordingly.

Jennifer Tow, IBCLC, CT, USA
(sorry for typos--cannot fugure out spell chick on my new mail system)

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