The large number of messages concerning the IBLCE SOP and the value
of the IBCLC certification has been very educational. I have been
very interested in how everyone "sees" the conflicts and anomalies
and indeed there are many.
Firstly, a brief background. I am "only" an IBCLC. I used my
credential as a private practice IBCLC in Zimbabwe from 1991 -
2003. Clutching my brand new certificate in 1990 I presented
myself within days to the Health Professions Council only to be told
that I didn't have "a snowball's chance in hell of being
registered". The main reason? I hadn't received a recognized form
of training. The Registrar did, however, volunteer the information
that this was a double-edged sword; not being registered meant that
my activities could not be regulated by the Council, so I was free to
practice.
Because there was an existing breastfeeding culture (well over 99%
initiation, 23% of 2 year olds still breastfeeding) which was
strongly supported and enforced by government policy I was seen as a
useful practitioner, not an advocate. I received referrals, had
hospital privileges and was treated as one of a team, who were all
working for the best health outcome. I wouldn't have dreamed of
contradicting a doctor. In the very few cases where a GP or an OB had
given advice that didn't seem evidence-based or helpful, I was able
to contact the baby's paediatrician to obtain his support for
offering alternative information - often with the specific request
that I update the GP/OB. Obviously, I tried very hard to do this as
tactfully and professionally as possible, citing references, sending
photocopies - it worked. Often GPs and OBs would ask me for info
they couldn't locate themselves.
The point is that in this very baby-friendly environment, the LC
could call on the evidence and expect that the physician would be
required to use the same evidence. There was policy back-up -
political will. I hear on LACTNET again and again how
paediatricians, say in the USA, support formula feeding and how LCs
are unable to contradict this medical advice. Surely, though, the
SOPs we're discussing don't preclude the IBCLC from offering
up-to-date research and guidelines in support of protecting and
maintaining breastfeeding? If this is not the case, do I understand
correctly that MDs and OB/GYNs and pediatricians in the US (or any
other country) are able to give so-called "medical advice" which is
clearly not only harmful to health but also out of date??? It occurs
to me therefore that the "fault" here is not with the IBLCE SOPs, but
with a health insfrastructure that does not require breastfeeding to
be endorsed as an absolute health requirement, but sees it through
the eyes of a bottle-feeding culture; at best an optional extra; at
worst condoning medical "advice" NOT to breastfeed, which IBCLCs are
unable to contradict. What is the solution? Perhaps to strengthen
Dept of Health initiatives to protect and promote breastfeeding -
including the logical requirement that primary healthcare providers
should be prevented from giving out-of-date non-evidence-based infant
feeding "advice".
Secondly, since moving to the industrialized countries I am gradually
learning, with increasing dismay, that non-nurses are simply not
employed in hospitals and doctors offices as IBCLCs. The IBCLC
position is often advertised in job descriptions, but the bottom line
is that only nurse-midwives can apply. Even in private practice in
Zimbabwe, I was almost never able to have my fees paid by the health
insurance companies, and I note that those IBCLCs who are lucky
enough to obtain third-party reimbursement in UK and in Australia
(and in the US?) do so primarily through their RN (or other)
qualification, not because they are IBCLCs. In effect, because it
is not their IBCLC certificate which brings in the $$$, perhaps it is
fitting that they should be bound by their other professional
standards and guidelines in earning them? Perhaps this is at the
basis of the ruling that "only" IBCLCs, with no other certification
should be bound by the IBLCE SOPs?? Once again, it seems that the
"fault" is not with the IBLCE Board, but with a global healthcare
system that doesn't yet recognize the IBCLC credential.
The sticking point to recognition seems to be the type of training
seen as sufficient by licensing boards, health professions councils
and other healthcare providers who need to be reassured before
referring on to a "consultant" who is not also a something-else. As
a non-nurse, non-anything-else, I find this infinitely regrettable
but it seems that we are at a cross-roads. I feel that the Board
could take a more active role in seeking recognition of its own
credential as a stand-alone certification, perhaps to provide "proof"
that the experience gained in the voluntary breastfeeding-support
organizations, and perhaps through distance education, is
sufficient. And to address the situation where employers advertise
for IBCLCs with no intention of hiring them in that capacity.
Pamela Morrison IBCLC
Rustington, England
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