The discussion provoked by the NYTimes article brings up an issue that I
have concerns about. One lactnet response to the article stated, "I can
assure you that no IBCLC has earned her certification based upon a weekend
course."
I have watched a growing number of postpartum nurses who have attended one,
and only one, continuing education course on lactation and using their hours
as floor nurses qualify for the exam---without having seen a baby older than
4 days nurse. And given the fact that most women are discharged within a
few days of delivery, these nurses rarely encounter even engorgement. Or
what happens with the discharge-given advice over the next few weeks...
Here's a quote from the Evergreen Lactation Educator course website: "You
will meet all classroom education requirements for IBLCE exam eligibility by
following the Lactation Educator track of the six-day course, Lactation
Education for Healthcare Professionals". Evergreen is a great course & I'm
glad that so many nurses are becoming educated, but I am uncomfortable that
a week long course & exposure to only one viewpoint is enough to satify all
the lactation education needed.
Now granted, to get recertified at 5 years, they need at least 50 l-cerps
plus ethics, etc--but that allows for 5 years of IBCLC practice before that.
Another response to the article was "Choosing a lactation consultant is no
different than choosing a pediatrician or a plastic surgeon. When you are
looking for a specialist, you look for a board-certified practitioner."
Unfortunately, in the hospital, which is where I think most mothers will
encounter an LC, there is no choice in who you see; it's whoever the
hospital hired. And given the one CERP course fulfillment and bedside
nursing hours, even a board-certified LC may have a very limited
perspective.
As an RN myself, I'm grateful for that background which helps inform my
practice. As a learner, being exposed to wildly varying opinions from the
many experts whose conferences I attend (& those of you on lactnet!) gives
me a wider perspective. As an LC, I'm beholden to the many different points
of view that I learn from mothers. I work in a variety of settings, from
postpartum to outpatient to support groups. I find I need the experience of
seeing mothers after that first few days just to bolster my own confidence
and hope in breastfeeding. And to give me perspective on how breastfeeding
evolves, and how the instructions given in the hospital are interpreted
(often differently than intended, and often transitional advice regarding
pumping or supplementing is continued without any instructions or knowledge
on when or how to change). Our post epidural, post c-section, moms of babies
who are separated for blood work/circumcisions/hearing tests, etc are a
strangely artificial construct on which to build a knowledge of
breastfeeding.
I'd like to see IBLCE require lactation education from more than one source
or at least as many hours as needed for recert (why 45 for initial cert and
50 plus for recert? why no e-cerps for initial cert?) I'd also like to see
a requirement of clinical experience with breastfeeding at multiple stages
in life (some outpatient or support group time).
This is not to flame any individuals; I know dedicated LCs who started this
way. But I'm interested to hear other lactnetters thoughts (respectfully,
please!!) about this.
Susan Lawrence,RN, IBCLC, LLLL
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