First of all, anyone who is on this list probably doesn't fall into the
category of those who are IBCLC's in name only. So anyone out there reading
these posts should not feel that they are in any way pointed at them. Also,
there are varying degrees of competency in any profession.  For instance, I
am a medical technologist, in addition to being an LC. I have always been
the type to seek out new information, keep up with the journals, learn from
those more skilled or informed than myself (no doubt, genetically induced,
not some kind of  inherent virtue LOL).  As in many professions, some techs
never progress much beyond their basic skill levels, others try to stay on
top of new developments. Fortunately, in most labs, techs frequently go to
their supervisors, in this case me, whenever they feel out of their comfort
zone. Also, one of my daily jobs as a supervisor is to review the work of my
techs and see that all quality control standards have been met. I think that
the big difference between what happens in the lab and what happens on a
hospital L&D floor or during a home visit (both of which I have expereinced
as an LC) is that there isn't a whole lot of oversight. Moms come and go,
they are seen by someone and then it's on to the next dyad. There isn't a
lot of time for oversight or review. Also, being an LC is very personal and
immediate. If I find that a mistake has been made in the lab, there is
usually time to correct things without any real harm to the patient.
Everything is very analytical, anything out of the ordinary is quickly noted
and it is very rare that I find a mistake that will really hurt someone
(although the potential is definitely there.) With breastfeeding, one or two
visits with an underdeveloped LC, be it in the hospital or at home with an
PPLC, can be devastating to the breastfeeding dyad.  It is all very
subjective and often only the mom and the LC knows what went on in the room.
There really isn't any oversight or ability to monitor quality assurance.
Even if an LC would like some help with a mom, there just may not be anyone
else better available or not time to get a second opinion. Many LC's are
just so busy all the time, so overwhelmed by the job, that they just don't
have time to come up for air. They think they are doing a good job just
because they are seeing so many moms.  They know they should be keeping up
with the latest and greatest, but just don't have the time and feel that  by
sheer volume or years of experience, they must be doing at least a decent
job. And maybe they are - but maybe not.  And who is going to try to measure
it and how?  In the lab, we have to pass proficiency tests on an almost
monthly basis and are intensely inspected by the state and other agencies on
a regular basis.  There is no such scrutiny of lactation support that I know
of - nursing in general is subjected to review, but lactation, in most
places, receives only the briefest of oversight.

So what to do?  I am so torn here. You should know that I have backed off
from doing LC work this past year and have been concentrating on my work
with a lay-group that supports breastfeeding..  After a lot of thought, I
will be recertifying this year with IBLCE, but it is not without
reservations.  Part of me feels very strongly that for most dyads,
breastfeeding is a natural thing that will go well if there is adequate
support from the culture and community, including groups such as LLL and
ABA. However, there is also the reality that childbirth and childrearing has
been so compromised by modern culture, that breastfeeding is no longer
natural or easy for so many dyads and help from lay groups may not be
available.  Where is my energy best spent?  For now it is in saving an
organization that has a history of supporting the needs of the baby and
promoting close links with the biological normal way of being human.  But I
don't want to lose my ability to support those that need that little extra
help to reach their goals and to do so as an IBCLC.  An IBCLC should be able
to go that extra mile. IBLCE must find the will and the way to substantiate
hours/training until there is a standardized program of study that includes
college-level courses and internship with experienced IBCLC's in order to
sit for the exam (that internship does not have to include day-to-day
personal contact - I think that there could be creative ways found to do
internships regardless of where a candidate is located). I think that
quality rather than quantity should be the goal.  A new profession needs to
set a high standard, IMHO.

So, I think that this dialogue should continue, with respect and
consideration for the wide range of people involved. We definitely need to
not tar everyone in a group with the same brush.  I am fearful for the
future of both professional and lay groups that are presently in the thick
of breastfeeding support and promotion.  But I am dedicated to helping any
mother who wants to make breastfeeding the foundation of her baby's future.
And that includes mothers for whom the normal "picture" of breastfeeding is
not possible due to medical issues beyond her control.  Heck, it includes
any mother who thinks she might want to make breastfeeding a foundation,
even if she's not quite there yet.  All she has to do is ask.  Still hoping
for some kind of "breakthrough" moment in the medical profession and society
in general before my first grandchild is born.  A crazy dream, I know. We
shall see.

Warmly,
Sharon Knorr, New York, USA

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