At the risk of undermining my own IBCLC credential I'm going to disagree,
respectfully, with Judith Gutowski on the need for an IBCLC to see every
baby.  I would like IBCLCs in policy-making positions for writing hospital
procedures affecting breastfeeding, though, just as I'd like all employees
in the maternity services to comply with Baby-Friendly Initiative standards
AND have the possibility of referral to an expert when they run up against
a BF problem that requires more than basic knowledge.  A few well-placed
IBCLCs in ministries of health and the bodies who oversee care wouldn't be
bad either.  And I guess in places where normal birth never happens, you
could argue that every baby starts life in need of the specialist expertise
of an IBCLC.  While I am flattered as an IBCLC by what Judith writes about
our perspective and the way we take birth events, maternal history, and the
other things she mentions into account when looking at breastfeeding, I am
not convinced we are the alpha and omega of breastfeeding.  Also, as a
midwife, I like to think I have all the same perspectives in mind, because I
think I did consider all those things before I was an IBCLC too.  Granted,
many midwives are only cursorily interested in anything happening after
third stage of labor, but not all of us are that limited.

Where I live, most babies see a pediatrician for less than five minutes in
the second 24 hours of life, and unless there is something glaringly wrong
with them, they don't see a pediatrician again unless they are admitted to
hospital later in childhood for some new, serious, health disturbance.
Pediatricians are not part of the primary care team for normal
healthy babies, period.  They do the newborn physical exam and that's the
end of it.  In such an environment, that is, one in which infancy is
considered a chronological stage rather than a primary diagnosis, I find it
hard to argue that an IBCLC should be involved in the care of every baby.
I've come to appreciate the difference between being classified as a baby
rather than a pediatric patient.  I prefer to view breastfeeding through the
lens of nurturing/attachment theory, or perhaps love of eating, and reserve
the health care provider approach for the cases in which it really is a
medical issue.  Most people manage to feed themselves without a health care
specialty supporting them - so, too, with breastfeeding.

I delude myself that it is easier to present BF as something doable by
pretty much any mother with her baby if we can remember that all of us alive
today are the descendants of countless generations who figured out how to
keep their offspring fed and healthy, and then a handful of generations who
figured out how to cack it up almost beyond recognition before organizations
like LLLI and all the other mother-to-mother support groups appeared and
turned the tides so that the basic survival skill of breastfeeding was not
lost to us forever.  I know that babies were lost in times past because of
BF problems no one understood.  But we who are here now come from the ones
who survived, either by our foremothers figuring out how to feed their
babies or finding someone else who could.  If we paint a picture of
breastfeeding as something complicated, requiring high-level specialist
expertise in nearly all cases , I'm not sure we are doing breastfeeding or
ourselves a favor.

I understand from Judith's post that she works in a heavily medicalized
setting, which of course colors her view, just as my work setting colors
mine. (Oy VEY how it colors mine, don't even get me started!)  I sympathize
and empathize with, and respect her.  But I would settle for just knowing
that all staff will refer to the next level of specialized care without
delay when they find mothers and babies struggling and they are unable to
help them with their own knowledge.  That way, everyone has a share in the
success of breastfeeding in the institution, rather than it becoming the
sole property of the IBCLC, because the back side of that shining medal is
that everyone else can just wash their hands of it.  That's how it used to
be where I work, and writing as the person who 'owned' everything having to
do with BF within a ten km radius of my hospital, I can say it's much more
comfortable, and feels much more right, to have joint custody with everyone
else on staff and with all the kind, generous women who work as peer
supporters, paid or otherwise, to help other new mothers get started in this
richly rewarding process.

Sorry for monopolizing the soapbox for so long.  Who's up next?
Rachel Myr
Kristiansand, Norway

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