Marsha writes:

"I guess I have the exact opposite opinion than Jennifer regarding licensure of IBCLC lactation consultants. The purpose of licensing 
is to protect the public. While we all certainly know licensed health professionals whose poor?practice (especially regarding lactation 
care and services) certainly does not protect the public, we need to look a little closer at why licensure is so important. Licensure 
would help advance the profession of lactation consulting, at least in the US by putting the profession on a par with other licensed
?health care providers. Respect, inclusion in policy making, status, third party reimbursement eligibility, a?stronger voice for improved
?lactation care, a broader base of job opportunities?are a few of the pros for licensure. With licensure comes a legal responsibility, which
?means that cooking lavender blossoms in?one's kitchen to smear on sore nipples would probably not be considered appropriate
for a licensed health care provider.:

Marsha makes my argument for me better than I did myself. The gatekeeper approach to disease-care means that "I get to perform in 
xyz capacity and you don't". I define my title by certain practices and therefore only people with that title can do those things. While this
may appear to be protective, it typically follows that any part of what you already do that some other licensed profession also does becomes
a sticking point. Often, the practice becomes less effective than it was before, of limited in ways that those seeking the panacea of 
licensure never anticipated. This is what happened to midwives, to PTs and to chiropractors. Usually, the limitations are imposed under the 
guise of "protecting the public", but no one in the public in the US has been protected by the limitations on midwifery. Yet, right here in this 
post on LN is a very clear statement that there is a consensus that IBCLCs should be limited to practicing within some medically defined 
model that protects the public from what? Crazy, unprofessional witches who use herbs and home remedies? Breastfeeding is no more a 
medical event than is birth--medical practices will not ensure its success, but will quite possibly spell its demise.

What I read very clearly in Marsha's comments is exactly what I have been writing about for a long time--the intentional desire
on the part of some members of our profession to fully medicalize breastfeeding, imposed under the altruistic guise of "professionalism" 
or worse yet, "protecting the public". This is what has been done to midwives. Once the medical model of care became the norm in birth, 
midwives who practiced in the midwifery model were judged based upon the medical model, as if it were the correct standard of care. 
Who decided that? Well, doctors could get on board (if they had to) with nurse-midwifery b/c it was good for marketing (look, we have 
midwives right here--no need to have  a  "dangerous" homebirth) and was utterly and completely controlled by them. For example, in the 
midwifery model of care, breech birth is normal, not a medical event (b/c midwives know how to catch a breech baby and docs do not). 
Yet, the avg person thinks breech is dangerous, b/c the medical model says so. So, I suppose we might extrapolate here that an IBCLC 
who suggests reglan for improving milk supply might not fear sanctioning, but an IBCLC who suggests an herbal infusion might be at risk 
of losing her license. So, will the practices that are acceptable be defined by the limited knowledge of a certain few?

When I read what ignorant people have to say about midwives, they talk about them as if they are witches and ill-trained, using derogatory 
terms such as "crunchy", non-scientific and ultimately dangerous. It is assumed midwives have no knowledge of medicine, since they wisely
choose to use less risky and invasive approaches to caring for women and babies. Practitioners supposedly trained to evaluate research 
believe these things, even though all of the research contradicts them. They also openly attack and threaten their own colleagues
should they be supportive of holistic, health-care practices. 

So, when someone makes a comment like this:
:"With licensure comes a legal responsibility, which means that cooking lavender blossoms in one's kitchen to smear on sore nipples would
?probably not be considered appropriate for a licensed health care provider.:"

What is see here is the very same kind of ignorance that has surrounded midwifery and birth for decades now in the US. People make uneducated, 
absurd comments that demean a profession and everyone else nods and goes along, feeling validated in their own ongoing ignorance.  
So, what I think is being said here is that with licensure comes the medicalization that has plagued every other profession that came from a strong 
foundation in health care vs disease-care. So, someone with a purely medical knowledge base gets to decide how the rest of us can practice?

"The fear of licensing is that another profession will take control and dictate practice parameters. That is why in Massachusetts we have
?been trying to get legislation passed that would establish a licensing board for LCs only, not have LCs carried under nursing or medicine
?licensing?boards. In Texas legislation was defeated because physician groups did want want LCs licensed. This is to be 
expected when other health professions feel challenged on what they consider their own turf, especially
if it means money going to someone else. In Vermont, legislation was defeated because it could not be
shown that harm would come to patients if LCs were not licensed. Licensing can also be expensive, since
licensing boards are funded by the fees collected from those they license. We can learn from all of 
these defeats and keep up the goal of securing licensing."

I am thinking that we should be more afraid of the members within our own profession who fear they will only be taken seriously if they embody
American medical model's concepts of "professionalism" than if they actually embody practices that serve women and babies. I am far more 
concerned about those who want to give away our power to be effective than those would would attempt to take it from us. I hope that others 
will not be seduced by the offers of a better future, when this has not been the case for professions like ours. For the most part, I see those 
who are in favor of licensure either being strongly in favor of the medicalization of the profession and /or being uneducated about the process 
of licensure.

"Look at the number of posts in Lactnet that describe the frustrations of LCs who practice in hostile
?hospital environments, who have no say in ridiculous hospital practices, who cannot actually do their 
job because hospitals insist on feeding their addiction to formula company handouts. Mothers and babies
 are suffering because?LCs need?a more powerful voice in the care that is delivered to them. Licensing 
is but one way to step up to the plate?on equal footing, get our message across, improve care, secure
 good jobs?with adequate reimbursement."

Yes, but all of the licensed nurses on this list who work their butts off to eliminate formula marketing packs, attempt to create simple 
changes like S2S and so on are making no headway based on the fact that they are licensed. Do these nurses, who are licensed have a powerful 
voice? Licensing is a two-edged sword and anyone who presents it as a panacea is misleading everyone else. A far better option than licensing
would be to work in individual states to cover IBCLCs under Health Care Freedom legislation. We would be far better off establishing educational 
criteria such as the midwives have done, with a much more solid grounding in apprenticeship/mentorship evaluation and doing a good job at our 
own PR. 

Personally, I find it insulting and belittling that a colleague would make a comment like the one referenced above. ("With licensure comes a legal
responsibility, which means that cooking lavender blossoms in one's kitchen to smear on sore nipples would probably not be considered 
appropriate for a licensed health care provider.:") Tell that to all the MD herbalists out there!!!

OTOH, it should not be terribly surprising, since this profession has slid further and further into medicalization over the past ten years. I rarely have a
clients who takes meds for anything breastfeeding related b/c they are unnecessary. Herbs, homeopathy and body/energy work are fare more aligned with
the needs of lactating mothers and their babies than is allopathy. Our profession would be well-served if IBCLCs were required to have some basic 
knowledge in these areas. I have spent almost 20 years of my life assisting women and babies with very high levels of success BECAUSE I integrate 
my knowledge in other fields into my work. In my area, just about every hospital has an Integrative medicine department/program. Granted, I think the 
rationale is far from altruistic and as with anything else, stems from an attempt to take control of any modality that draws money away from itself. 
Even so, the idea that IBCLCs are less than professional should we practice holistically is absurd. I would argue that practicing less than holistically
is where we limit ourselves so drastically and make ourselves far less useful than we ought to be.

Just for the knowledge of anyone interested:

One would not boil the lavender flowers and smear them on the body. One does not boil flowers to make an infusion. Generally, roots are boiled, but flowers 
are gently steeped after the boiling water is poured over them--like making a tea. One would not choose lavender for for sore nipples, however. Calendula 
would be a far better choice, best prepared as a succus.


 

From the University of MD Medical Center:
use of lavender:
http://www.umm.edu/altmed/articles/lavender-000260.htm

Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC


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