I don't know, Regina--I usually think you are brilliant, so I am willing to flesh out this idea with you. It's synchronous that you bring this up actually, b/c I was at a ped's office today as my client's baby was getting a tongue-tie clipped and a Resident was observing the procedure. I looked at her badge for her name, which ended with the "MD" of course, and it occurred to me that she had a lot to learn, yet was standing there with her credential in hand. Yet, she was not let loose on families--she was completely supervised. 

I so agree with you that this system makes so much sense. When a physician is competent to practice at an "entry level", based on educational achievement, everyone knows this b/c she is a Resident. I had to telephone an on-call Resident for my daughter a couple of weeks ago and I certainly knew that I could ask to speak with an Attending if I was not satisfied (she was great, though!). We have no way of letting the public know that an IBCLC is newly accredited and inexperienced. We have no way of supervising her practice while she gains the skills we would like someone to have when practicing on her own. And she has little opportunity to gain those skills on her own.

I agree with many who have posted here during the past week about competency of LCs. It is a very disturbing situation and IMO has been designed this way. I raised this issue 12 years ago to ILCA and the reaction was far worse than dismissive--it was appalling. I think there was such a desire to have increased numbers of IBCLCs and increased numbers of nurses as IBCLCs, that the opportunity for fraud as well as very poor preparation was intentionally overlooked. I know that these comments may be seen as inflammatory by some, but if those of use on this list can attest to first-hand awareness of such situations, then certainly those in power are equally aware. 

I am the first to defend health care freedom (of which there is little in the US) and do not think that there should be restrictions on practice in most situations. I think that we as consumers have an obligation to know what we are buying and we have the right to buy what we want (I am speaking of health care, obviously). I think it is absurd that the AMA (American Medical Assoc) can go about calling everything on earth "the practice of medicine" so as to restrict trade and control health care dollars, in the name of "protecting the (obviously ignorant) public". OTOH, I think that any organization that calls itself a certifying body has its own obligations to meet. I think that the IBLCE has placed its emphasis in the wrong place and acted to restrict our practice b/c it cannot guarantee the quality of our certification. 

I absolutely know for certain that there are cases where moms and other folks have reported what another LC has said to me incorrectly, just as I know this is true in any profession. I also know that my own words have been incorrectly reported to others. I also know that most moms are not so far off the mark in reporting their birth and pp experiences, often verbatum. I also know that there are IBCLCs (not just the other "LCs") who have no business practicing at all and only have the credential b/c it was beneficial to them in some way. IMO, the credential protects these folks and not babies or moms. When I see the same report over and over again about the same LC, I know that there is not a conspiracy among mothers to defame that person. I see PPLCs who seem to have a rote response to every mother and are clearly not current on bf'ng info. More often, though, I see the moms who saw an "LC" in hospital, INCLUDING IBCLCs, who received awful misinformation and lack of support. I think this is why I so resent the retesting--we already know that incompetent people can pass this test rather effortlessly and practice w/o any consequence. While this is certainly not the majority of IBCLCs, I think it is enough to warrant overhaul of the entire system. 

So, getting back to Regina's suggestion--I think it is fantastic. I would love to see PPLCs experience the hospital/clinic setting (I think it made me a much better LC to have done so) and hospital-based LCs be required to experience PP. When I was an LLLL--before I was an LC. I kept hearing complaints from nurses in hospitals that LLLL's didn't understand the NICU and gave mothers information that made it more difficult for them to bf in the NICU. I was very upset about these accusations, until I worked in hospital and quite extensively in the NICU. They were right. One has to understand an environment like that to be helpful to mothers who have to interface there. I realized I was a much better ally to the babies and their moms once I understood the NICU culture (not that I think it should not change drastically in many ways--but it sure helped to understand it!!) So many hospital IBCLCs in my area have no idea how the advice they give often cascades into disaster once the mother goes home, nor do they understand how the mother's experience of having seen an "LC" in hospital informs her decision to seek additional help at home or not. I imagine that if they did, just as I was awakened by my experience in the NICU, they would adapt their practices accordingly. 

I know there are many who advocate for additional formal education, but I am such a believer in the apprenticeship model that this troubles me. It only further medicalizes infant care and feeding. But, a model based on the "residency" concept could work very well. I think it is well worth exploring b/c it has the potential to enable quality across the profession and allow us more freedom to practice, knowing that we have skills deserving of our role. 


 



Jennifer Tow, IBCLC, CT, USA

Intuitive Parenting Network LLC

 







From:    "Regina M. Roig-Romero, Bs Ibclc" <[log in to unmask]>
Subject: Wild/Crazy Idea with a Question

While I'm brainstorming about how to further the birth of our
profession, I've come up with an idea, but it's based on my limited and
possibly incorrect information.  Doctors: don't they take their exams
(or an exam) and even get called "Dr So-and-So" BEFORE they are then
interns/residents?  In other words, doesn't the medical field take the
approach that the passage of an exam (or the completion of a course of
study such as medical school) allows you to THEN go and get SUPERVISED
clinical hours?

If so, then (and I'm thinking out loud here so be merciful) perhaps
we've got this all backwards.  Perhaps we're putting our board exam at
the end of a process, whereas it actually belongs somewhere in the
middle?






 








 


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