I am one of those JHL-Riordan and Auerbach-LLL Series people.  I have no
formal breastfeeding education except for a 18-hour volunteer course I took
it 1986.  I do have a BA.

I think the practice hours are invaluable.  What has me uncomfortable is the
number of nurses that consider all their working hours as qualifying for the
exam.  One of our hospitals here wants to send one of their nurses to the
exam as a marketing gimmick.  Another hospital just sent a couple dozen of
their nurses through the UCLA program.  Gee, they've just got educators...we
have a board certified lactation consultant--deliver at our hospital!

 The QUALITY and scope of those hours should count for something.  I do not
believe all these  hours that come before any interest or education in
breastfeeding should count as qualifying practice hours.  I do not like that
a new CLE can qualify to take the exam because she's been a swing shift nurse
in nursery the past year.  What practical experience does she have?  She may
be great at getting a sleepy, drugged, twelve hour old baby onto a soft,
non-engorged breast of a mother who just had a c-sec, but what would she do
with a eight-month old on a nursing strike, a biting four-month old or a
three week old that hasn't regained birth weight?  I would think this RN
would be able to easily pass the exam, but I would bet her experience
wouldn't serve her well.  I find it comforting that she will probably go back
and still be the swing shift nurse in the nursery and work with the same
population of moms and babies.

  On the other hand, I think a LLL leader is better prepared,in most cases,
to handle breastfeeding challenges during the years of breastfeeding.  I
think she will find that during the five-plus years needed to amass the hours
to qualify to sit for the exam, she'll see more than she imagined.  Chances
are she hasn't seen a mom twelve hours after a c-sec, though!  This leader
will go back to her community and continue to see the same population of moms
and babies.

Maybe some documented experience in several stages of breastfeeding ought to
be required.  What do you think?

I didn't just read the books and take the test.  I had more than 4000 hours.
 I had nine years of volunteer experience, including both home and hospital
visits.  I had more than enough CERPs.

If a candidate truly completed the hours and the continuing education, I
think it would be difficult not to get a passing score.  Maybe if one takes
it in a foreign language.  Maybe if test anxiety is a real barrier.  Six of
us took the exam at one time:  four RNs, a CLE and me. We all thought the
test was not challenging enough.  We considered suggesting a written
component:  "Given this scenario, what treatment plan would you suggest for
this dyad?  Why?"  But then we wondered who would do the scoring, what would
a written component do to the cost of the exam, what if we disagreed with the
score, ad infinitum!

I don't think the test is entry level.  I do believe it is a minimum
competency exam.  There are twelve IBCLCs in my area.  I believe they all do
excellent work in their own settings--the ICN nurse LCs do a superb job, as
do the private practice LLL LCs. I can honestly say I do not know any
incompetent IBCLCs.  We have our stylistic differences, but I would have no
problem referring to any of them.  I wouldn't feel comfortable with an  ICN
nurse-LC instantly hanging  up a private practice shingle any more than I
could see a private practice LC with a LLL background helping a family with a
500 gram preemie.

This lactation stuff is a wonderful combination of art and science.  We are
all just "practicing".  Just when we feel we've got this pretty well wired,
we attend a conference and are shocked to find out how little we really know.
 Or we're confounded by the baby who does that indescribably weird wagging
motion with the left side of her tongue, but only when approaching the right
breast.  Go figure!   Think of all we learn from each other right here on the
lactnet!

I learn a lot from parents, too.  This past year I got to help a family with
a 335-gram baby boy.  That's 11 and a half ounces.  I did the mom and pump
stuff, the hospital LC did the baby stuff.  We were all in uncharted
territory.  None of us had worked with a baby this tiny.  I'm proud to say
he'll be a year old soon and he's a breastfed baby.  It's all so humbling,
isn't it?

Elizabeth