I believe this topic may also be one that should go to another forum,
(probably www.uslcaonline.org) that ONLY addresses US issues, to save those
not in the US the weeding out e-mails addressing a topic that may not be of
any interest/application to their practice.

I am willing to discuss this off-line if you would like, and I want to
clarify I never was and am not now "sold" on licensure, but I've recently
learned some of the "pro's" from an "outside" perspective.  

In my recent experience as an IBCLC who meets with California state-level
people (I have been working as a "contractor" to deliver services such as
developing their website, collaborating with local and state-level
organizations to assure the materials are correct, and provide input to the
meetings I attend when their topics address maternal and child care) I have
learned that one way to get IBCLC's reimbursed for prenatal and postpartum
care through the state Medi-Cal system is to get ourselves licensed - this
would not completely resolve the issue, but it would be one step to
clarifying our level of expertise and give them a way to easily identify
those having the expertise to deliver breastfeeding support services. 

I know this is not the only path, but it may be ONE path that some may want
to follow.  Right now an IBCLC who is an RN can get reimbursed via a program
called Comprehensive Perinatal Services Program (CPSP) - she needs to be
added to a CPSP staff list and the reimbursement is minimal, but it CAN be
done - however, a NON-RN IBCLC can get reimbursed only at a level similar to
any other health worker who has a high school diploma and a year's
experience in the perinatal field.  This is less likely to attract IBCLCs or
encourage CPSP's to hire non-RN IBCLCs to provide these services.  In
addition, CPSPs only provide services up to about 6 - 8 weeks - so many moms
cannot get services.  

Agencies such as WIC and the CPSPs have encouraged the use of IBCLCs, but
people in the "system" (read: those who actually pay the bills) have no idea
what an IBCLC is and how they are different from a nurse, a midwife or a
health worker.  I THINK having licensure would make it easier for those who
don't know a thing about our profession to identify what we do and how we
can be of value.  And THAT's what I was mentioning in the short e-mail.  

I am certainly open to the concept that this would NOT be in our best
interest - I was just reflecting my own experience! 

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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