Melisa wrote:
"You know in thinking about this it really hits close to home.  I am a  student midwife.  However you can be "just" a midwife, a direct entry midwife, a lay midwife, a Certified Professional Midwife, a Certified Nurse
 Midwife, and I am SURE that I have forgotten a few, oh wait also a Licensed  Midwife.  It is up to the consumer to know which level of care she wants.  I  think if we can leave this choice up to the consumer, then maybe we should  also leave the whole CLC, CLE, IBCLC debate up to them too??  Just a  thought."

Melisa,
As someone who has taken numerous "certification" trainings in various areas, I feel somewhat ambivalent about certification in and of itself. I have a tendancy to take the training, do all of the requirements and skip the exam and certification part of it. I find that initials tend to mean more when we are speaking to those above us in authority and less when speaking to others. In other words, we attempt to elevate ourselves to reach those with whom we wish to communicate (or by whom we wish to be heard). In my experience, it is less important to my clients that I am board certified than it is to HCP's. Which is actually the reason I took the exam. It was a rather tortured decision, b/c I knew I was comfortable using my knowledge as an LLLL and in running a Peer Counseling program. And I am not comfortable (putting it mildly) about bf'ing as a medicalized experience. I have to admit I am not one to study and I take exams easily--my entire preparation: I spent a couple of hou!
rs w/ an LC friend asking her so
me questions and then I stayed up almost all night before the exam and read the chapters in Riordan and Auerbach that I had questions about. The point is, I had learned enough by working with moms and making it my business to read and go to conferences before I ever thought of being an LC. So, I don't feel judgement toward others who aren't inclined toward exams.
    I am trying to think through the correlation you draw to midwifery. CNM's are nurses who become midwives. There is a clear process involved, which is similar to MD's and other HCP's in that it is standardized throughout the US. They have claimed to be the gold standard for midwifery care, and have attempted to be the gatekeepers for midwives. So, in this way, it might be very similar and that does conern me. But, most other midwives practice in birthing centers or attend home births. MANA and NARM are akin to ILCA and IBLCE. NARM certifies direct entry midwives (CPM's), in an effort to standardize and thus preserve the apprenticeship model of study.
    Here is where I see a difference. LC's fuction in a very allopathic, mainstream environment. Almost any bf mother might find herself in need of bf help, usually  postpartum when she is not prepared to do a lot of comparison shopping. A woman choosing a midwife (in the US, where a surgeon--OB--is the standard of care for healthy pregnant women) has plenty of time to research her choices and if she is birthing at home, she is making very conscious choices, taking full responsibility for her actions. Homebirth mothers, in general, are the best educated consumers of birth attendents. So, the only real concern I have is that CNM's (their college, not individuals) have attempted to squash the kind of midwifery I personally prefer to purchase. This makes me squeemish about the gatekeeper role.
    I do feel concern though, that by comparison, there is such a degree of obvious confusion about bf'ing assistance. Mothers really do not know what they are getting. I hear what Jan is saying about "lesser standards". We could say that LLL has lesser standards, so why bother? But, the differences are that LLL does have an international process of accredidation. Unfortunately, there really is no process for evaluating Leaders once they are accredited nor is there a process for removing credentials. But, there is insurance and universal guidelines for practice.
    The same (only more so) is true for IBCLC's. So, my problem is that there is no way for me as a consumer or me as a professional to know one certificate from another. I know what to expect from an LLL and from IBCLC's (of course, not all Leaders are well-prepared or of equal skill, nor are all IBCLC's equally skilled), but still I have a sense of the baseline for each. That is not true of any of these other certifications. So, is the answer to educate the consumer or is it to expect those who take these trainings to use a term such as educator rather than consultant or counselor? I worry that by pushing IBCLC too much, we are hurting the role of LLL, but I think these other levels of care make it almost inevitable to push IBCLC's even harder in our effort to educate.
    One last point--the smallest part of my job is to utilize my technical skills, no matter how complex the situation. Technical skills are meaningless if I cannot find a way to assess, communicate, teach and support. I would never want to be thought of as a specialist in the same vein as a medical specialist, who tends to spend very little real time w/ clients. This is where I would much rather be like a midwife.
Jennifer Tow, IBCLC, CT, USA

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html