After being a LLL Leader for 24 years and IBCLC for almost 20 . . . . . 

I honestly think that there is no hope of IBCLC really meaning anything, professionally speaking, unless it is earned after completion of a recognized course of study at the university level.  This is what makes us different from all other health care professions and will continue to set us apart and keep us from being widely employed in the health care field.  While it is true that a few people have broken through this barrier, the vast majority of IBCLC's, who are not also RNs or MDs, are unable to find reasonable employment in this field - that is, a job that pays a living wage.  If you are self-employed, there is the issue of insurance reimbursement - an ongoing problem in many areas also linked to our lack of professionally recognized credentials. Most IBCLCs who are self-employed and making any kind of money are doing it through sales and rentals.  Some supplement by speaking and/or writing books.  I know that pioneers in any field have to work hard to get things going, but this has been a life-long "career" for me and although my knowledge of breastfeeding has increased enormously because of the re-energization that the emergence of IBLCE and ICLA have brough to the field, I am still subsidizing my own career as a lactation consultant.  The little bit of money I do make is immediately spent on books, education, etc.  While some of the money I make as a medical technologist goes to the same thing, it is a very small percentage of my total salary.  So, I work 45+ hours a week in the lab to pay the bills and then put in a lot of "overtime" being a lactation consultant as well as doing LLL stuff. This is what a lot of IBCLCs are doing and it really wears you down after a while.  The joy of watching a mother and baby connect is what keeps me going each day.

What my "dream" situation would be is that IBCLC would indicate completion of a unique (not nursing) degreed university education.  Those who are really serious about pursuing status as a health care professional would follow this course and be employed and paid appropriately, be it in a hospital, clinic or in a private practice, acknowledging that private practice will always be more iffy on the income side - just like any other HCP in pp.  In addition, there would be a large and dedicated number of lay breastfeeding folks, be they LLL or otherwise, who will be available in every community to provide the follow-up and day-to-day support that HCPs most often cannot.  Some of these laypeople will probably function as IBCLCs and charge for their services, just as lay midwives do.  And some moms will seek these folks out - no problem.  But an IBCLC would not just be a nurse with a little extra training that managed to pass an entry level exam (no offense to the many nurse LCs who are dedicated to breastfeeding - I'm talking about the many others that are just adding a credential to get a job or more money.)

It may be that the chance to claim this profession as our own and not a subspecialty of nursing has passed.  I dearly hope not.  My question is, how to we take the next step?  How did other professions break away from nursing and separate themselves?  Perhaps we need to do some research into those experiences and draw upon them rather that trying to reinvent the wheel.  Not just in general, but what specifically happened at what times along the path to establishing, for instance, physical or occupational therapy as a profession?  How do you get widespread offerings of a specific program at universities across the nation (world? - I fear I am being very USA-specific here).  It does not need to be offered everywhere.  For example, in the state of New York there are only a few universities/colleges which offer degrees in health care professions such as medical technology, physical and occupational therapy or pharmacy. But if you want to be one of those types of HCPs, then you find a place to go and get into the program.  We need to start taking the specific steps that would be necessary to move from where we are now to where we want to be.  I don't see how another "credential" is going to help get us there. 

OK, so I have a lot of ideas, but no solutions.  I would be willing to work towards this goal.  I'm home sick today.  Maybe after some sleep I will search the web and see what history lurks out there that may be of help to us.  Or perhaps a lot of work has been done on this already that many of us are not aware of - I would love to hear about it if there is.  Anyways, my brain cells are already swimming in mucous today, so I think that is all the meandering that I should subject all of you to for today.  We have this conversation every year.  Many of us keep saying the same things.  We need to either move towards an achievable goal or quit tilting at windmills and accept what has evolved.  Good luck to us all.  And the moms and babies we are trying to help.  Peace.

Sharon Knorr, BS, IBCLC
freezing and wheezing in upstate New York




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