Dear Lactnetters,
I recently posted this message on IBCLC2B, a listserv for aspiring IBCLCs.
Many of them are frustrated, discouraged, or have just given up in ever being
able to qualify to sit the exam. Among those are non-RNs, midwives, doulas,
and others who do care about and support breastfeeding others. Some
discussion has been generated by this letter, and I am wondering what you think.
Dear Future IBCLCs,
Everything I am about to say here is my personal opinion. It should be read
as such, and in no way speaks for my past or present employers' views on any
of the following subjects.
I strongly encourage all of you who are looking at the 2500 -4000 hours of
supervised practice hours as hopeless in terms of every becoming an IBCLC to
write to the new executive director of the IBLCE (check the website for her
name and address) and the Chairman of the IBLCE Board (Dr. Wendy Brodribb, send
it to the Falls Church address and she will get it) and explain to them if
you feel it is unfair to you to deprive you of the opportunity to become IBCLCs
within a reasonable amount of time when you have so much to offer. RN's do
not necessarily make the best IBCLCs, and the data used to base the 2500 and
4000 hour requirement is more than 20 years old. It is time, I believe, and
perhaps you do too, for a new study to reassess how many supervised practice
hours and lactation specific and general medical education hours it REALLY
takes educated, intelligent women to become competent, entry-level IBCLCs.
Did you know that number of hours required, specifically the 4000 hours, can be
accumulated over an indefinite time period? This means that a nurse can
count back 20+ years and count post-partum ward hours she did when doctors were
still recommending nipple scrubbing with toothbrushes, and she was telling
mothers to nurse 3 minutes a side. Those hours were supervised and are valid.
Even if a nurse has never stepped beyond the post-partum floor, and every
hour of the 4000 is there, and she has never worked with an infant more than 5
days old, she has qualified to sit the exam. And any hours that are that
old are very difficult to verify. Yet, they count as valid hours, while hours
you spend as doulas, midwives and in other positions do not count because
they are not "supervised". This needs to be addressed to make the process more
fair for everyone. How this can be done, I am not sure, but I am sure it
needs to be addressed.
The 3 day and one-week courses with no supervised practice hours and a
non-psychometrically valid exam do not truly give you the credential or experience
or knowledge you need to become paraprofessionals. They certainly have
value for some students, and are excellent orientation courses. You can learn
just as much, if not more, however, through independent and group study of
Riordan, Lawrence, and the suggested reading list for the IBCLE exam, attending
conferences, and shadowing with IBCLCs. A one-week butt in the seat course is
not the answer to 'certification' and a medically recognized credential.
Five years of La Leche League Leadership comes very close to preparing you
for entry-level IBCLC, because you work with a variety of ages of infants, but
still it is not complete because LLLI's rarely see NICU babies, premies, or
special circumstances babies, but not everyone is cut out to be a LLLL. La
Leche Leage Leadership is not simply breastfeeding, it is a way of life, a
theory of parenting that includes lifestyle choices other than breastfeeding.
It is unethical to become and LLLI, nor does LLLL want potential women who are
"using" LLLI as a pathway to IBCLC-dom.
I wonder why Pathway F has been temporarily discontinued. It was a valid
program that was clearly working. When will the analysis of the data be
completed? Read carefully the newly added "news" and "pathway F" paragraphs on the
IBLCE website that talk about our credential as an "add on" credential.
What does this mean to you? Does it mean that first you do something else like
become an RN, RD, or MD, and throw this IBCLC on for the heck of it? Does it
mean to you that our profession is discredited? Does it infer, to you, that
being a professional lactation consultant is not a real, valid allied health
care profession that doesn't deserve to stand alone? When I read this, I
immediately felt devalued. Do you aspire to be an IBCLC and nothing else? Do
you want a two year AA degree in lactation consulting that would offer you a
standardized program, supervised practice hours, and the opportunity to sit
the exam at the end of your degree program, much like other paraprofessionals
(e.g., respiratory therapists, dental hygenists, etc.)? If any of these
issues mean something to you, express your feelings to IBLCE, become ILCA
members, and inform the ILCA leadership as well. You don't have to be an IBCLC to
be an ILCA member, and your voice counts. ILCA represents all of us, giving
them support and strength through numbers will help move these issues forward,
as they have a seat on the IBLCE board and it is their responsibility to
take the lead in education issues for lactation consultants. Yes, it costs
money. But remember, becoming a professional ANYTHING costs money. You are
making a commitment to a career. Two or four years of college, trade school,
cosmetology school, anything, costs money. Don't expect this to come free. You
don't deserve to be a professional if you expect it to.
While the long hours of pathways A and B, primary pathways continue to
exist, I also strongly encourage you to add supplemental pathways G and H to your
preparations. In fact, I would go so far as to say I think they should be
required parts of the application process, but I have always been pretty tough
when it comes to education! Yes, they reduce your practice hours, but more
importantly, they offer invaluable preparation in terms of academic
preparation and hands on experience you simply cannot receive otherwise. This is
critical --every other allied health care profession demands this, and if we as
IBCLCs want to be accepted by the medical community, this has to happen too.
There is at least one academic program for IBCLC students, at the University
of California at San Diego. But how many people can give up their family
life and commit two years to that? Perhaps one focus of ILCA's education work
needs to focus on the need to establish lactation programs at community
colleges known for strong nursing programs and who intern their students at
lactation-friendly hospitals. Approach local ILCA affiliates to encourage interest
in this kind of program. Maybe you'll find someone looking for a challenge.
Again, ecouraging this vocally, call it lobbying, could make it happen. Do
nothing, and nothing will happen; this I can guarantee you.
IBLCE and ILCA cannot effectively grow our profession and serve the hundreds
of women who want to help mothers and babies if they do not know how you are
feeling. Rather than lamenting how long it takes, and how hopeless it is,
you CAN advocate for change, and I strongly encourage you to do it.
Barbara M. Ash, MA, IBCLC
Former Assistant Executive Director
IBLCE
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