On behalf of Barbara Ash, I am trying to post this without the signal
characters that make it impossible to read.  Apologies to all, esp. Barbara,
if this attempt also fails.  Rachel Myr

"I have been following this thread with great interest, as it has been one
of my major concerns both in private practice, and during my past years at
IBLCE.  I agree that Debbie Albert’s original post (May 16) that the issue
of uneven skills among IBCLCs is one that we need to discuss, not only here,
but also within our credentialing organization, and our professional
association as well.  While the profession was born and has come remarkably
far in 20 years, we have a long way to go if we aspire to full recognition
and respect by the medical community, insurance companies, and the public at
large.  No one organization or group of people can address these issues, let
alone ‘solve’ them, but all of them need to acknowledge that they exist (so
far undone) and include plans in 5 and 10 year plans to direct actions to
ameliorating the situation.

This post is by no means a comprehensive plan, nor is it meant in any way to
be a criticism of IBLCE, ILCA, USBC or any individuals or organizations who
have worked tirelessly to build our profession to where we are today.
Indeed, I have great admiration for all of those who have contributed to the
development of our profession.  Instead, it is my solely my personal views,
offered in good spirit, as an honest reflection of what I see as the major
challenges facing us now and in the immediate future.   They are discussed
in no particular order.

Debbie called our attention to mothers and babies coming to her care with
problems that never should have been allowed to progress to the point of
nearly no-return.  I have heard from many colleagues.   I sympathize
completely, having built  private practices in Australia and in the US
dealing nearly exclusively  with ‘train wrecks’ referred by hospital IBCLCs,
public health IBCLCs and nurses, other private practice IBCLCs, LLLLs, and
others have not been able to help.  I find it appalling that within 20
seconds of the baby opening its mouth I can clearly discern the
problem…frenulum, palate, oroboobular disproportion, or a sucking problem
that mystified 3 or 4 other IBCLCs.  If IBCLC is the “gold standard”
credential, and this happens and, it would seem, more often than it should,
then “gold” isn’t clearly enough defined.  Yes, we should be worried about
what the silver and bronze standards are (CLC, CBE, CLE), but we also need
to be concerned about the universal quality of our professionals.  Setting
ourselves up as the best means that we need to perform as the best.  The
IBCLC is advertised as the entry level credential, yet also viewed as the
crème de la crème in lactation counseling; it   seems to me that this is a
disconnect.  Either the entry level person needs to be able to deal with the
complicated problems without screwing up, or maybe she shouldn’t be an
IBCLC.  We complain about the CLC, CBE, CBC, etc. but who knows how many
IBCLCs are actually performing at this level?  I know that some say that
there are some doctors who are better than others, some OTs who are better
than others, etc., but they have the luxury of having been around a while,
AND having subspecialties.  We don’t and what we do has an overarching
impact on the entire medical profession’s view of lactation consultants.  

Yes, horrors, I’m saying maybe everyone who is interested in lactation,
sincerely wants to help mothers and babies,  or who thinks the credential
will get her more money, is pursuing it because it adds to the string of
letters behind her name, because she needs to keep up with the Joneses, or
for whatever other reason doesn’t really need to be an IBCLC, and doesn’t
really deserve to be an IBCLC.  Perhaps the solution is the lower level
credential, one that will ensure a level of competence that does not include
the ability to recognize and work with such problems as these.  I think it’s
more important to have fewer qualified IBCLCs than just to have a lot of
them.  As others said before, the incompetent, misinformed, uneducated,
and/or inexperienced “gold standard expert” doesn’t do our profession one
bit of good.  On a local level, it hurts it.  You know it only takes one or
two pediatricians to spread the word that the local lactation consultants
are not very knowledgeable.  (And in here, I would include those PPLCs who
don’t report to the primary care providers after consultations.  They are
not meting their professional responsibilities either.)

Many of us have encountered IBCLCs (unfortunately, many of whom, but not all
of course, are hospital based) whose expertise is limited to babies under 3
days of age.  The “gold standard of lactation expertise”, friends, extends
beyond 3 days.  Not being able to recognize a nursing strike, not knowing
how to deal with teething, tandem nursing and a host of issues can be “book
learned” enough to pass the exam, but in reality how many candidates have no
experience with these situations, and have little or no motivation to
acquire it?  Even if these IBCLCs don’t use this information on a daily
basis, they are in fact, not equals to other IBCLCs, even though we all pass
the same exam. " (continued)


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