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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