The discussion about pathways is wonderful, useful, and  thought-provoking.  
Let's not let it die. We can see how infuriating  it is to all of us to live 
in a world of how the issues of RN vs non RN, mother  support leaders earning 
'free' (in some people's eyes) hours annually, the  intrinsic unfairness of the 
system to doulas, midwives and others who may  practice independently, yet 
are qualified, and the seemingly senseless rules of  hospitals for hiring 
IBCLCs, even within the same city and systems, put  additional stress on many 
already stressed, burned out IBCLCs, as well as those  who want to become stress, 
burned out IBCLCs.
 
Ms Feather, I have never heard of such dedication to pursuing hours and  such 
imagination and cooperation and love of the profession by both you and your  
mentors.  You deserve to be congratulated by every single person on this  
listserve.  You make an excellent, cherished point.  Our credential  should be 
good enough to stand alone.  But in many people's eyes it is not  yet.  This is 
not anybody's fault, but there are ways to fix it.  Our  professional 
association, ILCA, should make this a top priority on the US  agenda; those RN/IBCLCs 
should stop making such a big deal about their RNs and  how it 'makes them a 
better IBCLC'; individuals without RNs should apply to  hospitals and ask to see 
the written hospital policy that strictly forbids  hiring of IBCLCs without 
the RN credential - be an activist.  Local ILCA  affiliates could, on a local 
level lobby local hospitals, and their lactation  directors, to bring this to 
the attention of hospital administrators.  With  guidance, "talking papers, 
i.e. guidelines and notes on what to say", every  group could do this.
 
Almost everyone has views on the pathways. The originators of the  credential 
wanted to guarantee that there would always be a pathway open to  
mother-to-mother counselors. It was meant to honor the roots,  the foundation of the 
profession, which grew from La Leche League.  If  you are not familiar with this 
story, read the first page of IBCLE's  Candidate Information Guide or the LLL 
Website.  When the credential  was created, that was a time when many 
counselors did not have college  educations.  That meant they would fall under pathway 
D, requiring 6000  hours of practice.  Without a college education, it would 
be nearly  impossible to acquire these hours.  Many people now, especially the  
non-medical profession new moms who are "in love" with breastfeeding and what 
 their IBCLC did for them are motivated to do the same for others want to 
fast  track and for them Pathway F was the answer.  Some will argue that the 4  
year of post secondary education vs 2 years of post secondary education is  
discriminatory; others argue that doctors who know practically nothing and don't  
need to be 'supervised' become eligible by virtue of only being MDs.  Is  
that fair?  Now the ABM (Academy of Breastfeeding Medicine is creating its  own 
'credential' --- actually more of a designation of interest and achievement  
rather than hands on work).  Fewer people than you'd think take advantage  of 
pathways G and H, but they are almost never the pathway B people, and nearly  
always the Pathway A applicants.  Why is this?  I leave you to draw  your own 
conclusions.
 
Regardless of how you feel about the pathways, whether or not a formal  
educational track/degree with REAL mentoring should be developed or not, let's  
talk about education.  The pathways, all of the except the defunct  (hopefully 
not forever F) have no requirements, no clinical competencies  checklist as F 
did.  I find this (a) hard to believe and (b) unacceptable,  if we are not going 
to have a standardized university program established.
 
ILCA has just instituted a new Education Department, headed by Judi  Lauwers, 
a longtime educator in the field.  She needs to know what we think  is 
necessary.   
 
Please think about this.  People have been responding directly to me,  which 
is great, but please, please post to the board.  Lactnet is meant for  
discussion--not just of clinical issues, but also of issues that affect our  careers.
 
Barbara

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