I have never been more disappointed to be an IBCLC than I am today.
It is quite enough that we are a profession completely disregarded by
the majority of heath care providers, but that we have so wholly
contributed to our own impotence is utter humiliation. That we would
have so little self-respect that we expend such enormous energy to
prove we are good enough by behaving as if we are not is further
humiliation. I am sorry to say that it is no surprise to me in a
profession run by women--I don't believe for a minute that a
profession run by men would belittle itself in such a way.
I have considered the IBLCE exam to be a poor assessment tool from
the first time I took it (ten years ago), learning that passing
required little more than having basic medical training and some
basic continuing education. Being a skilled clinician and even having
a commitment to breastfeeding are utterly irrelevant, as was proven
to me at that time by the process which I saw co-workers use to
prepare for the exam.
Ten years ago, I studied by reading several chapters of Riordan and
Auerbach the night before the test --that was all (and no, I did not
just barely pass). It never occurred to me to study for something I
do every single day, unless there are areas I never engage in--at
that time, I read about diseases and disorders I have never seen.
Besides, I am a good test-taker. I wrote two complete pages this year
about questions that I knew were absolutely wrong or were just poorly
designed.
I have homeschooled my children exactly for that reason--I didn't
want them to learn to be good test-takers--to give the answers
expected of them just to get a grade. I want them to be competent,
loving, passionate human beings with a depth of purpose and place in
the world. So, test-taking holds little value for me at all. At the
time I took the first test, I complained to a member of the ILCA
board about the lack of integrity in the testing process, and not
only was I treated rudely, but my private conversation with the Board
member was conveyed to a co-worker of mine who functioned in a semi-
supervisory capacity who behaved in a retaliatory manner toward me
that has affected my practice for over ten years. That was the last
time I had any desire to bring an issue directly to ILCA, even though
I am a member and have been a founding and active board member of my
local affiliate.
Lest this stir up a whole new debate about recertifying--I am in
favor of recertifying. I just have no desire to spend ten years
becoming expert in certain areas of my field, only to dumb myself
down to re-sit an entry level exam that was a poor tool in the first
place (this time I studied so I would know what the "consensus"
opinions are on many of the questions on which I disagree--based on
my own experience and research). I wonder how many other HCPs who
have become expert in their fields would like to retake their own
entry-level exams? We should have a process that acknowledges our
gains in expertise, not keeps us all at the same level. But, then I
suppose the only expertise of any value would be that approved by the
medical model?
So, after just proving myself competent again to practice at an entry
level and waiting an absurd three months for the results, I find out
today that the IBLCE has decided (when exactly were we asked our
opinions?) to issue a new "Scope of Practice". I have so many
questions, not the least of which is--was there any thought that many
of us might not have bothered to retest if this document had been
issued last Spring?
Okay, so I want to be clear about my "Scope of Practice", My most
glaring question is this--when did IBCLCs become pawns for the
allopathic medical model? Sometimes we sit in shock and amazement at
the words that come out of the mouths of doctors--we wonder how it is
possible that they cannot be working for the AIM companies when they
so blatantly undermine normal human feeding. No act on the part of
the AAP or an individual physician has served to undermine
breastfeeding more than these two lines:
As printed:
"The following activities are outside the scope of practice of an IBCLC:
Prescribing or recommending the use of alternative therapies.
Contradicting or ignoring the advice of a client’s health care
provider.
These two statements are not aligned with either my personal
integrity nor with the concept of holistic practice, nor are they
aligned with the right of infants to breastfeed, nor with the
obligation we have to give accurate information to our clients.
We have often wondered how it is that peds are not sued for telling
women outright lies like AIM is just as good as human milk or that
breastfeeding doesn't really matter or that AIM won't harm their
babies. I wonder now how we will not be sued for NOT telling mothers
about therapies or treatments that we know will protect or allow for
breastfeeding to happen. How will we not be sued for NOT telling a
mother that she has been given inaccurate info? Do we sit quietly
when a mother is told that AIM poses no risks or that breastfeeding
has nor "benefit" past the first few weeks/months? Do we nod in
stupid agreement when a mother is told that there is no such thing as
tongue-tie? That it is not normal for babies to feed every couple of
hours and this is cause to supplement with AIM (in a ped's booklet I
just read last weekend!!)? If I do not contradict a lie, then I, too
am telling that lie. If I do not offer a solution to a problem, b/c
the only solution to a baby who cannot bf due to trauma is CST, then
I am willingly subjecting that baby to a lifetime of consequences. My
karma is not willing to take that burden.
Let me be even more clear--who gets to decide what is "alternative"?
If I had been the client and an LC told me to see my OB for thrush
treatment, she would have been giving me "alternative info", as my
HCP was a midwife and the use of drugs is an alternative to me, not
within the realm of my normal life at all. Is CST as practiced by a
PT alternative? How about a chiropractor? Is it based upon what is
covered by insurance? Some insurance covers acupuncture. Some women
have no insurance. And, as Rachel said (apparently a shock to IBLCE)
some women do not live in the US!!! Can I tell a woman who lives in
Canada something different from what I tell a woman who lives in
China--and would I need to know what is "alternative" to her? Or is
it only based upon what is considered "alternative" by the great
Western God Allopathy?
So, I have a mom whose baby has blatant symptoms of food allergies
and whose baby has indications of tongue-tie and mom has a low milk
supply. I should do what exactly? Cannot refer her to a ENT? Cannot
refer to a CST? Cannot tell her about fenugreek or MMP or
domperidone? If her ped tells her that she can just "cut down" on cow
milk products for a few days to assess allergy and I know how useless
that is, do I just nod like an idiot?
Is breastfeeding a part of the normal continuum of life or is it an
irrelevant feeding option unworthy or our best efforts, knowledge and
skills? Because if it is the prior, then it is not a part of the
medical model and should not be cared for in reference to such. After
all, the obstetrical medical model (which is in no way evidence-
based) bears great burden for the fact that babies cannot breastfeed
now. Of course, the routine separation afterwards does nothing to
heal the wounds of western birth.
I am co-speaking at a full-day workshop at the APPPAH Conference in
California in Feb 2007 on healing trauma through infant feeding. My
first portion of the talk is based upon the work of people like
Michel Odent and Nils Bergman who understand that there is a
biological and spiritual imperative in the design for optimal human
health that begins in pregnancy and is woven through the maternal-
infant eco-system during the first year of life. The second part of
my lecture and that of my co-speaker relates to the brutal reality of
western medicine that has no frame of reference for the foundation of
human health as it has been designed into the primal period, and thus
recklessly imparts illness in its every act. Hence, the need to heal
trauma in the human infant.
Now, we come along as an entire profession and become, as perhaps
we were destined to do, one more part of the problem, leaving the
solution, as always with precious few champions.
So, assuaging the American allopathic medical community is of more
importance than babies being exclusively bf, or bf at all for that
matter? If we are taking this position, we as a profession have done
the greatest disservice to women and babies that has ever been done.
We can stop blaming uneducated doctors and look to ourselves and our
own fears because we, even more than they, ought to know better!
Indeed, our unique position as an international profession ought to
be our salvation--it ought to be our way of rising above western
allopathy and functioning from the position that that which unites us
is our strength--that which unites us is the biological norm across
all cultures and beliefs and customs is the biological imperative and
its inherent truth.
"We do not see the world as it is--we see it is we are". If we see
ourselves as inferior in the world, then so we are. If we see the
medical model as all-powerful, then for us, so it is. If we see the
world from a place of fear, the we should be very afraid.
Jennifer Tow, IBCLC, CT, USA
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