Lois Mathews writes: “Dear Pam, We hospital based IBCLC, also R.N. Are
not gagged we can and do question Dr.s orders and challenge them when
they give wrong info”.
Perhaps nurses are less gagged b/c they are more valued? Or perhaps
they are just less likely to challenge docs on the issues we are
talking about here. After all, it is usually the nurses who give most
of the misinformation about breastfeeding that mothers receive in
hospital. Just in the past two days, I have seen moms who have gotten
horrible info/advice from nurses.
In my community, IBCLCs in hospital are told in no uncertain terms that
there is information that they not allowed to give to mothers. I had a
hospital RN/IBCLC call me years ago to inform me that the hospital did
not approve of my giving info about chiropractors to mothers who gave
birth there b/c some of the peds did not like it!!!! She was perfectly
comfortable saying this to me and did not see why I should do it if the
doctors didn’t want me to. Ummm, b/c the mothers had a right to
information that would help their babies heal from the trauma the
hospital practices had inflicted upon them. She also thought the
hospital had rightful authority over my practice!!!
I have also seen nurses agonizing behind the backs of doctors over
things doctors did that they felt they could do nothing about. I saw
this often in OB, especially when I did labor support. Most of the
supportive things nurses did were very quietly done, lest they draw the
attention and ire of the OB. They would openly lament “having to do
things b/c the doc liked it this way” even though they clearly
disagreed. OTOH, many nurses were in no way supportive and pushed as
many poor practices as the OBs did. When my own son was in hospital, I
found the PICU nurses very supportive of me, but they did not dare
confront the doctors—they just quietly told me helpful things that
supported my choices. I appreciated them very much, but the one RN who
did actually support my rights directly to the doc was reprimanded for
doing so. I will always be grateful to that nurse, but that should
never have happened to her.
If nurses routinely question orders they, then why is it that there is
routine supplementation of almost every baby in my community? Is it the
case that the nurse’s opinions are generally just dismissed or is it
that most nurses have no problems with this practice ?
And the value of the IBCLC credential.
Lynette Hafkin wrote: “How will the random mother or lactation
friendly hospital be able to determine who is really a gold-standard
breastfeeding professional without the IBCLC credential? “
I don’t think the midwives, OB’s, peds or mothers who refer to me have
any idea what IBCLC means. That is not for lack of trying on my
part—but as long as I do a good job, that is really all they care
about. They don’t understand the process and since anyone can be an LC,
it is too much to sort out.
Lynette: “Right now, the IBCLC means that the LC has cared enough about
demonstrating her knowledge and commitment that she has spent her own
time and money to earn the IBCLC. Obviously half of all IBCLCs will be
below average in their knowledge and skills, but that doesn't mean we
should just chuck the whole thing!”
This is just not true—there are many IBCLCs who did not spend their
own money or time to take the test or get CERPS. There are also many
IBCLCs who are not in any way committed to breastfeeding—some who even
did not find that “breastfeeding was for them”. Also, I don’t think the
exam is very rigorous, nor does it assess many of the skills I think
should be most valued. As someone else said—if you are good at
book-learning, you can easily pass, especially if you have a background
in nursing.
Lynette: “There is no perfect system.But if all the excellent people
leave the "pretty good" system, then we will be left with a badsystem.“
The thing is—I think it is already a very bad system—at least in the
US.
Lynette: “There is a saying, "the perfect is the enemy of the good." I
know we are all in this field because we believe in giving of ourselves
to the cause of mothers and babies, not because we need to make the
most money or have the most prestige. So think about what maintaining
the institution of IBLCE will do for breastfeeding, even if it is
currently facing some difficult issues. Not that you need to "give up"
and adopt the bad SOP, just spend some time thinking of what the
credential DOES for us, rather than what it doesn't do. Then let's
figure out how we can get involved (even in a small way) in fixing
things."
Maintaining the credential may do as much harm to breastfeeding as the
“childbirth education” model has done to childbirth. It was co-opted by
hospitals, became inculcated into the medical model and gave women a
false sense of their own level of preparedness and ability to make
choices in birth. I don’t think it needs to be fixed—I think it needs
to be torn down and rebuilt with a new premise—-with normal
physiological processes as the compass and a commitment to protect them
in an honest, ethical and educated way as the framework for a SOP.
Patricia wrote: “ If the board certification is meant to be an addition
to other credentialing then those of us without additional credentials
who already are board certified will be grandfathered in. “
Who does this benefit? I have no desire to be the gatekeeper, saying
that the next LLLL, doula, peer counselor or other committed person
cannot become an IBCLC so long as I can practice. I also have no
interest in being grandfathered into an organization which places the
interest of the medical establishment above the interests of
moms/babies and places absurd restrictions on my practice, completely
demeaning and degrading my years of work, commitment, education and
success.
Veronica Tingzon writes: “I am lucky. I have fought hard to get a job
as an LC in a hospital, but I am called a lactation educator- as I am
not an RN. A way to be paid less, I guess. I have no problem with this
for now. I am still just starting out on my journey as a LC. I am,
however, very saddened that my credentials are viewed as substandard
just because I don't have that RN. I am forced to play the game,go back
to school, spend countless hours away from my kids being in class and
pursuing a degree I really don't want, in order to be viewed as a
valuable LC.”
How can you say you are lucky, Veronica? You are a fully-credentialed
IBCLC who is NOT ALLOWED to identify yourself by your rightful
title???!!! I would say that bodes quite poorly for the profession.
Veronica: “I have seen many RN IBCLC or RN CLC that have "missed" very
crucial components to the breast feeding situation. I have been the one
who has discovered a baby's tight frenulum after the dyad has been seen
2 or 3 times prior by an RN LC. I have been the one to tell a mom about
an SNS when she had low milk supply and nothing else was working to get
her baby's billirubin up after being seen by an RN LC. I have been the
one to have mom try to BF after a breast reduction when an RN IBCLC
told her she shouldn't bother because she won't make milk. “
I don’t know an LC in private practice who does not often have this
experience.
Veronica: "I feel I received really stellar training from Gini Baker at
the UCSD CLC course. Sure, there are other programs out there that may
not be as good, but the proof should be in the pudding. Actions should
speak louder than initials, folks.’
Yes, but what we are being told is that initials speak louder than
anything and that the MD initials have authority over everyone
(including mothers). It doesn’t matter how good you are—it matters that
you are put in your place and never dare to contradict anyone with more
important initials.
Jan Barger asked: "Jennifer, I would like to know what you mean by
"using nursing training as a foundation for building the credential."
" While I don't agree with what is going on now, with the IBLCE
backpedaling on their SOP stance (how silly to say it is just for the
non-licensed HCP), I don't see that the founder used nursing education
as a foundation. By the way, nurses are educated, not trained. Dogs are
trained.“
I do apologize for the poor choice of terminology—you are quite
correct, of course.
No, I do not think this was the original intent, but I do think that
somewhere along the line, maybe ten years or so ago, things took a turn
and the material that is the foundation of nursing education became the
guideline for the education and evaluation of all IBCLCs.
Jan: “It happens that nurses are in the right place to become IBCLCs
as they are the people that are working with the mothers and babies in
the hospitals, and as birth becomes more interventive (far more so now
than it was in 1984 when the credential was first thought of -- and
I've been an RN in MCH for more years than many of you are old, so I
know whereof I speak....) mopping up the messes -- or trying to,
anyway.”
Yes, this is true, but that should not be enough, especially given the
birth nightmare. Remember that as birth has become more medicalized,
nurses in hospital have the opportunity to see fewer and fewer babies
behaving in a normal way, nor do they have the opportunity to see how
things go after the baby goes home. Often things get much, much worse
and significant intervention on behalf of mom and baby are needed.
There needs to be a two-fold effort on behalf of the dyad—-first from
the hospital nurses and LCs and midwives, then from the private
practice LCs. (Of course, once birth returns home, we can all find
other things to do with ourselves.)
Jan: “So it is not a credential that is designed only for health care
professionals. It was designed for people of many backgrounds to become
credentialed in order to legitimize their education and knowledge.”
I do think that was the original design—but I do not think it is the
intent any longer.
Jan: “The fact that 20 years later the board was short sighted enough
to write a scope of practice that benefits NOBODY should not be a
reflection on the original intent. The question before us all is what
are we going to do about it?
And one thing we are doing is working on a new scope of practice.”
But, Jan—who is working on a new SOP? And who has the right to do so?
I am sorry, but I cannot believe there will be an ethical, functional
SOP written by non-IBCLCs or even by IBCLCs who are working from the
medical model. An ethical SOP must serve mothers and babies and I have
not seen them prioritzed in this whole debacle.
Lynnette Hafken writes: “Did the 7 founders of LLL wring their hands
that moms just should not be given twilight sleep and separated from
their babies for days and then told to schedule feed? No, they figured
out what needed to be done to change it, and did it. The climate they
faced was MUCH worse than what we are facing now.”
I don’t think it was a worse situation. Infant and maternal mortality
and morbidity rates are much worse now than then. Breastfeeding was not
important enough (nor enough of a threat to the status quo) to become
the domain of the medical model. As I see it, we now have the fox
guarding the henhouse.
A better idea:
Sima Leah writes: "All I want to say is that It doesn't make sense to
have to answer to someone who is not a specialist. keep them informed,
yes, but not able to contradict, do.=
<snip>
I for one am for more anatomy, physiology and endocrinology background
information and maybe more intense learning of herbal and other health
promoting remedies, rather than being in the shadow of a DOCTOR
Sima, I agree. It is a conflict of interest for me to “answer to” the
very practice that has undermined birth and breastfeeding. We should
set ourselves apart from the medical model, not be seduced by it. The
fact is that so long as birth is so brutal, babies will not be able to
breastfeed w/o a lot of assistance—and we need to have access to every
tool at our disposal to allow that to happen. That includes our
knowledge of nutrition, herbs, homeopathy, chiropractic, whatever we
can bring to the table to heal these injured babies.
Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC
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