I am so grateful that issues are arising that address the differences  
in practice in different countries wherein even the ethical  
guidelines are impossible to apply across the board. The suggestion  
that an IBCLC has less freedom to practice than an LLLL or CLE or  
anyone else should be waking all of us up--b/c based on the IBLCE  
documents, it is completely accurate. Jaye's point that mothers would  
be better served by LLLL's, peer counselors or even their neighbor is  
also accurate.  There are so many ethical concerns for me here that I  
hardly know where to begin.

It has been stated that phone or email helping borders on the  
unethical! Is IBLCE aware that there are mothers who do not live near  
an IBCLC? Should these mothers be denied care? Should the mother have  
no right to seek another opinion if she is not satisfied with the  
local IBCLC? Most of breastfeeding counseling is not a medical issue.

What I am hearing here is that the IBLCE has forgotten who we serve  
and that the rights of the mother outweigh the perceived "rights" of  
the PCP to be in control of everything we do and say. Further, the  
wording used in reference to obtaining permission from the mother to  
report to her HCP crosses the line into coercion. If a mother has no  
choice or she will not be served, is that not coercion? It seems to  
me that the US has gone much further in forgetting about privacy and  
human rights than many other nations.

It is not doctor-bashing to demand a code of ethics and SOP that  
reflects our obligation first and foremost to our clients, nor is it  
disrespectful of the role of the HCP (when indeed there is one). The  
relationship between the HCP and IBCLC should better reflect the  
commonalities between cultures and countries and should be written  
with the rights of the dyad, our obligation to them and our ability  
to practice with integrity as our point of reference.

I have been concerned for many years about the direction of this  
profession, but today I am not at all proud of my credential. I will  
not adhere to rules that consider the protection of the western  
medical model more important than the well-being and rights of the  
dyad or more important than the personal integrity of the  
practitioner. One of our greatest assets is in the breadth of our  
backgrounds, in our ability to apply the same skills across all  
cultures and languages. This speaks to the real nature of  
breastfeeding as a human experience rather than a medical issue.  The  
IBLCE's work should ALWAYS reflect this.
Jennifer Tow

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