While it is all well and good for the IBLCE Board to review the SOP,  
I agree with Rachel that they need to take immediate action in  
reference to those of us who will not practice under such  
debilitating and destructive guidelines. My preference is that there  
be an immediate rescinding of the SOP as it is written until a new  
one is drafted, otherwise we are still left in an impossible position.

Frankly, I believe the current SOP might well be an illegal document  
as it binds us to contradictory practices and compels us to act  
unethically,  placing us in jeopardy. I do not believe it is legal  
for a SOP to force a practitioner to place herself in legal jeopardy  
and IMO, this document places me in jeopardy as I am expected to be  
complicit is care that could well be described as malpractice. I am  
also expected to act without integrity or ethics and to act in the  
(perceived) best interests of physicians, not in the best interests  
of my own clients. I also wonder if it can be legal to state on the  
website that the SOP is not the final document and yet expect us to  
abide by it.

I do not believe for a minute that the members of the IBLCE Board did  
not comprehend the potential interpretations and/or  
misinterpretations of the SOP. I believe they wrote exactly what they  
meant to write. Intelligent people, who practice under their own  
SOPs, do not spend two years writing a document such as this without  
knowing exactly what they are doing, Unless there is an extraordinary  
explanation that we are overlooking, then what they are doing  
reflects a decision to eliminate the IBCLC as an independent  
profession, relegating it to a useless set of letters and an add-on  
for other HCPs.

Further, I am shocked that anyone would not find this document to be  
a threat both to us and to our clients. Also, as I reread some of our  
other guidelines, I see more areas of concern in both interpretation  
and what I see as in intent to undermine our ability to practice  
effectively.

In reference to BWC's post, I find it interesting that in one of the  
examples she used to argue that the new SOP simply reflects existing  
guidelines, there is much room for differing interpretations and even  
jeopardy.

She references:

"Require and obtain consent to share clinical concerns and  
information with the physician or other primary health care provider  
before initiating consultation."

"Tenet 23 speaks to the issue of scope of practice.  Unless otherwise  
qualified and additionally licensed, most LCs are not primary care  
providers.  Consequently, they are obligated to consult with and  
report to the patient/client's primary care provider.  Patient  
confidentiality requires that the patient be informed of the intent  
to share information.

This intent should be made clear prior to beginning the consultation.  
Signed consent must be obtained."

This is confusing--we cannot compel a mother to give such consent and  
yet the language suggests that we must have it to proceed. This could  
mean that we cannot see a mother who refuses us access to her HCP or  
it could mean that we are required to obtain consent, but of course  
cannot compel her to give it and would simply proceed without it. I  
sometimes have clients who are very clear that there is certain  
information they do not wish to have shared with their peds (usually  
we are talking about non-clinical issues like tandem nursing or co- 
sleeping, but sometimes other issues arise--I almost always urge  
parents to share these things as a way of education, but moms often  
feel threatened in doing so). This statement literally uses the term  
"obligated", yet says we must have permission, which of course the  
mother has the right to withhold. So, what to do? Refuse care? The  
more I read of our guidelines, the more I see inconsistencies and  
vague instruction just about everywhere.

What needs to happen is the IBLCE must remove the current document  
snd open meaningful dialogue with IBCLCs to determine how best to  
support us in effective practice guidelines. This dialogue must  
include those of us in private practice who come from varying  
backgrounds, not only those from medical backgrounds. I also believe  
that so long as the IBLCE Board composition reflects the western  
medical model, we can never hope to normalize breastfeeding, as that  
model will continue to be the compass for all action.

What I would like to see is the iBCLC as an independent practitioner,  
who is prepared through one of two tracks--either through an  
apprentice model (such as many midwives are) or through a structured  
educational model, both to include required clinical oversight. This  
would preserve the depth and texture of our profession that has  
proven most appropriate in a field that references normal physiology  
and function vs dis-ease. The IBCLC must be free to be the expert on  
breastfeeding, not the expert on lip-service and must be free to  
fully support the best outcome for mothers and babies, not the least  
offensive to HCPs who may be resistant to challenge or education. Any  
caregiver who practices at the whim of another has no power, no  
respect and no integrity and never will.
Jennifer Tow, IBCLC, CT, USA

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