I have not really been following this thread but am now cluing into it. 
Personally as an IBCLC, I have never had difficulty recommending an 
alternative therapy or provider to a client (or to the involved doctor), 
nor have I ever been chastised for recommending something that might help.

I,too, was one who received and completed the survey that was sent to some 
of us. I guess up until now, I did not see the reason for the survey.

May I humbly suggest that there are many factors involved here. I think a 
major one is where you practice, what credentials (excluding the IBCLC) 
you have (nurse, doc, dietician,etc.,),but maybe most important, the 
rapport you have developed with the medical community. Like it or not, 
they are here to stay. If we (as IBCLC's) work with them (in our own way)
we will get a lot farther in the long run. I know that is easy for me to 
say because I have the credibility of an RN license in addition to my 
IBCLC. I can make suggestions and recommendations to doctors and midwives 
and ask for therapies that those of you who are non-RN IBCLC's cannot.I 
can take a verbal order, call in a prescription and I know that I probably 
generally have more access to alternatives than some other non-IBCLC's do.

But I think we all need to remember that regardless of the kind of IBCLC 
we are, we are there to support the parent and encourage them to seek the 
help they need.Part of our job is to teach advocacy. That is no different 
for a nurse IBCLC or a non-nurse IBCLC. You can make all the 
recommendations to a parent that you wish. That is not outside anayone's 
scope of practice. What that particular client does with the information 
you give is up to them. It's sort of like the old expression "you can lead 
a horse to water but you can't make them drink." Change only comes with 
consumer demand and if the consumer doesn't require their HCP's to expand 
and change, they won't. Change is consumer driven.

Personally, I have found my local physicians to be extremely receptive in 
general.One of our hospitalists just took the "40 hour" lactation course, 
probably because she realized she knew nothing about lactation conplared 
to me and many of my colleagues. I consider that a b ig plus for my 
credential (and for our babies). I considered it a big step forward when a 
NNP I deal with started recommending cabbage leaves to an engorged mother 
when in the past,she was totally undereducated in most everything 
breastfeedinf related. She heard about the cabbage thing from another 
IBCLC colleague and then she was passing it along to the new mother. So, I 
consider that a point for our side!

So, I know some non-nurse IBCLC's are probably the ones who will be more 
frustrated(or maybe I should say restricted) by these new practice 
guidelines but that's the way it is. All of us (no matter what our 
profession) must work within guidelines whether we like it or not.

Most professions require some kind of updating. At least in this area, 
pediatricians have to retake the specialty boards every 7 years to keep 
current. They take the same test the new docs do: just a shorter version.

I know some of you will not like what I have said, but we all have to work 
within a framework: like it or not. Let's not cut off our noses to spite 
our faces. We can continue to make inroads into lactation and continue to 
help mothers.Let's make that a priority.

Betsy Riedel RNC, IBCLC
Connecticut

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