Dear all:

I've had a bad week, bad month, bad year because I thought I joined a sisterhood that 
would be expanding through camraderie (and perhaps a little competition which hones 
one's skills).  Unfortunately, what I have seen since I joined a profession that I thought 
would be a culmination of far too many years in school seems to be dwindling before my 
eyes.  One practice of the old school that had come up through LLLI has gone out of 
business.  Another  colleague has moved away. Two colleagues are writing books; one 
starting a book, another finishing a book and on the conference circuit.  It has finally 
pierced my thick-headed denial that while I think the hospitals in Manhattan are 
understaffed when it comes to lactation services, the private practice sector is even 
worse.  There are just a handful that do private practice and with the demise of one 
group practice it really is not enough.  Because I am pig-headed, I won't give up on trying 
to figure out a way to make things better for the handful of us that do continue to work in 
private practice despite a scope of practice that makes it a huge legal liability to work.

On top of this, I have just had some of my careful evidence-based gentle comments 
questioned.  I sent an article from the Journal of Neonatology in response, only to receive 
the comment from a health care practitioner, but what I did with my child was ..... And I 
thought, but did not say, that I did too but that doesn't mean that I would recommend that 
practice myself because I know better now.  And it is a practice for which there has 
already been one lawsuit due to the negative consequences.  Between having my IBCLC 
yanked and getting sued because a baby dies (OR MORE IMPORTANTLY, knowing that a 
baby might die because I did not provide accurate evidence-based conflict of interest free 
information), I prefer the former.

Some have excused the poor scope of practice and I can't help but go back to the books 
of my childhood.  A section of Black Beauty came to mind.  Talk about moral values, it is 
a total indoctrination in the old school model of novels that include a moral lesson in 
every chapter!  This little section stuck with me...

After Black Beauty almost died because of a stupid mistake, his groom responds to a 
comment about the mistake being only ignorance with:

"ONLY ignorance! only IGNORANCE! how can you talk about ONLY ignorance?  Don't you 
know that it is the worst thing in the world, next to wickedness?  --- and which does the 
most mischief heaven only knows.  If people can say, 'Oh! I did not know, I did not mean 
any harm,' they think it is all right. I suppose Martha Mulwash did not mean to kill that 
baby when she dosed it with soothing syrups; but she did kill it, and was tried for 
manslaughter."  

I cannot, in good conscious, even though I may not ever be able to practice again 
because some other health care practitioner might have done things differently with her 
own child, withhold information that I know to be true, evidence-based, and conflict of 
interest free when it may have an impact on the health of the baby involved.

Best regards, Susan Burger

PS.  I am on an I mac and per others suggestions I have checked this and I am sending it 
in plain text, not HTML so I have no idea how to rid my posts of the =20.

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