Pam:  Non-licensed vs licensed IBCLCs?  This is an extremely complex issue.  I, 
as a licensed IBCLC, do have as much difficulty understanding your role as an 
unlicensed IBCLC as you do mine as a licensed IBCLC,  because the 
expectations of my role are different than yours.  This issue is really 2 sides of 
the same coin.  All of us RNs and other licensed HCPs are first and foremost 
bound by our professions' practice acts, just as IBLCE is attempting to bind 
non-licensed IBCLCs to a Lactation Practice Act by way of SOPs.  SOP is an 
integral part of my state's Nurse Practice Act.  If a lawsuit were brought 
against an unlicensed IBCLC, that person's biggest asset she stands to lose is 
probably her home (at least here in the US).  If a lawsuit were  brought 
against a licensed IBCLC, she stands to lose her license to practice in her 
profession and, therefore, her livelihood, as well as her home.  As has been 
stated by others, I jealously guard my license for this reason.
You brought up the issue of an MD writing an order for formula 
supplementation.  A patient who is in the healthcare system ALWAYS has 
choices.  I have repeatedly explained to our docs that I am not there to 
question their medical judgement re: supplementation.  I DO question the fact 
that they take away a mother's choice when they write such a restrictive 
order.  When a doc writes a supplementation order, the MOTHER has the right 
to choose which milk (formula or EBM) she will put into her baby and the route 
of administration (syringe, bottle, cup, etc.).  MY role is to give her the 
information about her options so that she may make an INFORMED choice.
My cardiologists (and there are many of them!) all know me well enough by 
now that they only half-kiddingly will ask me what course of medical treatment 
they should prescribe before actually writing the orders.  What this tells me is 
that they are aware that I and I alone manage my health care, which is how it 
should be.  It is easy to forget that the PATIENT is the most valuable and 
important member of the health care team.
Sorry for the rant, but I firmly believe most HCPs' styles of practice and the 
way they approach patients would change dramatically for the better were 
they to spend a week IN the bed instead of NEXT to it.


Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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