I am posting this message for Dr. Melissa Bartick, chair of Mass.  
Breastfeeding Coalition. She is not on Lactnet, but is aware of the  
discussion taking place on Lactnet and elsewhere about RN and non-RN  
IBCLCs working in hospitals.

Naomi


Begin forwarded message:

>
> There has been much discussion about RN-IBCLCs versus IBCLCs in the  
> hospital setting, and I'd like to spell out my own thoughts on these  
> issues. I would hate to see this issue cause divisions among the  
> lactation community.
>
> Around Massachusetts, as far as I can tell, hospitals have phased  
> out all their non-RN IBCLCs and replaced them with RN-IBCLCs. I'm  
> not sure the reasons: It could have to do with licensure and  
> liability, or it could be because they want the option to use those  
> personnel as staff nurses when needed.
>
> Regardless, if local standard is for hospitals to only hire RN- 
> IBCLCs, it is a risk management issue for a hospital to contract for  
> people with fewer qualifications then the local standards.
>
> The question of whether RN-IBCLC should be the standard in hospital  
> involves several issues. First, until IBCLCs are licensed, it is  
> somewhat risky for hospitals to have non-licensed personnel in  
> clinical care. For IBCLCs in private practice, this is not really an  
> issue-- they do not have a risk management department or  
> reimbursement department to answer to.
>
> Are non-RN IBCLCs capable of caring for dyads in the newborn period,  
> in the hospital setting? Personally, I think they are, as long as  
> they have hospital experience. Since most hospitals don't hire non- 
> RN-IBCLCs, that means most won't have this experience currently.  
> These people certainly could get it by being mentored by other  
> IBCLCs with hospital experience, and I see no reason why they  
> couldn't perform well.
>
> But, in the case of UMass Memorial, the hospital is bringing in  
> personnel who have no hospital experience, and who will have no one  
> with hospital experience to mentor them. For example, an outpatient  
> doctor could not just jump into inpatient medicine without any  
> training or experience, just because they have an "MD" and even a  
> board certification. By the same token, an outpatient IBCLC can't  
> necessarily be ready to jump into inpatient experience without a  
> mechanism for on-the-job training, mentoring, or experience.
>
> The issue of the NICU is separate.  By definition, these infants are  
> they very fragile with critical health issues. To continue my  
> analogy, that would be like putting an outpatient doctor with no  
> inpatient training straight into an ICU to care for critically ill  
> patients.  In this case, I think an RN-IBCLC would be the best  
> suited for the job--- but it would also have to be someone with  
> training an experience with preterm infants, or at least an  
> opportunity to be trained and mentored on the job by someone who is  
> experienced. It couldn't be just anyone with an RN-IBCLC.
>
>
> I think it could potentially be beneficial If hospitals hired some  
> non-RN IBCLCs but trained/mentored them in inpatient care of healthy  
> term dyads-- if this would allow hospitals to afford more IBCLCs and  
> increase the staffing ratios and improve access to care. This is not  
> the case with UMass Memorial.
>
> And, I feel strongly that lactation consultants should be licensed  
> as a consumer protection issue, and we should keep working for that.  
> The best licensing strategy would be to allow licenses only those  
> with up to date IBCLC certification.
>
> These are my personal opinions and don't necessarily represent the  
> views of the Mass. Breastfeeding Coalition or all its members.
>
> Melissa Bartick

------------------------------------------
Naomi Bar-Yam Ph.D.
Executive Director
Mothers' Milk Bank of New England

[log in to unmask]
617-527-6263
www.milkbankne.org
------------------------------------------
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