Lactnet Friends,
I appreciate the Time article identifying a barrier to breastfeeding for
women and recognition of the wonderful breastfeeding medicine physicians
among us. I wrote the following and submitted as a comment to add that
IBCLCs do have adequate training and USLCA is striving to improve access to
care for breastfeeding families.
This article by Lisa Selin Davis aptly describes the pervasive barrier that
women confront in obtaining appropriate breastfeeding information and
support from the current health care system. The article states, "That's
because lactation is probably the only bodily function for which modern
medicine has almost no training, protocol or knowledge." While it is true
that the health professionals mothers expect to help them with breastfeeding
do not routinely receive necessary training in the area of lactation the
article excludes mention of the International Board Certified Lactation
Consultant (IBCLC) professional.
The article goes on to say that "When women have trouble breast-feeding,
they're either prodded to try harder by well-meaning lactation consultant."
This statement is misleading and indicative of the pervasive 'lack of
recognition' for the skills and qualifications of the IBCLCs who work in our
health care system, but are not available to mothers in adequate numbers,
capacity or in a timely manner. IBCLCs are health professionals certified in
lactation management and who are equipped to provide clinical management of
complex breastfeeding problems. Unfortunately, since the IBCLC professional
is not independently licensed, many individuals call themselves "lactation
consultants" who do not possess the training and qualifications to provide
appropriate lactation support for complex problems. The public, and health
care professionals, do not realize that highly skilled care of IBCLCs exists
and is available for families. There is an erroneous assumption that lower
levels of care, equivalent to providing basic information, are all that is
available to help mothers with complex problems.
The article continues describing the ambivalence in the health care system
about who should provide breastfeeding support, "In addition, doctors
practicing today don't know where to place breast-feeding problems-breasts
are attached to the women, so shouldn't they be the province of OBs, say
pediatricians. And OBs note that breast-feeding is for infants; shouldn't
the baby's doctor handle it?" IBCLCs may be the only health care provider
with an obligation to fill this gap because they have a duty of care to
three patients: the baby, the mother, *and* the breastfeeding relationship.
Additionally, the IBCLC will consider the environment of support at home and
work as part of the lactation management plan. IBCLCs operate, clinically,
as part of the healthcare team and have an ethical duty to communicate and
collaborate with the primary healthcare provider to assure appropriate
diagnosis and care.
The Surgeon General in the Call to Action to Support Breastfeeding (2011)
recognized the role and need for this service in Action Step 11 to "ensure
access to services provided by International Board Certified Lactation
Consultants." Yet most hospitals in the US do not meet recommended levels
of IBCLC staffing and there is little available IBCLC care available on an
out-patient basis after the family leaves the hospital which is when most
problems occur. If care is available, it is not usually covered by health
insurance.
Dr. Steube makes an important point regarding the lack of available codes
for individualized lactation assessment and management services which poses
a barrier to providing this care. The article states, "It doesn't even exist
as a diagnosis, no accompanying health insurance code for which doctors can
bill." Individualized lactation assessment and management services provided
by IBCLCs are face-to-face visits with a mother and her newborn child to
identify and manage feeding problems relative to the specific anatomy,
physiology, and environmental factors of that particular mother and child.
The United States Lactation Consultant Association (USLCA) has made
application to CMS for such a code in 2012 and again in 2013 on behalf of
IBCLCs who currently provide these services. IBCLCs have been certified by
the International Board of Lactation Consultant Examiners (IBLCE).[1] The
IBCLE program is the only international certification in lactation
consulting. IBCLCs must complete 90 hour of classroom training specific to
breastfeeding and 300-1000 hours of clinical experience (depending upon
prior qualifications), satisfy college level course requirements as
prerequisites or have an existing health professional license, pass a
certification exam, and recertify every 5 years. In addition to
breastfeeding medicine physicians, there are over 13,000 IBCLCs in the
United States who, along side the primary care doctor, can support
breastfeeding families. The Landscape of Breastfeeding Support from the
Massachusetts Breastfeeding Coalition can help readers differentiate
qualifications among the many, other than physician, sources of
breastfeeding support available http://massbreastfeeding.org/landscape/
Judith L. Gutowski, BA, IBCLC, RLC
_____
[1] The IBCLC certification is accredited by the Institute for Credentialing
Excellence (ICE) which is the leader in setting quality standards for
credentialing organizations. ICE is the parent organization for the National
Commission for Certifying Agencies (NCCA), the accreditation body which
accredits quality programs which meet a rigorous and objective set of
standards.
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