Laura, I neglected to add this perspective of the small West Virginia town where I lived from 1980 - 2000:  the sole hospital in Randolph county provides childbearing services for 600 births a year, serving a 7-county region.  Three of those counties have no obstetrical services at all.   Six hundred births a year is an average of fewer than 2 births a day, and thus it is impossible for a self-supporting IBCLC to survive on that income alone with so little work.  

It's the hard math facts of an exceedingly small patient population, in stark contrast to the hefty credentialing fees that are disproportionate to the amount of work that is available in most parts of the U.S. with rural land mass.  Those IBCLCs who have always lived and worked in large urban areas would likely find it hard to comprehend the financial constraints of IBCLC work in the smallest towns and rural areas, so I'm sharing my perspective.  The passion and dedication for the work is not lacking among small town and rural IBCLCs - - the patient population is just so very low.  You can imagine the experience of a small town or rural IBCLC contemplating the certification and recertification fees, not to mention professional membership fees, etc.  

Debbie  

Debra Swank, RN BSN IBCLC
Program Director 
MoreThanReflexes Education
Ocala, Florida USA
http://www.MoreThanReflexes.org

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