Well, I'm on another tear. I hope our international buddies will excuse this
as it is focused on US interests.  However, I appreciated our S. African
colleague's post about her perspective on how the profession needs best to
be fostered in her homeland, and I think it is valid for all of us to
consider such issues in our own situations.

 I went to on a home visit to see a mom who couldn't get out and who needed
help.  Her insurance would have covered my visit had I been a "liscensed
practicioner."  What I think is that managed care is going to put most
private practice people (and not just lcs!) out of business sooner or later
-- or that only very well off folks will be able to handle the out-of-pocket
and out-of-system care provided by private practice professionals.  I think
most services will be taken over by hospt. or other managed systems.

 I heard that there was much soul-searching at the DONA conf. last week in
Cleve. about hospt. wanting to take over the doula function.  No offense to
our hospt. based colleagues, but we all know what happened to natural
childbirth when classes began to be held in and taught by hospt. employees.
The childbirth instructors  are passing out the consent forms while the
anesthesiologist describes how the epidural is administered (just after the
pit drip for the induction at 38 wks.) The poor birth ed. people are in a
terrible spot: to feed their families, protect their jobs, they have handed
over the empowerment componant of their work and now neither they, nor the
moms get to have woman-controled, empathetic births.  The doulas are a lot
like us. They are looking for respectibility and thinking that linking up to
institutions will confer it.  I'm suspicious from what I've seen.

I think a very smart move for us is to really emphasize we are NOT nurses.
Our knowledge base owes something to nursing, but no more, really, than it
does to several other disciplines.  And the counseling componant is
certainly unique.  I think we should toughen our entry standards, consider
limiting the number of lcs we certify, and begin to go to state legislatures
to lobby for liscensure.  We need to emulate RDs and OTs and respiratory
therapists etc. Professions we have much in common with.  They are
relatively new, but did not let their autonomy get usurped by MDs or RNs.
They carved out respectibility in their own areas with liscensure and now
operate with relative independence clinically.  They have knowledge not
possessed by other specialties, and while they may be supervised, they are
entrusted with direct care of their own patients, and receive reimbursement
from 3rd party payees.  This is what my vision for our future is.

Comments?



Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html