HI,
Mary P. was interested in what we CLE's do in regards to women and babies who
are our help and when do we refer to LC's.
For myself only, since I cannot speak for anyone else, I refer out all the
time!  If a mom has a simple problem, such as a low milk supply or a premie
in the hosp and mom just needs to get her supply in (ok, not simple to the
mom, but I think you know what I mean), I can take care of that.  I will do
demos of positioning and proper latch-on, and give lots of info to the mom to
help her in her particular situation.
If, however, we are talking about a situation where a premie is not BF well,
or mom has cracked and bleeding nipples, suck probs, etc, I will refer out
100% of the time.  These are the cases that need HANDS ON, and CLE's ahould
not be doing hands on, IMHO, unless supervised by an LC.  THere is a big
difference in talking positioning over the phone and actually showing mom how
to hold her baby correctly.  Also, with the various body types out there, a
cradle position may not be the best thing for every dyad.  I have seen moms
whose arms were just short enough and their breasts just large enough to make
the cradle position virtually impossible with which to get a good latch.
 Sometimes you have to see what is going on.
When I took the LI CLE course, one of the things that was stressed was the
difference between a CLE and an LC.  There is a BIG difference.
 Unfortunately, some people don't see this and start doing things they
shouldn't.  They call themselves LC's when they are not, and do hand's on
when they are not ready.
I know that there are probably many CLE's out there who have been doing this
long enough to be able to do the hands on thing just fine, and they do a
great job.  But there is a fine line here, that can get confusing.  How many
years do you have to do this to do hands on without being an LC?  How do you
get your hand's on training?  WHy not just go ahead and take the IBCLE exam,
and become an LC if you are able to do the work? (I know $$ is a factor
there)  THere are a lot of questions, and there are areas of this feild that
have yet to be clearly defined.  We are still in the process of becoming a
"recognized" feild of professionals.  I wonder if it is time that we start
defining these areas of who can do what and when?  Lots of questions, not too
many answers...
I believe that the CLE has a lot to offer.  We can take a alot of the "simple
questions" off the hands of the LC's, so that they can focus on the tougher
problems that moms face.  We can do a lot of the follow-up support and tell
when a mom needs to come in and be seen again.  I consider myself to be a
collaborater with the LC's I work with.  It is the only way we can be.  There
is no room for competition in this field.  We all have to work together to
help these moms and babies.  If we don't guess who will be laughing at us,
and guess who gets hurt?

My .02!

Jay