"there is a dangerous tendency to view lactation work as either medical or
non-medical... being a nurse is separate. people who view lc work as being
something wherein we cannot "prescribe" but only recommend "unless you are a
nurse" are confusing the essential nature of our work. it has to include
both areas, and if that means making recommendations on parenting practices
as they relate to breastfeeding, then it is a necessary part of what we do."

Interesting points you make, Carol. As a nurse, I have to say that nowhere
in my scope of practice as defined by the state of NY does it say I am
qualified to "prescribe" about parenting practices. I don't think I can
"prescribe" anything, actually; I can advise, or make recommendations, or
teach, and in some cases I can be an "expert witness". I am mandated to
report suspicion of "abuse or neglect", and failure to do so could lose me
my license. I can be sued for malpractice. I can lose my license to
practice. I think that all of these things are the case for an IBCLC too -
is that not true? (Well, except we aren't licensed as LCs - but we can lose
our certification, our initials that enable us to earn a living doing what
we do.)

I don't see how we can possibly *avoid* advising parents about parenting
practices. Babies can't really be broken down into "feeding-related" and
"non-feeding" aspects; it all goes together with a baby. I'd just be pretty
darn useless and incompetent if, for example, I visited a mother/baby who
were having trouble BFing, and when I got to the house and checked the whole
scene out found that really the only identifiable thing preventing this baby
from really flourishing was that the parents fed on a schedule, only held
the baby for feeding, parked the poor little thing in a room down the hall
at night and in a lovely playroom all alone all day, and never really just
cuddled up skin-to-skin with their baby. How would I do my job without
saying something like "It seems from what we know about human development
that babies were really designed to be with their mothers pretty much all
the time at first. They usually nurse better if they have a lot of physical
contact with their mamas. Have you tried bringing her into your bed with you
and just snuggling with her there?"? Etc...

It's OK to tell parents what babies need - how else are they going to find
out? But what it's NOT OK to do is take your "belief" about something that
isn't substantiated by research and present it as "fact". That's what all
those *other* hcps that we love to get all inflammed about are doing - as in
"If you let that baby use you as a pacifier, he'll never learn to settle
himself to sleep!" or "Babies who nurse more frequently than every 3 hours
grow up to be obese" or "Your baby is allergic to your breastmilk - that's
why she spits up so much" Or any of the other outrageous things we hear all
the time. The other thing it's not OK to do, in my book, is to fail to treat
parents with respect and kindness (even when there's not too much you can
actually find good in what they are doing!) - so you don't say "If you loved
your baby, you would...", or imply that everyone must parent the way you
would, or make the parents feel like they've just been doing everything
wrong and they are fools for ever reading that stupid book in the first
place.

Sometimes I think that part of the problem we as LCs have is that we just
haven't *really* taken hold of the power that we have. We ARE the experts,
when it comes to baby-feeding and lots of other baby-related stuff as well.
That's why they pay us the big bucks(?!?) That's why they are engaging with
us on matters of baby care & feeding in the first place. And in this sense
it really doesn't matter whether you're a nurse or not. As a nurse, I'm
probably more confident making some judgement calls than I might be
otherwise - I've seen thousands of babies, both sick and thriving, I know
what healthy babies are supposed to look and act like, and *maybe* I feel
more sure of myself on some medical-type matters. But as an LC, you know
what you need to know - that's what differentiates us from the old lady at
the supermarket who tells you not to eat those strawberries 'cause they'll
be bad for your baby! If we were to just let the knowledge and the skill and
the caring that we have shine right out into the world,if we carry in our
persons the authority and knowledge and power that we in fact have
*already*, we would just dazzle the world. Plus we'd have to spend a lot
less time fussing around about who's qualified to say what to whom!

Cathy Bargar, RN, IBCLC Ithaca NY

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html