Hi fellow Lactnetters -
I have been most interested in the thread about qualifications to sit for the
IBCLC exam, and what credentials make the "best" LC.
There is a wonderful book entitled "From Novice to Expert" by Patricia Benner
(1984, Addison-Wesley Publishing Co.). It is written by a nurse, for nurses,
from a nursing perspective. But the general theme applies to many
professions, including Lactation Consultants. It talks about the beginning
practitioner and how she develops a certain expertise over time and with
various experiences in her field. It also talks about differences between
practical and theoretical knowledge. To quote, "Expertise develops when the
clinician tests and refines propositions, hypotheses, and principle-baqsed
expectations in actual practice experiences" (p. 3). It goes on to say that
experience "results when preconceived notions and expectations are
challenged, refined, or disconfirmed by the actual situation. Experience
therefore is a requisite for expertise."
I, personally, (correct me if I am wrong) have always thought of the IBCLC
exam as an advanced certification (hence, the first "C"), NOT an entry-level
exam. We, in the LC profession, do not have an official entry-level exam
(equated to a basic licensure as RN or MD). The IBCLC is an advanced
Certification (equated to a nursing certification in ER, Maternal-infant,
NICU or a medical specialty such as Board-certified in Pediatrics, etc).
Maybe we *should* have one, that designates beginning Lactation practitioners
from more experienced ones. As one gains more hands-on expertise, then one
would be qualified to sit for the IBCLC. Of course, we DO have unofficial
beginning levels, such as the LLL leader, the RN who works in a mother-infant
environment, the pediatrician who sees M/I dyads in their office, the OT or
PT whose focus is infants, etc. We just do not recognize them "officially".
I have found in my own experiences, that the nurses who do not work with moms
and babies beyond the neonate stage, have problems with the counseling and
"older baby" questions on the exam, while LLL leaders who do not have a
science background may have difficulty with the medically- or
physiology-oriented questions. A good exam will not allow anyone with gross
deficiencies in either area to pass! I do applaud the recent updates by the
IBLCE to include more science courses in the prerequisites, and to look more
closely at the hands-on documentation. This should help to ensure that the
standards to be Certified as a Lactation Consultant remain high.
As to which credentials make the "best" LCs: I would think that those of us
who work continually with NICU or newborns will be the experts in those
areas; while those of us who work with moms after discharge or with moms with
older babies will be the experts in these areas. Some of us will be more
well-rounded in our practice, working moms with general, routine problems
(getting started, dealing with sore nipples, weight gain, mastitis, etc)
while some of us will focus on a specialty (cleft palate/lip or
ankyloglossia, or example). That way, we can all help each other via
networking!! And, I believe that there are enough moms and babies to go
around.
Just my humble opinions and two-cents worth on this discussion.
Kathy Rubin in NJ
IBCLC, RN, C (Maternal/Infant), APN, C (Family Nurse Practitioner)
PhD Candidate at Rutgers, NJ College of Nursing
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