In my state you need a license to paint nails!  I mean really, to  paint 
nails!  You can go to any school that teaches the course and pass the  test, and 
get your license.  This is not to be confused with a occupational  license 
which you need just operate any business at all.  That is a  separate license.  
You go to school for 9 weeks, you learn about nails, and  take a test, and then 
you are able to work in a salon doing manicures and  pedicures.  How odd is it 
that you can work with a dyad where the  possibility of real harm is there 
without any such thing?  An 18 hr. course  and you can be a certified...fill in 
the blank and be in a position to  manage newborn health outcome -- and it is 
only the IBCLC that requires we  report to a physician.  Those that just call 
themselves 'lactation  consultant' have no code of ethics to follow other than 
whatever they make up  for themselves.
 
The way I see it is, if insurance companies only recognize licensed care  
providers, the only way women will have fair access to care in the USA is  
licensure.  As for the qualifications, lets face it, IBLCE did not protect  the name 
lactation consultant.  CAPPA did it...they claimed the name  "certified 
lactation educator' as their very own.  Why lactation consultant  did not get 
claimed eons ago, I don't know. (Maybe we need a new name that  we can copyright 
and trademark)  I am sure there was a logical reason and  maybe it wasn't 
possible.  But, since it wasn't done, anyone, and I mean  anyone, can claim 
themselves to be be a lactation consultant and charge for  services.  There is a woman 
in my area who not only charges, but claims to  be superior because she did 
not 'learn' her breastfeeding knowledge from a book,  she breastfed. ARGH!  She 
gets the same fee I do--and I also breastfed --  and did the work and 
education needed to become IBCLC.  It is what it  is.  Licensure will not likely 
change anything in terms of competency of  practitioner.  The very same people 
providing care at whatever level of  competency will continue to do so.  They 
will likely even be able to become  licensed.  And just like any other health 
field, some are great, some  rot. But, what will change really?  Not much.  
Except that  insurance companies may or may not choose to pay for the service.  
But,  they more likely will pay for a licensed care provider than one that is  
not.
 
The concern about volunteers providing help being in trouble for practicing  
without a license?  I can see that as an issue. So, the solution may be to  be 
sure  the goal is 'only licensed persons are able to accept pay for  
services', or something that protects the volunteer.  
 
As for the credential itself, and the recertification process....I  don't get 
it.  I have already used cerps for my 5 year recert, and now  I take the exam 
again this year.  It keeps being said that  re-examination provides assurance 
of competency.  I don't know  what other health care field has to take the 
board exams again.  They  have to have proof of continuing education for sure, 
but do they take  the test again?  And, if they do, wow, that is scary since I 
assure  you I question the competency of some and they do indeed have their 
license to  practice. Even re-exam guarantees nothing.  Nothing guarantees  
competence really.  If it did, malpractice insurance would be a non  issue and we 
would not be discussing the dumb things docs say and do that  sacrifice 
breastfeeding.  We all know great doctors and nurses, and those  that really should 
pick a new career.  The same is likely true of  IBCLCs...seeing as we are all 
human.
 
  Once a lawyer, do you take the bar again?  Once you are a  doctor, do you 
have to take your medical boards again and again and again?   How about nurses? 
 How many times do they take their nursing  boards to remain nurses?  I don't 
see the point of taking the exam  over and over again.  I do see the point of 
expecting continuing education  hours yearly and even a yearly renewal of the 
certificate for that  matter at a reasonable fee would not bother me.  
Licensing  issues  will likely vary state to state just as insurance payment varies 
from state to  state.   But, the bottom line seems to be if lactation 
consultants  want payment in the private sector, they will have to comply with the 
powers  that be that provide that payment or depend on fee for service and accept 
that  it leaves out a large part of the population in terms of access to care.
 
Yes, we all care about competency and want some assurances that women and  
babies will not be in danger, but we cannot guarantee that in any other health  
field either.  I don't see a future for private practice LCs if something  is 
not done to increase the likelihood of payment from insurance companies, and  
the fact that an entire segment of the population is under served without  
medicaid payment available is abhorrent.  We will never guarantee  competence.  
We may know that IBCLC is the gold standard, that the  qualifications and 
education requirements are higher than the CLE or the CLC or  the "I call myself a 
lactation consultant therefore I am", but the truth is, the  public in general 
doesn't see that or know the difference.  

Maybe, just maybe, creating a licensure requirement for pay in the  private 
sector will make a difference.  Maybe, just maybe, it will give the  field a 
name in the public view and the medical community and with that maybe we  can 
become the gold standard of something that actually exists...an allied  health 
care field at the very least.  I do see the possibility for good,  and for 
harm.  I can see where licensure may help, and where it may  hurt...especially 
considering who will manage the licensure, state to state,  nation wide, global 
(if that is even an issue), etc.  But, when I think of  all things I am 
certified as ....  eeks....  I don't see it being much  of a big deal to be called 
"certified" anything in the USA unless you are also  "licensed to practice" 
whatever that is you are calling yourself.  
 
Interestingly enough, this is not what I believed 5 years ago, or even  10.  
It is where I have grown to though watching this field change,  watching it go 
from women working very hard to learn all they can about  lactation to be 
worthy of the exam, to mostly nurses who take a couple of quick  courses, and 
pass a test. And watching organization after organization jump  on the bandwagon 
and offer a 'credential' of some kind for the most minimum of  time and 
expense when compared to the IBCLC credential.  At this  point, I don't see it 
gaining value at all, but losing value in a sea of  certifications with the word 
lactation or breastfeeding attached.  And it  is much more expensive to obtain.  
 
I have watched this with midwives in my state also.  Some balked at  the idea 
of licensure and government interference.  Others welcomed the  licensure 
along with the qualifications and examination that brought with it the  
possibility of insurance reimbursement and medicaid payments---opening the right  to 
choose midwifery care to the larger population.  I see the same with  IBCLC, or 
lactation consultant licensure.  The cost in terms of autonomy  and our own 
ideas of ethics, etc. may be lost but the gain will be more women  with access 
to care.  Some of it will be substandard care in  lactation...just as it is 
ob/gyn and pediatrics and a slew of other medical  fields and allied health 
fields. You should see what is offered on late  night tv for education in a health 
field.   ILCA may become the  organization of IBCLCs in the same way AAP and 
ACOG are for peds and  ob/gyns.  Maybe if there is more of us, and there likely 
will be if there  is a possibility of actually making money at this outside a 
hospital (Like I  said this is expensive and at the end of the year, my 
husband calls it a nice  hobby that at least pays for itself!!) then ILCA will have 
some clout and some  financial backing to push for what we want to see as the 
minimum standard of  competency for licensure.
 
As things are now, I don't see a future at all unless it is only going to  be 
a tag on for health care providers.  Which realistically, is not  profitable. 
 And, in today's changing medical climate, the importance of  IBCLC may not 
be growing.  The reality is that other less expensive  credentials and 
certifications can easily be obtained by nurses and those  can be used to say they 
have "lactation specialists" as a window dressing.  
 
I think this issue is very important for those of us who do not desire  
hospital employment.(Nothing personal, and I do so respect those who  beat their 
heads against a stone wall every day, day in day out, but I would go  insane!! 
Five years of WIC taught me that bruises on your head lead to  insanity. 
Hahah.)   I do hope I pass the exam! Haha.  If I don't,  well, the truth is, I can 
call myself a lactation consultant anyway, and  continue to work as I do 
today...actually minus the hassle of reporting to the  docs. Haha.  I can continue 
to go on as if nothing changed.   Why?  Because nothing is required to practice 
lactation consultancy unless  you want it to.  
 
Take care,
Pam MazzellaDiBosco, IBCLC
Florida, USA
 
P.S.  Am I a member of ILCA?  Some years yes, some years  no.  If I make any 
money that year, I join.  If not, then I don't have  the funds.  Would I be a 
member at a reduced fee without the JHL?   Absolutely.  Then the years I see a 
black number I could buy the JHL  subscription, and those years that my work 
costs  money and I end in red, I  could still be a member, but minus the 
benefit of the JHL.
 
 
 
 

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