I hear ya, Sara.  The Lactnet Archives are rich with discussion about Who
Knows What the Best.  I am not trying to re-open that debate, but I can
readily say that -- for me -- my mother-to-mother counselor training did
NOT cover oral digital exams.  I picked up how to do that (as did many) by
attending conferences, watching colleagues, talking and reading, remaining
curious, etc.

IBCLC do have a scope of practice, which is administered by IBLCE, and they
claim international jurisdiction both for the scope's reach, and their
enforcement authority.  The language is fairly general, but I think that
"IBCLCs have the duty to provide competent services for mothers and
families by performing comprehensive maternal, child and feeding
assessments related to lactation" covers an oral digital exam.  2008 IBLCE
Scope of Practice, third listed duty, page 3.

One of the great challenges as each state plods slowly toward IBCLC
licensure (a move I whole-heartedly endorse) will be: what language for
scope of practice will each state recognize?  Model legislation encourages
states and licensing boards to use the IBLCE standard, as it is an
international credential, and IBCLCs outside the USA are held to that
standard.

I agree this is a topic ripe for ongoing discussion, precisely because
these definitions and regulations are in flux in the USA, during a
political election year, when healthcare regulation are also in play.

Never a dull moment!

-
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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