As for WIC PC standards in general, I, for one, will be the first to stand 
up and say that there is no direct supervision of PCs. They are thrown upon 
clients after a 20 hour, butt in the seat, all pass session. Yes, they are 
required to have previous BF experience, but by WIC language, BF experience is 
offering the breast ONCE A DAY! I have personally worked with quite a few PCs who 
predominantly bottlefed their babies, and they just do not get it. How are 
they going to impart a good example, when their own experience is contrary?    
   The language of the 2nd credential states that "the new credential will 
provide basic lactation support as related to the "healthy BF dyad." In Texas, 
PCs are supposed to refer cases that are beyond their level of expertise. In 
State language this is, "PCs shall make immediate referrals according to the 
LA's established referral system when they encounter: A) BF problems outside the 
normal BF experience; B)BF problems that are not resolved within 24 hours of 
the PC's intervention; or C)problems in an area other than BF." The words 
"healthy" and "normal" leave quite a bit of room for interpretation, and we must 
keep in mind that the interpretation is often left up to an individual with less 
credentials than the IBCLC. It is my experience that PCs work with premature 
babies, cleft palates, Osteoporosis imperfecta, failure to thrive, mastitis, 
low supply caused by birth control timing, you name it! Are all these things 
included in the definition of normal or healthy? 
   Let me emphasize that in nearly 7 years of working at two different LAs in 
east Texas, I have seen referrals take place less times than I can count on 
my fingers. Let me also emphasize that this depends entirely upon the LA's 
established referral system. Even if the PC does refer a case to her BF 
Coordinator, for example, the BFC is not necessarily qualified to handle the case and 
may make a judgment call that the client needs formula. I worked, for 5 years, 
under a BFC who took her required training at the identical time that I took 
the course. She had no clinical skills, very few counseling skills and minimal 
BF knowledge, yet she was my supervisor because she had seniority and the 
Director decided that she should be the BFC. This woman was a clerk who did not see 
the need to promote BF when formula was a viable option, in her mind-end of 
the chain of command! My point is that when much of the PC management process 
is left up to the LA, BF services suffer. This particular LA did have a 
contract (read-token) IBCLC, but she was 300 miles away, and only available by 
telephone, at the BFC's option. In 5 years, I was permitted to contact the IBCLC 
once and she never performed an on site consult or saw a client in person!
   Will the new credential replace IBCLCs? Of course! When the FNS 
appropriates money separately for PC services, but LC services are included in the 
amount provided for allowable BF costs-which include costs of materials utilized in 
the BF initiatives, travel and salary for other WIC staff to attend 
trainings, costs of clinic space devoted to activities related to BF (including space 
and furniture set aside for nursing during clinic hours), BF aids such as 
oversize flanges, nipple shields, breast shells, SNSs, nursing bras, nursing pads, 
breastfeeding incentive items (like pencils, bibs, cups, books, t-shirts for 
staff, picture frames)-LC services will be minimal. In my own case, I was 
allocated 7-8hr/wk to serve all the LA clients needing my services in a clinic with 
an approximate caseload of 3,850. When the only cases I received were train 
wreck scenarios, I often took 1 1/2 to 2 hours with a client. Believe me when I 
say that there were more than 4 clients a week that needed IBCLC services. 
But every woman that declared herself to be BF (even if only once/day) received 
a bra and cotton pads.
   At www.nal.usda.gov/wicworks/Learning_Center/support_faq2.html, you can 
read, under allowable costs, that "research recommends that PCs be provided 
career path options (e.g. training/experience to become senior level peer 
counselors: advanced training to become lactation consultants, etc)." You can also 
read that USDA "would not expect to see an implementation plan heavily focused on 
training IBCLCs." "The funds can not be used to disproportionately hire and 
train lactation management experts versus PCs." This is a wake up call! UDSA 
has no intention of utilizing more IBCLCs and seems to have little intention to 
train them by the route of PCing. Who ever believes otherwise has been 
deceived.
   Look, again, at the language of the 2nd credential. "The IBLCE envision 
such individuals as PCs, doulas, dieticians, public health workers, medical 
assistants, licensed practical nurses, and women who have been empowered by their 
own personal BF experience". Five out of seven of these categories already 
work at WIC offices. How does this figure into why there is not a job 
classification for an IBCLC, seemingly anywhere within WIC? If WIC can get their foot in 
the door, in terms of having professional (read IBLCE credentialed) BF support 
on staff, without paying for the credential of an IBCLC, what a deal! They 
can continue getting federal funding for supporting and promoting BF, without 
even hiring an IBCLC as a staff member. Instead, they hire IBCLCs as contract 
employees, pay no benefits, have them cover all their own business expenses, 
exclude them from the clinic environment on a day to day basis, continue to do 
things the WIC way. No one on staff is going to admit that WIC is giving formula 
before consults for lactation problems are even referred. No one on staff is 
going to admit that the easily available, free formula might sway a mother's 
decision making process when she is under stress. When no one on staff is 
available to jump in immediately, and has the clinical skills and knowledge base to 
do so, formula is the only answer. And of course, human nature being what it 
is, no one who wants to keep their job is going to rock the boat, and 
jeopardize their job by trying to promote change within the WIC system. THIS is what I 
have seen for 7 years now.
  Do low income women need better LC services? ABSOLUTELY! This is why we 
need to push for licensing-so that IBCLCs can be reimbursed by Medicaid and these 
women and babies can receive the care they are entitled to. But I beg you, 
give this more thought before you sell the IBCLC credential to WIC!
   As a final note, I want to say that I lost my contract with my LA little 
more than a week ago. I attempted to protect my clients' right to privacy and 
insisted that consultations were not interrupted as frequently as 6 times by 
staff members who had no respect for privacy, confidentiality, or the IBCLC 
credential. Coincidentally(?), I also lost my position w/the affiliated county 
hospital, on the grounds that I was giving clients information which conflicted 
with the pediatrician's mandate to give all newborns Pedialyte after every 
attempted BF, in order to prevent jaundice. If you look at the numbers in my 
geographical area, you will find that my LAs numbers for 2005 are: ever BF-24.48% 
and exclusive BF at 3 months-1.47%; does this surprise anyone? 
   As I am the only IBCLC practicing in this county, what do you think will 
happen to the LAs numbers now that I have been taken out of the loop?  I will 
practice in a professional manner and uphold the ethical standards, and I will 
continue to correct misinformation, or I will not practice as an IBCLC at all. 
Did I need this job? Absolutely. But my professionalism does not attach to a 
price tag, and I never earned more than about $13,000/yr working for WIC in 
the entire 7 years I endured the hostile working environment. Yes, my case is 
only one, but I doubt that my situation is unique. When WIC can make their own 
definitions and their own interpretations of BF policy, they have nothing to 
gain by upholding the IBCLC standards, but everything to gain by getting this 
2nd credential issue implemented. Who will benefit from this? Not the WIC 
participants! Certainly not IBCLCs. Yes, the ranks may swell, but in whose mind is 
quantity better than quality? 

Niki Konchar, IBCLC


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