Barbara,
Like you, my reputation has been built on reparing train wrecks. Frankly, it is much easier to work with mothers and babies much sooner and is finacially much more rewarding. These moms are already tentative--coming b/c a friend or HCP has convinced them to try once more and they have already spent a lot of time and money. They need a lot of hand-holding and taking care of them is labor-intensive. 

I have complained before--including to ILCA about what I believe are poor standards for credentialling and was very rudely treated. In fact, my complaint was shared with a person who at the time had authority over me at the hospital where I worked and she personally was excatly the tyoe of LC about whom I had complained. I have since avoided any and all contact with ILCA, except to maintain a membership.

I have to take my exam again next year and I am honestly reconsidering. I am a highly skilled clinician and I have excellent relationships with my clients. But, I have learned so much that is so beyond the "entry-level" that I find it both insulting and frustrating to think about retaking this test. So much of why I am effective is in contradiction to what is taught for the exam. I am a good test-taker--I can figure out what is expected of me--I just don't know if I think it is worth my integrity. 

I practice holistically and utilize homeopathy, cranio-sacral therapy, energy medicine, herbs and a lot of nurturing and mentoring. I believe that a lower level of certification is absurd and that we should instead have a higher level of certification. I think continuing education should be required and should be more specific to the area of practice. For example, those practicing in hospitals should have their continuing ed geared toward more effective teaching and should be expected to understand the long-term consequences of their interaction with mothers. There should be room to specialize in certain areas, such as NICU. 

How in the world can we think it is okay to take nurses who have no real interest in breastfeeding, round them up, give them their 45 hours in a week and sit them in front of the exam, even when these women as mothers CHOSE not to breastfeed, b/c it "wasn't for them"? I have seen this happen. IMO, there is something very, very wrong with our certification process at its core. 

I am not at all thrilled with the idea of requiring a college degree in lactation. I think, as with midwifery, the apprentice (or mentoring) approach is the best option. Some of the very best LCs, who are not nurses, would never have become LCs if this were required. I certainly would not have done so--I had a 4-year degree and was working in my profession when I felt called to this field. My children were very young (and homeschooled) and I could work around them, but there was no way I could have done school around them as well. I honestly do not think doing so would have benefiited me or my clients in any way. Nor was I mnetored, BTW--I placed myself in a position in hospital where I simply had to learn. I know this is difficult to do, but I think we need to intentionally create such opportunities.

I recently opened a lactation and mentoring center and one of the reasons I did this (besides that the driving to homes was insane) is to create an opprtunity to mentor other LCs, especially in holistic practices. 

I am with you-- I cannot bear the thoguht of seeing one more tongue-tie this month that other LCs missed ( moms were told they had flat nipples and given nipple shields!!) or one more baby whose structural restrictions from birth trauma literally prevernt him from going into extension (or flexion, depending on the trauma) and achieving a proper latch. I am truly fed up. IMO, these ought to be basic assessement skills and I don't think the test evaluates for them in any way.
Jennifer Tow, IBCLC, CT, USA

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