Dear all:

Anytime I have heard anything about national trends regarding breastfeeding practices in 
other countries, I have always tried to ensure that I included a question for those working 
in those countries to correct me if what I heard might be wrong.  If I have failed to do so 
in spite of my efforts to be diligent, my apologies.  

My apologies because I think it is unfair to make comments about a few posters opinions 
and extrapolate on the basis of nationality.  In any one country, in any one state, 
province or other national subdision within a country, in any one city, in any one group 
within a city, there are always differences of opinions. 

The United States represents immense diversity of opinions, state to state, region to 
region, city to city.  Since I have worked internationally, I would love to see far more 
IBCLCs who are from other countries.  Yet, I do not believe that I can take any posting 
from a few IBCLCs from any one country and say that their opinions are representative of 
that country.

The last time we had a discussion on scales, I wrote a post that commented that there 
may very well be differences in a public health sense making scales unecessary in certain 
settings except for rare exceptional cases and more widely used in other settings and we 
should understand "appropriate" use of tools on a public health level based on the 
circumstances we encounter.  Never once did I state that everyone everywhere should 
always use them.  I once said to try them out and play with them to see for yourself even 
if you decided never to use them because you found them inappropriate for your context.  
There are many tools others have used that I finally played around with and rarely use 
but now I understand them better.   I also asked both my colleagues from the 
Netherlands and Australia if what I had heard from clients about routine 24 hour test 
weighing in both countries had really been the case and expressed the opinion that such 
use would NOT be warranted and certainly would create an understandable antipathy 
towards scales if what I had heard was true.  I did not make any statements assuming 
that the few people that told me this were correct.  

The most vociferous defender of the IBCLE posted SOP was not from the United States 
and I would NEVER in my wildest dreams have ever extrapolated this to be an opinion 
representing the entire country that this person was from.  That would be ludicrous.  

I have seen a wide range of opinions on the topic of scale use and that vast majority of 
posters that find a value in them have not made blanket statements that everyone shoulld 
use them.  Most have merely pointed out situations in which they have found them useful.  
I've tried to post about appropriate and inappropriate use on a public health scale.  One 
mainstay articulate poster has made many points about overmedicalization of IBCLCs and 
she happens to be from the USA.  (And a personal comment that I think she is very 
professional in her practice even if she never lays a finger on a scale ever in her entire 
career).  A MINORITY of posters on scale use have suggested that everyone should use 
them always.  

On the other hand there have been a lot of posts too about the harmful use of scales.  I 
myself have pointed out examples of public health programs where they have been 
harmful.  Yet, I have not tallied up the nationalities of those who do not use scales and 
claim that those who call them harmful are from a particular nationality.  Nor would I 
ever think in my wildest dreams that all those that do not use scales think those of us 
who do use scales are "harming our clients".  There are a few posts that I could take 
excerpts from and misconstrue and extrapolate into that unfounded position --- but it 
would be ludicrous.

As with the comment that about the "silent 3000", please don't extrapolate or project to a 
particular group based on one or a few posts.   

One of the things that I personally would like to see is a conserted effort to ensure that 
the IBCLC profession truly becomes international so such comments about nationality are 
no longer even considered.  There is much expertise in many parts of the world in 
breastfeeding support that is not captured and we suffer because those voices are not 
heard that would give us a much broader interpretation.  I was shocked to discover that 
the statistics from the 2004 exam showed that over 90% of the exam takers were from 
the United States, Australia, Canada, and Germany.  

Best regards, Susan Burger

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