Pamela,
I agree with you.  There is plenty about providing breastfeeding care to
justify two years of formal training, and maybe three or four if you add in
the additional subjects that an "educated" person is supposed to study in a
baccalaureate program.  I would love to see aspiring LCs able to take a
course that included detailed attention to babies' oral-motor function and
development and a variety of methods for helping those babies that puzzle us
so much.  And a serious exposure to and evaluation of the so-called
"alternative" therapies like herbs, craniosacral work, homeopathy, hypnotism,
even cabbage leaves.  And then there's the mother side.  There should be
specialized info on reproductive hormones and breast function.  There should
be plenty of work on counseling skills.  There should be supervised clinical
practice.  LCs should at least understand how to read and evaluate research,
and if possible how to do it.  Finally, LCs should learn about the history of
infant feeding and understand how breastfeeding fits into women's lives in
all their complexity.

Every healthworker who has contact with babies, young children, or women
should know why breastfeeding is good and be able to evaluate a baby at the
breast, assist with basic positioning and latch-on, and most important, how
to First Do No Harm.  Then that would leave the LCs to handle the difficult
cases---and you may be right, it could be as much as 30% of mother-baby
pairs---and to provide the basic training for the non-specialists.  Oh, and
to participate in the research studies that would find out the rest of the
things we need to know.

One reason (among many) that we don't have these LC training programs yet is
that NOBODY knows some of the things LCs need to learn.  Is there really a
codified body of knowledge about babies' oral-motor function and development
as it relates to breastfeeding and breast function?  The Lactation Institute
has made a strong beginning teaching what they have learned through practice,
but I'm not sure they have got the research and documentation base to make
the case yet that they have gathered a complete body of knowledge.  Of
course, everybody knows and recognizes that other areas of healthcare
practice are evolving bodies of knowledge---AIDS care, cardiac care, for
example.  Breastfeeding care ought to be no different.

But it IS different.  It is different, one, because we have commercial
products competing with us, and two, we have all sorts of political issues to
contend with.  Nobody questions that the cardiac patient ought to get care,
and most cardiac patients WANT to get care.  Nobody is on television selling
them artifical hearts (not yet!).  But we often have to begin by convincing
women that they want to engage in a certain behavior (breastfeeding) that
then may generate the problems that we're here to solve.  And we have to
convince other people (employers, grandparents, partners) to let them and
even encourage them!  It gets complicated.

Your comments interested me because they show there is a place for a
breastfeeding specialist even in a breastfeeding culture.  I have always
believed that the IBCLC credential developed in North America because we were
one of the cultures where breastfeeding almost disappeared from the health
care lexicon.  LCs had to declare themselves as a profession because most of
the other health care professionals were clueless about breastfeeding.  But
what you say makes me think that we ARE needed everywhere, to help the
mothers and babies who would just take too much of a standard caregiver's
time, with problems that are too rare to expect the standard caregiver to
know about.

Cheers,
Chris Mulford
Swarthmore  PA (eastern USA)

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