A lot of this comes out of how the IBCLC started in the first place, which
was with a group of La Leche League Leaders who saw the need for
breastfeeding support that was beyond what could be consistently given by
volunteers. These women came from a great variety of backgrounds and gained
their advanced lactation skills through experience, sharing with their
peers and self-education. And while at the same time they wanted to retain
this diversity of backgrounds (avoiding overt "medicalization" of the
profession), they also wanted to be recognized as allied health
professionals - get referrals from HCPs, be covered by insurance, etc. The
issue was, all other health care professionals graduated from a recognized,
degreed college program and getting recognition as professionals without
that step was problematic, and remains so to this day.

In an attempt to rectify this situation, the pathway towards becoming an
IBCLC has become more closely aligned to what is seen in other health
professions. One of the most vexing problems is the lack of a clinical
phase which is part and parcel of any health professional's training - how
can you really judge a person's abilities without actually watching them
practice on a daily basis? Because only those already in a health
profession (nurses, mostly) have easy access to this kind of supervision,
those who are not already nurses are left scrambling for access to mentors
and still are unlikely to gain access to hospitals in order to participate
in the care of immediate pp women. IBLCE is actually suggesting to those
that call in for help with this to become LLLLs because it will likely be
the only way they could ever get the number of hours necessary to qualify
to sit the exam - not sure how LLLI feels about this. And this could become
problematic because neither LLLI or some of the other organizations listed
as acceptable actually fulfill the stated requirements of IBLCE. IMHO, the
lack of mentorship by experienced IBCLCs has been the root of many of the
problems that we see with those who have the credential, but not really the
skills - they passed the test (and there is no dearth of programs to help
you do this), but don't really have the deductive nor counseling skills one
should expect when consulting with an IBCLC.

I applaud the IBLCE for trying to tighten things up by not allowing
applicants to use previous experience as countable hours and the
supervising IBCLC having not been newly certified herself. I don't think
that the philosophical divide between looking for respect from the medical
profession while still looking for diversity of backgrounds (and a
non-medical pathway) has been resolved.

It has long been a fear of mine, and probably others, that the medical
profession would eventually co-opt the whole process and make lactation
another nursing specialty that could then circumvent the whole IBCLC issue
entirely. I do see that happening now. Considering that the only IBCLCs
that are actually making a working wage (for the most part - there are
always exceptions to the rule) are those employed by hospitals, clinics or
physician groups, that would eliminate income for all those folks, unless
they were already nurses (many of them are) and can simply acquire the new
credential. Please do not misunderstand that I do not have respect for RNs
who are IBCLCs - many of my close friends back in NY fell into that
category and we worked together for many years helping the women and babies
in Rochester. However, there is also no doubt that in the past many nurses
who did not have a strong background in lactation were nevertheless able to
obtain the IBCLC credential by taking advantage of the pathway that was
available to them.

I do not have a good solution for any of this. I do think that if Healthy
Children is in any way making it easier for folks who are not IBCLCs to
present themselves as equivalents, then that is a big problem that the
IBLCE needs to address immediately for the sake of our profession. Those
who are teaching CLCs need to make the distinction very clear and there
needs to be follow-up on those who may be abusing their credential. I am of
mixed feelings about licensure. When licensing became mandatory in the past
few years for medical technologists in NY, I saw no benefit to the
profession - it simply put more money into the state pockets. However, we
were already recognized professionals, graduates of a four-year university
program, do not generally work solo, so the analogy may not be appropriate.
For a profession trying to get recognition and to put themselves apart from
the many other lactation folks in the field, it could be beneficial. Would
it really give us better standing with physicians? I don't know, would like
to hear more about that. As for insurance companies, that is also a
dual-edged sword.

So, those are my thoughts on this, for what it's worth. I do think that it
is remarkable that we (IBCLCs) exist in the first place and that we have
persisted through all these years - it is a testament to the hard work and
tenacity of those who have led the IBLCE and ILCA through the years and to
all of us who have continued to practice and promote the credential as we
help mothers and babies. We need to pull together and not let all of these
important, but difficult, issues to force us apart. I do think that issues
pertaining to the credibility of our credential are very important and do
deserve our attention. I don't think that giving that attention necessarily
means that other issues, such as Nestle, will not also be addressed or that
those concerned about the credentialing issue should in any way be
chastised or demeaned. We do know how to multitask.

Sharon Knorr, IBCLC
Colorado, USA







On Sun, Mar 11, 2012 at 12:34 PM, <[log in to unmask]> wrote:

> The discussion I have read this week is exactly why some physicians do not
> take lactation professionals seriously.  Whether by IBLCE, State Licensing
> or some other method, you need to take control of your profession, or the
> MDs  will!
>
> Nancy
> Nancy E. Wight MD, IBCLC, FABM, FAAP
> Neonatologist, San  Diego Neonatology, Inc.
> Medical Director, Sharp HealthCare Lactation  Services
> Sharp Mary Birch Hospital for Women and  Newborns
>
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