First of all, let me way I STRONGLY feel that limiting the IBCLC to ONLY those who are medically-oriented will diminish our profession and having access to IBCLCs with a different perspective among my peers has been THE most valuable part of my experience as an IBCLC - learning and listening to others and how THEY resolve/address problems.   And being able to refer a mom to them when it was beyond MY skills.

I don't think that's the plan from IBLCE, but my big fear is that perhaps when asked, those who answered the questions from IBLCE of what IBCLCs "should" know may have skewed the survey. I don't remember receiving a "needs assessment" but maybe I did, and didn't think thoroughly enough about what would be the consequences of my responses...  OR was it mostly the nurse/IBCLCs who answered the questions?  [Just like in all elections, if you didn't "vote" you "voted" and voiced an opinion even by NOT voting!]

It needs to be clear that although IBLCE is adding to the requirements, they are NOT requiring a nursing degree.  However, I can see that these requirements make it much easier for those in the medical field, thereby increasing the percent of IBCLCs who ARE medically oriented.  As a social worker first, then an IBCLC and THEN a nurse, I can tell you that earning a nursing degree opened my eyes as to where the NURSES were "coming from" ...  Unfortunately, we are losing a lot of the historical knowledge and skill of the COUNSELING part of Lactation Consulting.  If this continues, I'm afraid for our profession - for it is NOT the "nurse" or the "IBCLC" who breastfeeds  - it is the mother and baby.  Those who are skilled in counseling are the ones who can really make a difference in helping them develop the relationship that is needed to increase breastfeeding DURATION.  

Mothers tell me they breastfeed for the RELATIONSHIP not for the "milk"...

Truly, education is never wasted, and there is nothing wrong with encouraging IBCLCs to take these courses  - however, it is also important to realize how limited access can be a big barrier...for example I know of various peer counselors who would be wonderful IBCLCs in a few years - but their family income is very limited - for them to draw from that income to take courses would be unlikely.  BUT this is an international organization and it is imperative that we - IBLCE, ILCA, USLCA, the Gold conference, Health-E-Learning, and many other programs could find ways to help bring along everyone to increase the knowledge base we all "should" have.  

Perhaps these requirements could be stepped up gradually, as the courses become more generally available, allowing some to take the IBLCE exam with the understanding that in 5 years they will have completed what they are missing.  I had this happen to me when I moved to California - I didn't have the required courses to be a Public Health Nurse and was hired with the understanding that I would take the missing courses - it worked well, I was able to take courses through VCR tapes (yes, before Internet was so easy to use), I was able to take long-distance tests, even demonstrate conducting a physical by videotaping myself!

I do not want to go back to how I trained myself - reading in the library after dropping my kids off in school,  there were no IBCLCs then!  We DO need to keep expecting more and more of ourselves - but not lose sight of our roots - and the basic needs of mothers and babies...because it is for THEM that we do what we do!

In recertification, not only should we be looking at "did they take xx or YY course" but also - consider, besides "Ethics" and "Lactation" courses - that "counseling" courses be added...as this is as important a skill as assessing for a frenulum or correct latch.  If we cannot communicate these findings in a gentle, responsive, appropriate way - our knowledge is useless.  A series of studies have shown:
 - mothers need to have someone sitting NEXT to them helping them improve their "landscape" not across from them TELLING them what to do
 - mothers need to be listened to, assisted in developing confident commitment to breastfeeding - because they WILL have barriers to overcome

IBCLCs need to know not only the hormones that produce breast milk, and the way to measure and evaluate milk transfer - they need to know how to support and cheerlead moms through their problems - and, unfortunately, help mothers deal with failure.  

I'm feeling frustrated and at the same time hopeful that this group of brilliant young women that are our peers CAN find a solution to continue this profession to follow its own path - collaborating but not being sucked in to the "medical model".  

Jeanette Panchula, BA-SW, RN, PHN, IBCLC
California, USA

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