I have this post going over in my mind for days now.  I agree with Melanie
Young, and I agree with Barbara Wilson Clay and Nikki Lee.   We need to have the
door open to those who come from all backgrounds at the ground level of
IBCLC.  We need to have undergraduate and graduate level courses in lactation and
hopefully a degree in something specific beyond "nursing" or "physician" that
really addresses all that we need to know about the breast's lactation and the
infants ability to transfer milk.
The truth is, IBCLC is an entry level credential.  I would like to see tiers
of specialty grow from it.  I would like to see IBCLC add to the field without
taking back the entry level.

When I think of the medicalization of lactation management, it always brings
me back to the birth process.  Birth works as a comparison because it is
uniquely female and because it is the one place that used to belong to women.
Birth has been managed in many areas into something that is as far from normal as
you can be and still have the mother and baby when finished.  I don't want the
medicalization of lactation management to ever replace the normal of
breastfeeding.  However, I appreciated the comments of Barbara Wilson-Clay that indeed
in all things "normal" there is always that which is outside normal even in
nature and so the real possibility of anomalies is not to be ignored.  As more
women are choosing to breastfeed, we will likely see more issues not dealt
with in the past because her desire to breastfeed would have not existed.  Just
as I respect that we need all levels of care in obstetrics from the midwife to
the high risk ob, I believe we need all levels of care for the breastfeeding
dyad.  I respect that the need is there to do the research and gain the
knowledge we need to understand human lactation at least as much as we understand the
dairy cow.  It would be exciting to have a level of lactation specialty that
encompassed every possible knowledge base that effects lactation.  I can't
even imagine the level of education you would need to truly know ALL there is to
know about making lactation work for all women and babies under all
circumstances.  What I do find interesting is the idea that we should expect more of
IBCLC than we do any other medical field or health care field.  Instead of
altering the IBCLC, I think we should have a higher levels of achievement and
specialties for IBCLC's to aspire to.

One way I was thinking of this issue is with this scenario.  A child goes to
the hospital with a broken arm.  He sees a nurse. Then he sees a doctor.  Then
the x-ray tech.  Now, maybe he will be back with the doctor for his arm to be
set.  Maybe not.  Maybe he will need to wait for the pediatric orthopedist to
come because the break requires more than the doctor attending can treat.
Every professional played their part.  Even when the child saw the original
doctor, it was not an issue to say "you need someone who has more
training/skill/ability to treat this particular break".  It is true that not every IBCLC can
treat ever possible lactation circumstance, but every IBCLC should be willing
and able to recognize that fact and refer accordingly.  I see the nurse in this
scenario as the hand holding cheer leader with some training, the xray tech
as the family friend who breastfed and can help, the doctor as the IBCLC and
that pediatric orthopedist as the specialist the IBCLC can refer the mom to when
more is needed.

My request for the lactation world of great minds and people that brought the
field to be is take it further without taking it away as it is.  Bring in the
next step and create that field of specialist for the IBCLC to refer to or to
aspire to.  Create it and make it easily available, not just something you
can only get on line or in one or two universities.  Oh, and hurry, because I am
already in my 40's and I want to be able to be one of those sitting in the
courses offered.

Unfortunately, in my opinion, as long as formula is considered an equal
alternative it does not matter what letters we have after our names.  It is not our
level of knowledge  and credential that are not respected.  It is the work we
do.  It is that breastfeeding is not respected.  Until breastfeeding is the
normal way the majority of babies are expected to be nourished and artificial
feeding methods of all kinds are seen as the last resort of treatment after all
lactation management skills are exhausted, it won't matter how many
credentials can be listed before or after IBCLC the work of helping a mother and baby
to breastfeed will still be considered something that is "not all that
important" by those who to this day, have no problem seeing formula as the solution to
any breastfeeding problem.

With warmest regards and sincere gratitude for all those I learned from and
continue to learn from every day I read Lactnet,  everytime I read a book you
wrote, or listened to you speak,
Pam MazzellaDiBosco, IBCLC
FL, USA

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