I have never been more disappointed to be an IBCLC than I am today.  
It is quite enough that we are a profession completely disregarded by  
the majority of heath care providers, but that we have so wholly  
contributed to our own impotence is utter humiliation. That we would  
have so little self-respect that we expend such enormous energy to  
prove we are good enough by behaving as if we are not is further  
humiliation.  I am sorry to say that it is no surprise to me in a  
profession run by women--I don't believe for a minute that a  
profession run by men would belittle itself in such a way.

I have considered the IBLCE exam to be a poor assessment tool from  
the first time I took it (ten years ago), learning that passing  
required little more than having basic medical training and some  
basic continuing education. Being a skilled clinician and even having  
a commitment to breastfeeding are utterly irrelevant, as was proven  
to me at that time by the process which I saw co-workers use to  
prepare for the exam.

Ten years ago, I studied by reading several chapters of Riordan and  
Auerbach the night before the test --that was all (and no, I did not  
just barely pass).  It never occurred to me to study for something I  
do every single day, unless there are areas I never engage in--at  
that time, I read  about diseases and disorders I have never seen.  
Besides, I am a good test-taker. I wrote two complete pages this year  
about questions that I knew were absolutely wrong or were just poorly  
designed.

I have homeschooled my children exactly for that reason--I didn't  
want them to learn to be good test-takers--to give the answers  
expected of them just to get a grade. I want them to be competent,  
loving, passionate human beings with a depth of purpose and place in  
the world. So, test-taking holds little value for me at all. At the  
time I took the first test, I complained to a member of the ILCA  
board about the lack of integrity in the testing process, and not  
only was I treated rudely, but my private conversation with the Board  
member was conveyed to a co-worker of mine who functioned in a semi- 
supervisory capacity who behaved in a retaliatory manner toward me  
that has affected my practice for over ten years. That was the last  
time I had any desire to bring an issue directly to ILCA, even though  
I am a member and have been a founding and active board member of my  
local affiliate.

Lest this stir up a whole new debate about recertifying--I am in  
favor of recertifying. I just have no desire to spend ten years  
becoming expert in certain areas of my field, only to dumb myself  
down to re-sit an entry level exam that was a poor tool in the first  
place (this time I studied so I would know what the "consensus"  
opinions are on many of the questions on which I disagree--based on  
my own experience and research). I wonder how many other HCPs who  
have become expert in their fields would like to retake their own  
entry-level exams? We should have a process that acknowledges our  
gains in expertise, not keeps us all at the same level. But, then I  
suppose the only expertise of any value would be that approved by the  
medical model?

So, after just proving myself competent again to practice at an entry  
level and waiting an absurd three months for the results, I find out  
today that the IBLCE has decided (when exactly were we asked our  
opinions?) to issue a new "Scope of Practice". I have so many  
questions, not the least of which is--was there any thought that many  
of us might not have bothered to retest if this document had been  
issued last Spring?

Okay, so I want to be clear about my "Scope of Practice",  My most  
glaring question is this--when did IBCLCs become pawns for  the  
allopathic medical model? Sometimes we sit in shock and amazement at  
the words that come out of the mouths of doctors--we wonder how it is  
possible that they cannot be working for the AIM companies when they  
so blatantly undermine normal human feeding. No act on the part of  
the AAP or an individual physician has served to undermine  
breastfeeding more than these two lines:

As printed:
"The following activities are outside the scope of practice of an IBCLC:
  Prescribing or recommending the use of alternative therapies.
  Contradicting or ignoring the advice of a client’s health care  
provider.

These two statements are not aligned with either my personal  
integrity nor with the concept of holistic practice, nor are they  
aligned with the right of infants to breastfeed, nor with the  
obligation we have to give accurate information to our clients.

We have often wondered how it is that peds are not sued for telling  
women outright lies like AIM is just as good as human milk or that  
breastfeeding doesn't really matter or that AIM won't harm their  
babies. I wonder now how we will not be sued for NOT telling mothers  
about therapies or treatments that we know will protect or allow for  
breastfeeding to happen. How will we not be sued for NOT telling a  
mother that she has been given inaccurate info? Do we sit quietly  
when a mother is told that AIM poses no risks or that breastfeeding  
has nor "benefit" past the first few weeks/months? Do we nod in  
stupid agreement when a mother is told that there is no such thing as  
tongue-tie? That it is not normal for babies to feed every couple of  
hours and this is cause to supplement with AIM (in a ped's booklet I  
just read last weekend!!)? If I do not contradict a lie, then I, too  
am telling that lie. If I do not offer a solution to a problem, b/c  
the only solution to a baby who cannot bf due to trauma is CST, then  
I am willingly subjecting that baby to a lifetime of consequences. My  
karma is not willing to take that burden.

Let me be even more clear--who gets to decide what is "alternative"?  
If I had been the client and an LC told me to see my OB for thrush  
treatment, she would have been giving me "alternative info", as my  
HCP was a midwife and the use of drugs is an alternative to me, not  
within the realm of my normal life at all. Is CST as practiced by a  
PT alternative? How about a chiropractor? Is it based upon what is  
covered by insurance? Some insurance covers acupuncture. Some women  
have no insurance. And, as Rachel said (apparently a shock to IBLCE)  
some women do not live in the US!!! Can I tell a woman who lives in  
Canada something different from what I tell a woman who lives in  
China--and would I need to know what is "alternative" to her? Or is  
it only based upon what is considered "alternative" by the great  
Western God Allopathy?

So, I have a mom whose baby has blatant symptoms of food allergies  
and whose baby has indications of tongue-tie and mom has a low milk  
supply. I should do what exactly? Cannot refer her to a ENT? Cannot  
refer to a CST? Cannot tell her about fenugreek or MMP or  
domperidone? If her ped tells her that she can just "cut down" on cow  
milk products for a few days to assess allergy and I know how useless  
that is, do I just nod like an idiot?

Is breastfeeding a part of the normal continuum of life or is it an  
irrelevant feeding option unworthy or our best efforts, knowledge and  
skills? Because if it is the prior, then it is not a part of the  
medical model and should not be cared for in reference to such. After  
all, the obstetrical medical model (which is in no way evidence- 
based) bears great burden for the fact that babies cannot breastfeed  
now. Of course, the routine separation afterwards does nothing to  
heal the wounds of western birth.

  I am co-speaking at a full-day workshop at the APPPAH Conference in  
California in Feb 2007 on healing trauma through infant feeding. My  
first portion of the talk is based upon the work of people like  
Michel Odent and Nils Bergman who understand that there is a  
biological and spiritual imperative in the design for optimal human  
health that begins in pregnancy and is woven through the maternal- 
infant eco-system during the first year of life. The second part of  
my lecture and that of my co-speaker relates to the brutal reality of  
western medicine that has no frame of reference for the foundation of  
human health as it has been designed into the primal period, and thus  
recklessly imparts illness in its every act. Hence, the need to heal  
trauma in the human infant.

  Now, we come along as an entire profession and become, as perhaps  
we were destined to do, one more part of the problem, leaving the  
solution, as always with precious few champions.
So, assuaging the American allopathic medical community is of more  
importance than babies being exclusively bf, or bf at all for that  
matter? If we are taking this position, we as a profession have done  
the greatest disservice to women and babies that has ever been done.  
We can stop blaming uneducated doctors and look to ourselves and our  
own fears because we, even more than they, ought to know better!  
Indeed, our unique position as an international profession ought to  
be our salvation--it ought to be our way of rising above western  
allopathy and functioning from the position that that which unites us  
is our strength--that which unites us is the biological norm across  
all cultures and beliefs and customs is the biological imperative and  
its inherent truth.

"We do not see the world as it is--we see it is we are". If we see  
ourselves as inferior in the world, then so we are. If we see the  
medical model as all-powerful, then for us, so it is. If we see the  
world from a place of fear, the we should be very afraid.

Jennifer Tow, IBCLC, CT, USA






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