"CERPs are also not currently rated or ranked by level or difficulty.  Entry
level, mid-level and advanced experienced level program designation not only
would help individuals discern what would be appropriate for them, it would
also help to ensure that at least an effort is being made for continuing
competency and continuing learning.   

I must respectfully disagree with Kathleen B. that there is no real standard
of information, or standard of care for breastfeeding.  We do have the
beginnings of standard of information ad care, based on ILCA's evidence
based practice guidelines.  They need to be updated regularly of course, but
more importantly, they need to be used!  There are IBCLCs in practice who do
not know they exist.  There are others who do not observe them.  Is it any
wonder that MDs and others greet our profession with mixed reviews, if we
cannot even ensure that IBCLCs practice quality, basic care across the
board?

Education, and mentoring, is a huge issue, and one which evoke heated
discussion in lactation circles.  As some of you know, I was closely
involved in the introduction of the experimental Pathway F, or mentor
program for the past 2 years at IBLCE.  Instituting this program from the
ground up was a tall order.  Numerous issues still need to be resolved:  a
recertified IBCLC isn't necessarily a knowledgeable IBCLC; some perfectly
competent  IBCLCs are not good teachers; there have been complaints by
students that they are really not available at all for questions and
guidance; almost all of the participants in the first 2 years did all of
their hours in hospital settings because it was easiest and the guidelines
did not require otherwise (thus reinforcing the problem of the IBCLC expert
only in the 0-3 day old infant).  Most importantly the 500 hours MINIMUM
requirement is generally disregarded; to many applicants and mentors it was
a 500 hour requirement, and would you believe that it took EXACTLY 500 hours
for some of the candidates to master every skill on the clinical competency
checklist (available at www.iblce.com) to the satisfaction of her mentor?
The 500 hour requirement was arbitrarily set after discussion among the
board, with the intention to review the applications and adjust it upward or
downward accordingly after an adequate cohort could be established. I guess
they were just spot on at 500, although I for one can tell you I certainly
needed many more than 500 hours.  Pathway F also has no requirements, only
recommendations, for classroom work, discussion groups, post secondary
education, learning how to read and understand research, and other means of
learning.

Without a standardized, reliable, fair and verifiable method of educating
IBCLCs, we will continue to face the challenges of lack of recognition and
respect, lack of 3rd party reimbursement, failure to earn a living wage, and
the frustrations of disasters that never should have happened.  Multiple
pathways can and should continue to exist; there should always be a pathway
for mother support counselors and those without a college education to
qualify to sit the exam, but their eligibility requirements must be
consistent with those of the other pathways.  Physicians, too, need to have
their pathway examined.  They may earn 900 practice hours, but is that
enough?  And Pathway C as it currently stands gives an automatic get
eligibility free card to sit the exam, but students have told me their
coursework does not prepare them adequately for the exam.  Perhaps these
programs need to be validated too, if their students are automatically
eligible for the exam.

I disagree that we cannot and should not be trying to develop formalized,
accredited post high school education. It was, and is, my hope that the
Pathway F program will soon morph into a 2 year college program that would
allow for this. At this point, I do not believe a 4 year program in
lactation is absolutely required, but certainly could be useful in terms of
a broader liberal arts education.   I envision IBCLCs allying with local
community colleges to design a curriculum including such courses as human
anatomy, medical terminology, communication and counseling skills,
nutrition, pharmaceutical awareness, family psychology/relations, adult
education skills, and child development, among other courses, while
qualified IBCLCs would teach courses in breastfeeding basics, breast and
infant oral anatomy, breastfeeding equipment, case studies, The WHO Code and
advocacy, and other breastfeeding specific courses.  Together, under the
auspices of the university, students would be assigned rotations in
hospitals for their practical experience, much like RNs.  The best programs
would also arrange for other exposure, e.g. private practice, NICU, Easter
Seals rehab, speech pathology units, etc.  How can this happen if we put
aside differences, realize that the competition of week long courses and the
inappropriate nature of distance learning degree courses cannot train
professionals that will earn a place with such other allied health care
professionals as speech pathologists, occupational therapists and physical
therapists?

A word about the one week courses, and the "3 day wonders" as they are
known. I have just returned from a speaking engagement for WIC State
Breastfeeding Directors.  An alarming number of women with whom I spoke,
mostly nutritionists by training, were shocked to hear that the 'week long
training' did not qualify one to be an IBCLC, nor was it equivalent to
providing the skills and experience that the training and exam process of
the IBCLC process, nor was it REQUIRED to sit the exam.  Our professional
organization, along with the certification organization, and we, as IBCLCs,
have a responsibility to raise awareness on this issue.  Whether it is
through local ILCA affiliates, state breastfeeding coalitions, hospital
lactation consultants, individuals, or please pay more serious attention to
this issue, and explain the differences. 

There are a number of week long courses, some excellent, some less so.
These courses' directors, along with IBLCE and ILCA through their published
documents, and soon-to-be third role delineation study conducted by IBLCE,
together with the experiences of nearly 16,000 IBCLCs world wide over 20
years is enough to establish the basics of an associate degree program.  I
find it hard to argue that anyone's one week course could be an equivalent
educational experience, and can find little reason why we should not aspire
to establishing a degree program as soon as possible. 

I've seen and heard of some frightening laziness, burnout, lack of respect
for babies and mothers (May I touch you?  May I pick up your baby?, jamming
babies into breasts) recently.  If you're overworked, overstretched, or
underappreciated, find a way to save yourself.  Don't wait for your
supervisor or your colleagues to reach out and care.  You won't do your
best, and you won't leave a good impression of our profession if you aren't
at your best. 

If you are still with me, you are near the end, and may claim your prize by
emailing me when you have finished this paragraph.  Recertification is
another thorn in the side of lactation consultants who are tired of picking
up the pieces of their colleagues less-than-adequate work.  If I had a dime
for every hospital based RN (generally, speaking, but not always) who told
me she wasn't recertifying because (a) her hospital wouldn't pay for the
exam or the CERPs (b) it was too much work  (c) she didn't think it was
necessary, she already was tested in this stuff once or (d) she could
continue to be the 'lactation nurse' without the credential, I'd be looking
at that retirement property at the beach.  Where is the professionalism of
these IBCLCs?  Where is the pride, the professional obligation to 'do no
harm', to provide the best possible care?  Why do we not see these people at
conferences?  Even when the education is free, I see few of the local
IBCLCs, and I understand my area is not unique I this respect.  Maybe it is
these people that might want to encourage the development of the lower level
credential, with fewer requirements and responsibilities.  If hospital
administrations are pushing these people to become IBCLCs, maybe they should
be rethinking their objectives.

I would love to see the members of LACTNET undertake a serious discussion of
some or all of these subjects, and I would also be happy to discuss any or
all of them off-list.  If nothing else, I hope my post and those of my
colleagues have prompted you to think beyond your daily responsibilities and
clients to the bigger picture of our profession."



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