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  flat 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_ 
(http://www.iblce.com/) ) to the satisfaction of her mentor?  The 500 hour requirement 
was arbitrarily  set after discussion between ILCA and IBLCE, 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.  
There is now a system of accrediting educational programs through ILCA,  
known as ILEAC.  Forgive me, I cannot recall the full name, but the program  
amounts, essentially to peer review of programs and approval of these  programs.  
This is essentially equal to the hens guarding the  henhouse. 
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 appropriate? And 
Pathway C  as it currently stands gives automatic eligibility to sit the exam, 
but students  have told me their coursework does not prepare them adequately for 
the exam.and  the curricula is not approved by IBLCE or ILCA.  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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