Jay writes: "We are all different and have different needs.  Not all of us
NEED JHL to be a good LC, in fact, there are a hell of a lot of great LCs out
there who are not members of ILCA, and that is just fine.

ILCA and JHL are not the end all of LC-dom, if you catch my drift."

I have to disagree with you, Jay.  If we LCs are trying to establish our
vocation (or field of endeavor---whatever you want to call it) as a
profession, then we have to have some kind of professional standards.  It's
hard to know just What we are, and you and I might define different
territories as the territory of the LC.

I believe that LCs are like the midwives of breastfeeding.  We are advocates
for breastfeeding (the process), and for the mothers, babies and families that
breastfeed.  An LC knows a lot about the process and the people.  A good LC
also realizes there is a whole lot more that he or she doesn't know.

What is breastfeeding?

It is a physiological process which is part of reproduction.  So LCs need to
know a lot of health-care-related stuff.

It is a family relationship, so LCs need to know a lot about humans, cultures,
human development, families, their legal status, rights, etc.

It is an economic activity, so LCs need to know about domestic (household)
economy and national economy.  We need to understand the politics---the status
of women and children, and how breastfeeding fits in with other work women
need to do.

It is a productive activity, so LCs need to understand the "product," the
fantastic foodstuff called human milk, and its nutritive, protective, and
curative properties.  We need to understand how milk can be threatened by
pollution and chemical exposure.  We need to have "kitchen" and "bench"
knowledge about expresed milk as a food, as a medium for bacterial growth, and
as a subject of scientific inquiry.

It is a "woman" thing, so LCs need to understand women's culture, and women's
politics, and women's history---and these are different things in different
cultures around the world.

It is beautiful and spiritual---so it's nice if LCs can describe and teach and
enable breastfeeding in a way that respects its beauty and its spirituality.

And once we know some of these things, LCs have to be teachers and advocates
in order to present this knowledge to all the people who don't know as much as
we do.

Now, suppose you're a person who needs some "breastfeeding work"
done---teaching doctors about breastfeeding; helping the mom of a premie;
testifying in a custody case involving a nursing baby; advocating for a
lactating woman at her workplace; designing a breastfeeding promotion program;
drawing up a law to protect breastfeeding in public places; writing a pamphlet
for pregnant teens.  You don't have the knowledge to do these things, and you
want to hire somebody who does.  How do you do it?

If there's a profession called "lactation consultant," and members of the
profession are supposed to be able to do these kinds of breastfeeding work,
then you as a buyer of services have some protection, some assurance that
you'll be getting the expertise you're paying for when you consult an LC.  And
if there's no such profession, then you as a buyer will have a harder time
finding what you need---and you just may decide it's not worth looking for
what you need.  So in the end the people who need breastfeeding work just
won't get it done.

In the U.S. there are three kinds of credentialing process to give some
assurance to buyers that professionals are competent.  They are licensing,
registration, and certifying.  Licensing is the most restrictive; certifying
the least restrictive.  This is one reason that the IBLCE was set up to
*certify* LCs.  Because people come to the field from so many different
backgrounds, it was designed to be inclusive, not exclusive.   They didn't
want only health care workers to be LCs.

But this inclusiveness leaves us vulnerable too.  Anybody who can claim a lot
of hours working with mothers and babies, take some CE courses (and just
sitting at a lecture is sufficient; you don't have to prove you learned
anything), get a couple of recommendations, plunk down some $$, and pass a
written exam can be an IBCLC.  This takes a lot of work, and the great
majority of IBCLCs take the process very seriously and work hard at learning
what they need to know.  But in my opinion, passing the exam doesn't really
prove that you know how to be an effective LC.

Even if the buyer has the protection of some kind of credentialing of the
professional, the buyer is still well-advised to check things out.  You ask
the candidate for their C.V.; you interview her; you get references; you look
at their other work.  Of course, if you're an engorged mother with a jaundiced
baby, you may not have the time or energy to be picky.  If you live in a
remote area, you may not have any choice---you're lucky if there's ONE person
who can try to help you.   And the work you need done will dictate to some
extent the kind of LC expertise you need---writing, teaching, research,
designing, administering, advocacy...all of these might require different
skills from the clinical skills that a mother and baby with a problem would
need.

So as our profession comes of age, we have to keep working over the same
ground, looking at questions like, "How does a person become an LC?  How can
we be sure that LCs are competent?  ethical?  How can we be sure that LCs stay
current in the field?"  I doubt that there's ONE right way to accomplish these
ends.  A professional organization---ILCA---is one good way.  A high-quality
journal---JHL---is another.  Networking---meetings, Lactnet, local
coalitions---is another.  Supporting and improving the certifying process.
Setting up pre-service education programs as well as continuing education
programs.  Some kind of internal "self-regulation" to keep ourselves and our
colleagues up to standard.  And some kind of standards....which is where I
began this discussion.

During the years (most of my adult life!) that I've been involved in what I
think of as "the Breastfeeding World," I've been concerned about something I
might call our "validity," our truth.  I feel as if we (at least in the USA)
have been marginalised---or closeted---and our issue has been left out,
overlooked, forgotten---for so long, and our struggle has been so hard, that
we're in danger of developing a skewed view of reality.  You know that feeling
of identity, instant understanding, acceptance that you experience when you
find another lactation "nut"!  "Oh, good, here's somebody I don't have to
explain everything to---she (or sometimes it's even a 'he') already
understands about breastfeeding."   It feels so comfortable to be with other
people who see things through the same "breastfeeding glasses" that we do.
And because of that feeling, I believe that we have to be extra careful, extra
watchful, to be sure that there's some objective corroboration for our
perceptions.  A peer review process is what I'm getting at, I think.  We have
to help each other identify deficiencies in our understanding, our
presentation, or our goals and strategies.  We need standards that define
LCs---who we are, what we do.  If we don't do this for each other, surely our
critics will, and they won't be kind!

The rigor of the research process is one standard our profession can cherish.
Another standard is a clear position on the ethics of breastfeeding supplies,
equipment, infant feeding paraphernalia, and corporate sponsorship.  Others
might be cooperation among breastfeeding advocates of all kinds....Justice and
fairness in dealing with our colleagues....A global rather than a local
viewpoint....Accountability in clinical practice.  And I'm sure there are
others.  ILCA drew up Standards of Practice about 5 years ago.  That's a
start.

If we're a profession, we need to act like one.  And if we're not a
profession, we need to decide what we ARE.

Peace.   Chris.