Dear all:

Well, now that the topic is broached, I do confess I don't quite feel I've gotten to the bottom of all 
the controversy or how it all erupted.  I'd love others to let me know what they understand 
because it still seems murky to me.  What I THINK I understand so far follows, but I am totally 
open to correction.

First, there is the very important fact that IBCLCs are a new and struggling profession.  We have 
not yet been fully recognized. Since this profession is currently dominanted by a preponderance of 
nurses in the United States, we have to be cognizant of how a different credential will influence 
this base as well as look at how it will influence the rest of us who are outside this base. Even 
those of us who are not experiencing the same problems as our sisters in the US-based hospitals 
should realize that they need our assistance.

1) SALARIES AND LAYOFFS:  Currently, the insurance situation in the United States is putting 
pressure on hospitals to cut costs.    Under those pressures, professionals whose value is not 
completely understood and who have a higher salary level are most likely to be cut.  When other 
professionals are available who are perceived to provide the same services at a lower salary, they 
are more likely to be selected when the budgetary system is strained.  Moreover, even when the 
professional level is similar, such as recently happened with licensing of therapists when it was 
expanded from those who had a Masters in Social Work to those who have Masters in Psychology, 
the increase in professionals lead to downward pressure on the salaries.  The addition of a "lower 
level" credential may exert a downward pressure on salary levels of a profession that is barely 
beginning to be recognized and still quite fragile.  Many hospital IBCLCs are already being laid off 
even without another "lower level" credential that might be perceived as an easy fix for a hospital 
in budgetary crisis.

2)  PEER COUNSELORS AS A DIFFERENT SKILLS SET. Beyond the need for clinical skills in lactation 
there is a great need for peer counselors to encourage and provide emotional support to women 
for breastfeeding that extends long past the hospital setting and long past resolution of clinical 
problesm.   While there is some overlap, a peer counselor should NEVER be seen as a LOWER LEVEL 
professional.  It would be like equated psychiatrists with psychologists.  The two should work 
hand in hand with most people never needing to see the psychiatrist.   La Leche League is one 
source of these peer counselors and perhaps the most highly recognized.  Unfortunately, there is 
a wide array of courses for counselors that have vary widely in their content, and ability to 
transmit these skills.  
The skills of a peer counselor are a completely different set of skills than those of a profession 
that is designed to offer clinical assistance. 

3) LOW INCOME POPULATIONS:  There does appear to be a need in the United States for better 
qualified breastfeeding counselors within the WIC system. This is an unfortunate political reality 
that again influences an international profession.  In New York State, 50% of the children are in 
families that receive WIC.  For those of you not familiar with it, the system gives out food to low 
income women with children.  Although there is transfer of food, when I did my doctoral studies at 
Cornell the community nutrition folks considered it to be much more of an income transfer 
program, freeing up household resources that can be spent on other items.  These are the families 
that are most likely to be at risk for not breastfeeding.  I don't think that the ratios of families on 
WIC are all that different in other states than in New York.  Those of you who live in other 
countries have the good fortune to not have to face this particular problem, but should be aware 
of the need for a "qualified credential" for breastfeeding support WIC brings political pressures on 
how our professioin evolves.  There is no way that we can ramp up the process of producing 
enough IBCLCs to serve the needs of WIC or similar programs in other countries.  Should these 
women have to wait until there are enough IBCLCs in existence to serve them?  

4) CONFUSING INITIALS AND CREDENTIALS.  I'm sure many of us have encounterred this problem 
where someone who has no qualifications at all presents themselves as a lactation consultant.  My 
obstetricians office had advertisements for someone who hadn't even attended one of the many 
courses that dabble in breastfeeding until I sent a letter complaining about their advertising this 
person.  One of the most confusing of these credentials is the CLC.  I have to attest that, in my 
sample size of one, the colleague I know who went through this course came out very well 
grounded in clinical knowledge about breastfeeding.  She also has a high sense of ethics and 
never presented herself as a lactation consultant until she became and IBCLC.  The mere initials of 
this certification whether intended or not, however, are highly misleading.  CLC is so incredibly 
close to IBCLC that is but a very easy step for mothers, parents, pediatricians and other 
professionals as well as insurance companies, to become confused.  It just looks like one is an 
INTERNATIONAL credential and the other is local.  And what mother is really going to care?

5) LICENSING:  In at least one state IBCLCs are on the verge of being liscensed.  Again, while this 
does not pertain to other countries, it has implications for the overall health of the profession.  
Lisencing may strengthen the ability to become recognized and get reimbursement so that 
professionals can earn a living. A credential that is PERCEIVED to be similar or competitive EVEN IF 
THIS WAS NOT THE ORIGINAL INTENTION OF THE CREDENTIALLING BODY may make it more 
difficult for this lisencing to occur.

In some ways, I could take the attitude that because I'm in Manhattan I can generate what my 
husband calls a "boutique practice".  There are many therapists, pediatricians and obstetricians 
that will not take insurance in Manhattan and he calls these "boutique practices".  I'm sure 
Manhattan could be at least 10 more private practice IBCLCs without even making a dent into the 
potential client base.  So while it may not influence me per se, it does make a difference overall to 
the health of the profession how decisions are made about credentialing adjunct services, the skill 
sets involved, how these are marketed, and how these influence salary levels for those who must 
rely upon health care systems for their income.   Moreover, if our profession contracts rather than 
expands we will lose the richness and diversity of opinions and skills that makes for healthy 
growth and deepens the understanding of how to help women succeed in breastfeeding.  When a 
profession is limited to a few individuals, it stagnates.

Personally, I think those who live outside the United State might have some creative insights into 
the issues and constructive suggestions.

Best regards, Susan Burger

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