Dear all:

There are many IBCLCs who have professions that make for an excellent background in supporting 
breastfeeding.  None of these backgrounds should be considered any less valuable for 
communicating to other health care practitioners.  

Some of us are clinical psychologists, nutritionists, registered dieticians, herbalists, 
accupuncturists, MDs and many other professions.  At this point in time the profession of IBCLCs 
is dominated by RNs who also add their valuable perspective.  This perspective, however, is not 
the only perspective  and does not mean that the rest of us who are not RNs have any inherent 
lack of capacity in communicating with other health care professionals.

Moreover, I do not feel that a hospital-based system should be the standard for all IBCLC practice.  
At present, the managed health care systems in the United States are severely limiting the scope 
of nursing care.  California is in a severe crisis because of lack of nurses and I'm sure that is the 
case in other states as well.  The ability to help with breastfeeding within the first 2-5 days is 
important, but not sufficient and severely constrained by staffing cutbacks in many hositals in the 
United States.    Most of the breastfeeding relationship occurs outside of the hospital and deserves 
support.

Outside of the hospital setting is no other profession where free-standing health care 
practitioners such as clinical psychologists, nutritionists, dietitions, speech therapists, etc are 
effectively "gagged" if they have a disagreement with another health care practitioner.  Yes, they 
should retain professional standards and explain why, on an evidence basis, they disagree with 
the other practitioner.  But they are not "gagged" from saying they disagree.

Best regards, Susan Burger

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