Hi all. I am new to LACTNET, and am very glad to be a part of this forum. I'd just like to offer my perspective on the potential concerns with the medicalization of breastfeeding and specifically the concerns with an RN background as it relates to lactation consulting and the IBCLC profession. (And just as a little background, I am an RN and a lactation counselor working toward her IBCLC.) A little clarification: Although I know several nursing programs are taught in the medical model, this is not the standard in nursing curriculum. Many nursing programs are holistic in teaching. In the same way that IBCLC's desire to be respected as distinct and stand alone profession, nursing is no different. Nursing is not medicine. Nurses do not practice medicine just as physicians do not practice nursing. Nursing is a distinct profession and although nursing and medicine do parallel at times, they are distinct intities. I know there is much confusion on the similarities and differences. It is quite a common perspective to blend medicine and nursing and see nursing as a subset of medicine. Some nurses do mistakenly practice more in the medical model (cure), rather in the nursing model (care). 

I agree that breastfeeding is in and of itself not a medical issue (not to say that there are never medical problems related to BF). I think it would be egregious to require that all IBCLC's obtain a nursing or medical degree prior to or concurrent with the IBCLC designation.  However, as all health related professions (dietitians, speech, physical and occupational therapists, nurse practitioners, doctorate of nursing practice) are going to at least a masters and mostly doctoral level for advanced practice, it follows that the IBCLC fellow will one day have the standard of masters or doctoral preparation. Following up what Sharon Knorr mentioned, I would love to see many more universities offer human lactation programs at the undergrad, masters and doctoral levels. I believe if IBCLC's truly want to be seen as experts and a stand alone profession, a master's or doctorate in lactation is just the way the tides are flowing in the professional world. Having a master's or doctorate does not make one more qualified or intelligent, it is simply the way the culture sees 'professionals.' If this is not the direction IBCLC's want to go, they may end up forfeiting their standing in the 'professional' ranks. I am not trying to be harsh here, or saying this is right or the way the tides should be going, simply that it is reality. 

I would say the larger problem is not that RN's are becoming IBCLC's and therefore medicalizing the profession. The more significant problem is the environment in which many dual RN/IBCLC's are practicing. RN's who practice LC in a hospital setting are more prone to being forced into a medical model as they are products of the culture. As Jessica mentioned, hospital protocols (and dare I say insurance/billing?) require LC's to use quantifiable, chartable data, at times irrespective of individual mom/baby needs). The reason is not because they are RN's, but because in fact they are in a hospital setting. I want to go off of what Jane Kershaw was saying about truly consulting. I think one way around this issue (RN/IBCLC's missing details and practicing in a medical model) is to have IBCLC's (whether RN's or not) truly consult for the hospital. Rather than hospitals hiring their own IBCLC's, these IBCLC's could be in an independent practice role and consult and make daily rounds in the hospital, but not be hospital employees. I have no idea what the impact on costs and insurance would be (as at the moment most insurance companies don't cover LC services separate from the hospital), but it could be a future goal. And certainly I want to say that a good RN is a good RN no matter where she practices and a good IBCLC is a good IBCLC no matter where she practices. But our environment has a lot of influence on our philosophy, and working in a hospital makes it difficult to keep a philosophy distinct from medicine. I know this very well!

And and urge you IBCLC's out there to please educate educate educate! Share with pediatric, NICU, PICU, spec care nursery, L&D and mom/baby RN's on breastfeeding!!! Hold special classes for continuing ed, talk to unit managers and get classes together for these nurses. This will help the information given to parents to be congruent and not conflicting. 

Deborah Wetherill, RN, BSN, CCCE, Lact Counselor

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