As someone who has profitted from the generosity of information shared on
this list, I am unwilling to say that LCs shouldn't ever advise over the
internet.  However, I would like to raise a few issues in response to Anna's
comments.

  Many LCs, particularly those of us who served as volunteers for many years
before  beginning professional practice, have grappled over the issue of
charging fees.  I repeat what I have said before:  It costs time and money
to develop expertise, and we do not see our colleagues in the other
professions begruding each other the income they make from that effort.  I
don't know a single LC who is getting rich from this work.  What is far more
common is the number of (mostly) women who are sacrificing in order to stay
in the profession.  Often the very families who complain about the cost of
seeing an expert LC are the ones who blew hundreds of bucks on a fancy
breastpump, etc.

  Here's an odd paradox: the proliferation of well-intentioned but
non-expert lactation counselors has made life more difficult for LCs who
have invested in a professional committment. If everyone calls themselves an
LC, how is the general public to distinguish? I have recently experience a
rash of calls from people saying things like:  "I have seen two or three
LCs, and they've all told me different things, and I still have the same
problem.  Why should I waste any more time and money coming to see you?"

Time is important in the resolution of lactation problems.  There is no
substitute for good history taking, observation of a feeding, assessment of
the breasts and the baby's oral anatomy. If I had a nickle for every woman
who has told me on the phone that her sore nipples weren't caused by poor
latch because everyone told her her latch-on was great.... The internet can
provide research, net-working, encouragement, and referral.  Perhaps with
video and interactive capabilities consults could be done on-line, but I
believe in the healing that is done with touch, and the counseling that
takes place in response to cues which only come across in person.

I sympathize with the desire to help, but if it essentially delays getting
to the very best expert the parents can find, lactation may fail because of
it.  This is not help, but enabling. We would certainly not take this
approach in searching for care if a loved one had any other sort of medical
problem. Can you see yourself encouraging your non-lactating sister to have
a breast lump checked out over the Net? Or believing it is safe to have a
non-gaining bottle-fed infant evaluated by a stranger?

 LCs are not attempting to "medicalize" or "own" breastfeeding. Remember,
the LC is not the person who sees normal situations.  Excellent volunteer
help is available through mother-to-mother support groups for commom
problems.  A really complicated "train wreck" lactation situation requires
assistance from someone who has made the committment to be there to see the
mother and baby  through with intelligence and patience, and who is
constantly refining clinical skills to do this with the highest degree of
professionalism.

If we continue to imply that it is a sin to be paid for this work, we will
away drive all the experts who have families to support.  And it is not a
smart move for anyone who ever hopes to work in the field.  If the only jobs
are in hosptitals and institutions, we will be paid like nurses and WIC
staff, or stipends like peer counselors.  In such institutions LCs are lucky
if they are recognized as experts.  Their jobs are at risk if they buck the
institutional policies and mind-sets (which are very seldom truly interested
in empowering mothers.)  Take a look at what happened to the natural
childbirth movement when it was institutionalized and all the Lamaze
instructors began to work for the hospitals. Take a good look at other
well-intentioned government projects once funds get cut.  We need
well-trained and INDEPENDENT thinking LCs in all segments, and we should be
advocating for respect for our profession, not apologizing for our right to
earn a living at it. I can't believe doctors (or plumbers, or teachers.
etc), as a group, would care so little for their survival as a profession,
to set up roadblocks for each other in terms of being able to afford to
practice. However all these groups do have peer review and peer disciplinary
measures for incompency.  We should immitate both practices. And we should
hasten to protect the term LC in order to protect the public, who hasn't a
clue who to believe.

As for me, I will continue to advise people who contact me over the net to
seek the counsel of their best, nearest LC. And if she costs a lot of money,
it will still be a BIG savings for the family if she's smart enough to help
them save the lactation.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html