Dear all:

Imagine a world in which we decided that paramedics, emergency medical technicians, and those who attended a one day CPR and first aid course were all the same? All of them can administer CPR and First Aid.  So what's the difference?   We could eliminate governmental costs if we simply taught more people to use CPR and first aid.  Then we could eliminate the professions of paramedics and emergency medical technicians. Right?  Now, if I had an accident where severed an artery, I might be quite happy to have someone who could staunch the bleeding until the EMT came, but I really really would want that EMT to transport me to the hospital.  And while I'd be happy if someone could start the CPR if I had a heart attack and an EMT might help me survive, I'd actually prefer the paramedic transport me.  

Imagine a world in which the proportion of neonatologists to pediatricians was 20 to 1. Both deal with pediatric concerns.  Do we really need so many practitioners outside the hospital, when they could return for outpatient services?  Since the highest risk of death is in the hospital period, wouldn't we be just as happy with that ratio?  After all, most babies will survive after that period so we really don't need that many pediatricians.  I don't think too many of us would be happy however, if we had difficulty finding a pediatrician when our infants were sick because there were only a tiny number of pediatricians or had to return to the neonatologist in the hospital for care of our 3, 4, 5 or 13 year old child. Even though the death rates among infants and young children outside the early neonatal period is much lower, I'm sure many of us are happy with the fact that there are more pediatricians than neonatologists.

Imagine a world in which we decided midwives were unnecessary.  Birth is a natural process.  Women have birthed at home with family members since the beginning of human history.  Postpartum doulas can be excellent coaches and women do most of the work on their own.  Do we really need the hands on help? I mean really, women just need a positive attitude they don't need physical help.  Couldn't we just substitute postpartum doulas for midwives since most of birthing is about confidence?  Even though most of us would be just fine birthing on our own, I don't think too many of us would be happy if we did experience complications and didn't have access to a midwife or obstetrician to assist use with birthing.  

Silence speaks a thousand words.  The silence about the illogical attack on role of IBCLCs, which has already had a significantly negative impact on private practice IBCLCs, baffles me.  In fact, in defending themselves against this attack, it has been the private practice IBCLCs who have been criticized widely for even daring to suggest that they may have a specific and unique role to play among the many and varied actors that are needed to return infant feeding to some sort of approximation of normal.

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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