It's interesting that midwifery and lactation-assistance in the modern
world are both specialties that seem particularly rife with different
degrees and certifications.  Perhaps that's because, unlike much health
care, these specialties focus on healthy processes that, for the wide
majority of people,  will proceed best with a minimum of intervention.
(Notice you don't have apprentice heart surgeons or dentists -- we only
deal with hearts or teeth when there's something wrong.)

I wasn't going to post, but it didn't seem like the horse was dying fast
enough, so here's a bit more beating..

Most new breastfeeding mothers need such low-tech help, and
encouragement to "get out of the way" of the process.  It doesn't take
in-depth knowledge to say, "Wait just a minute until the baby opens
wider," or "maybe the baby could get on there better if you sat up
straighter and brought her in closer" or (the big one) "Yes, a week-old
baby needs to nurse a lot!  How are the diapers?  You're doing a great
job!"  It just takes good working knowledge, some empathy and an
assumption that breastfeeding is supposed to work.  For millions of
years, experienced mothers, friends, and neighbors casually stepped into
the helping role.  So when LLL got started, it was designed to provide
that crucial, but generally low-tech assistance.

*But* LLL was also the prime mover behind the creation of the IBCLC
credential, not because it didn't believe in the power of friendly
mother-to-mother helping, but because it recognized that there are
situations that demand much more. (Just as some pregnancies need
higher-level obstetrical assistance.)  As an LLLL, I can tell a mother,
"I'm not a medical professional. I have lots of good information to
share with you, but this sounds like a situation where you may need to
work hands-on with a licensed lactation consultant."  If she wants, I
can refer her to several.  Often I've stayed involved to be part of the
resolution.  And I am thankful that I have such resources to tap.

I don't see any problem with hospitals, or public health organizations
or "lay" counselors in private practice offering phone-counseling or
on-site help for the normal adjustments/learning curve of
breastfeeding.   These people perform a valuable service -- I don't in
any way want to disparage the knowledge and passion that such people may
bring to their work,  regardless of the letters after their names.

But I think that such helping should be presented as roughly equivalent
to the services offered by LLL, and it must be very clearly
differentiated from the services of an IBCLC -- someone suggested a
nicely worded disclaimer that seemed an excellent tack.  Otherwise the
public is going to be very confused by these secondary titles.  We have
to protect and strengthen the IBCLC "brand name," so it can be a
respected credential.

And many mothers are more comfortable turning to a IBCLC for basic
questions, and that's ok too -- let these hard-working people field a
softball every now and then.


Margaret
(probably sensitive to the issue since deciding to sit "the test"....)

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