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From:
Pamela Morrison IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 15 Aug 2001 16:14:11 -0200
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Sharon

I read your post, about getting paid to be an IBCLC, with great interest.  I
think you have raised some excellent points.  In Zimbabwe, where I work as a
private practice IBCLC, I think I have gone as far as I can go with the
credential as it stands - which falls short of third party reimbursement -
and my clients have to pay my fees themselves.

The environment I work in is about as "ideal" as any of us would want
(discounting current political and security issues!)  We are a very
baby-friendly country.  Our Ministry of Health actively supports and
promotes breastfeeding.  Our paediatricians are truly superb too in their
universal encouragement of breastfeeding for all mothers and all babies.
Ever since I certified in 1990 I have been enthusiastically welcomed and
supported by all the doctors, OBs and paediatricians, who don't hesitate to
"refer" moms and babies to me, and are always available to liaise and
discuss cases with me, and develop their care around breastfeeding.  Even
the midwives call me in to the hospitals when they have exhausted their own
considerable skills.

But in spite of all this, I still remain on the "fringe".  I have made many
approaches to our Health Professions Council for registration, supported by
sheafs of documentation outlining what IBCLCs do, and how the credential was
developed, and backed up by 30 or so letters of recommendation from the
doctors, OBs and paeds.  Registration with this body is required before
health insurers will provide third party reimbursement.  And the one
stumbling block to registration is *training*.  The Health Professions
Council quite obviously will not accept the thousands of hours I worked as
an LLLL, and the "self-study" I put in in order to pass the IBLCE exam, as
sufficient proof that an IBCLC knows what she is doing.

And you know what?  I suspect that they could be right!  Nearly every day I
*wish* I had trained as a nurse.  I wish I knew much, much more about the
physical and physiological and anatomical intricacies of lactation and
breastfeeding.  I wish I had much more theoretical and practical knowledge
and that it had been taught to me by someone with the "best" qualifications,
instead of mostly self-taught by observation. I wish I had been trained in
at least the basics of all the other health conditions that impact on
lactation or breastfeeding, and knew more about how breastfeeding affected
other health conditions.  I don't mind at all that other HCPs don't speak my
language, but I sure wish I could speak theirs!

I suspect that issues of third-party reimbursement, and salaries for non-RN
IBCLCs in the US and other countries also revolve around the issue of what
training we have, or have not, received.  We need the degree course that you
are talking about Sharon.  We need to be immersed in a full-time recognized
course of study, which includes theory and practice, for two full years,
maybe even longer, and then to pass the IBLCE exam, in order to be able to
demonstrate that we *have* been trained, and that we *do* know what we are
doing.

I, for one, am not afraid of the "medicalization" of breastfeeding.  I see
too many subtle and multi-faceted real breastfeeding difficulties to believe
that this is always something which happens naturally.  Most of the time it
does, but IMHO about 20% - 30% of all mothers experience such great
difficulties either initiating or maintaining effective breastfeeding that I
wonder what percentage of infant mortality in settings where mothers cannot
just reach for the bottle could be attributed *not* to disease, but to
lactation/breastfeeding failure.  I think it's more than we imagine. I
suspect that the numbers are masked in the industrialized countries because
these mother may "choose" not to breastfeed at all, or to abandon
breastfeeding much earlier than mothers do in less developed settings.  I
think most women can breastfeed with very little help (perhaps needing
support, encouragement, affirmation, reassurance and information about how
milk-production works).  I think some women require more practical
assistance.  And I think a small percentage require extremely skilled help.
Our profession was developed to respond to the needs of all these women, and
we should be able to sort out which is which.

But personally, as "just" an IBCLC, I wish I'd been able to attend a college
or university or a full-time course somewhere, and to have the confidence
now of knowing that I did so.  It seems to me, reading between the lines,
that the vast majority of IBCLCs who work in hospitals, or peds offices, or
obtain third-party reimbursement, do so because they are *first* RNs, or PTs
or OTS, and use these qualification to obtain payment for their IBCLC
skills.  Our profession is not really going to be taken very seriously until
aspiring LCs can obtain *formal* training followed by the exam.

BTW, does anyone know what happens after 2003 to the IBCLCs who have *not*
attended the full-time courses?

Pamela Morrison, IBCLC, Zimbabwe

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