Mary J. and Barbara W-C are both right, in my opinion.  While it may be so
that providing pro bono service allows the system to continue to ignore
marginalized groups, those babies won't wait.  We need to provide services
now, and we need to be activists.  Some of us do it one way; others,
another.

I think it must be hard for US residents to imagine what life for HCPs is
like, where you don't have to calculate into the equation whether the mother
can pay for your services, because the right to access to care is a given,
like the right to breathe.  Try to take in the significance of that, and
then, realize that YOU are the ones living in the atypical country.  Most of
the rest of the industrialized world has put a system into place to ensure
access at least to basic health care and many have gone well beyond the
basics.  No, it isn't perfect.  But look at the examples described on
Lactnet daily, of care that is being paid for, and not at cut-rate prices,
that is sub-standard and just plain bad for mothers and babies.  The price
you pay out of pocket doesn't necessarily ensure high quality.

Norway doesn't have a system for billing for LC services.  However, the
IBCLCs in Norway are at this point all public employees in the
maternal-child health system.  Not all of us are in positions designated to
support breastfeeding, but we are working with breastfeeding mothers.  There
should be a provision within the next year or two, for those of us who are
midwives to be able to get reimbursed as private practitioners for LC work,
but the wheels of bureaucracy grind oh, so slowly.

I don't believe that the world is a poorer place because Mary, or Cher, or
any of the rest of us give care when needed without charging for it.  And I
don't think it is a poorer place because IBCLCs are asserting the real worth
of their work and demanding that it be recognized as a valued service in a
money economy.  I don't see them as contradictory at all.  I am keeping the
thread about professionalism versus mother-to-mother support out of this
discussion in my mind, because it is about another aspect of our work.  This
part, about who pays for our services, is an issue that in my mind has to do
with those of us who define ourselves as professionals in the field.  I hope
mother-to-mother support never becomes a service for pay, and I hope that
IBCLCs will be able to support themselves through this vital work that we
do.  They aren't the same, and we are confusing the issue if we choose where
to refer a mother based on whether she can pay, and not based on what she
needs.

Rachel Myr
Kristiansand, Norway
midwife (and IBCLC) to put food on the table
mother-to-mother counselor to remind me of why I chose this path

PS I knit, too, and not just breast-warmers!!

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