Ok, forgive me, but I just can't be quiet any more!  I have been very
interested in this discussion, and have been holding my tongue for a few
days, but just HAVE to jump in!  This discussion reminds me very much of the
entry level to nursing debate in the US.  (To those who are international,
bear with me).  In the US a person can sit for the RN boards with three
different levels of education, 2 years (ADN), 3 years (diploma) and 4 years
(BSN).  Another entry is as an LPN with 1 year of training.  This is hotly
debated in nursing circles and has been since I began nursing school in
1975.

The other issue here is the comment about many RN's on OB floors knowing
less than a non-RN IBCLC.  This is true, however, keep in mind that the RN
grants ENTRY into practice.  Most experience in the specialities is gained
from working the floors, CEU's, reading, etc.  With the limited amount of
time an RN spends in school, she cannot come out a specialist.  She should
come out as a generalist, with exposure to other specialties.  From there,
she gains her specialization.  Yes, I believe basic breastfeeding concepts
need to be covered in nursing school, however, further learning comes after
graduation.

As a hospital based LC, I do support the theory that LC's in hospitals need
to be RN's.  At least at my hospital the LC provides home visits with
physical assessments of both the mom and baby 48 hours after discharge.  We
have picked up so many problems on the hv that RN assessment skills are a
must.  In fact, we require the home visit RN to have at least 5 years of OB
experience before she can work in our program.  This is because there are no
"seasoned" experts out in the homes with her, and she has to be able to
assess and refer.  Just this last week we had a wound evisceration.  We have
seen thrombophlebitis, newborn sepsis, and have found a number of heart
murmurs in newborns.

I am not saying that ALL LC's need to be RN's.  What I'm saying is that each
job is individual, and requires a different skill mix.  I think non RN
IBCLC's have much to offer in many settings.  I have learned much from
Allison Hazelbaker and Kathleen Auerbach.  I think as we debate this issue
we need to be careful not to "throw the baby out with the bathwater."  There
is not only room for all of us, our profession is richer indeed with
diversity.  Ok, off my soapbox!

Linda J. Tandy, MSN, RN, IBCLC
Cedar Rapids, Iowa

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