Oh, Yael.  The situation you describe in Israel  is just so similar to what
we are dealing with here.  In general, the midwives believe that
breastfeeding is their domain and *if* they see the need for further
education will perhaps manage something between 8 to 20 hours every 10 years
and then actually tell mothers that they are especially equiped to help them
with all sorts of bf issues as they have done a special course!  They
usually want to learn  about *techniques and gadgets*, but we always include
the basics , even if we have to sneek it in under fancy titles!  As one of
two IBCLCs in this city it has taken us 10 years to develop credibility, but
the midwives and well-baby clinic nurses want us to teach but hardly ever
refer, or if they do, it's so long down the line that the poor mother has
very little emotional reserves left!  (and usually hardly any nipples left
either!)

And I don't think it's a *money* issue.  We usually see a mother only once
or twice and she goes back to the well-baby clinic thereafter for further
weight checks, immunizations etc.  I think it is probably an ego and power
issue?

What is encouraging is that the dieticians have now decided to "own"
breastfeeding and they are really doing a good advocacy job on a local and
national level.  The teaching of breastfeeding to diatetic students at our
local universities in their second and fourth years is both accurate and
enthusiastic.   Some physiotherapists are also learning as much as they can
as they often see mothers with nipple trauma.

I agree, a *real* LC has so much to learn.  What would we do without
Lactnet?  When the bigger picture gets too overwhelming, I just try and
focus on helping one mother at a time.

Jean Ridler  RN  RM  IBCLC, Cape Town, South Africa  [log in to unmask]

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