I'm not losing sleep over this issue yet, but it's getting close, so I'm  
going to post this, and hope I can finally let go. Being a more practical and  
blunt (to a fault, ask my colleagues) person, and not widely know for my  
intellectual prowess, many of your posts are beyond me intellectually and  
esoterically, so I'm just going to shoot straight from the hip on this one, one  more 
time.  Be patient with me, please. 
 
Pam Morrison's post on the SOP issue makes some really great points and I  
think/hope we all (including the leadership at ILCA and IBLCE) should consider  
them very seriously.  And, it's not just because she happens to  largely agree 
with me! 
 
The fact that she doesn't "... have "a snowball's chance in hell of  being 
registered" in England, as you might remember, hit a nerve with me, as I  try to 
get American insurance companies to reimburse for my services.  This  is not 
news to anyone here.  The main reason? She says " I hadn't  received a 
recognized form of training. ..."  We all know, unless we have  been living under a 
rock in America, this is a serious issue.  We are the  only allied health care 
profession here without a university, college or  associate (2 year degree) 
program offering the consistency and validity of a  standardized (or even 
vaguely standardized program) that can be recognized by  the employer, insurance 
agency, government and/or consumer.  
 
There are excellent, quality education programs in breastfeeding out there;  
I know, I work for one.  They fill the need in many ways.  And when  clients 
ask me about my background, I say that I have an undergraduate and  master's 
degree, have practiced in the US and abroad, have taken college level  courses 
in nursing, anatomy and physiology, etc., attend many professional  
conferences, speak at them, write, am a retired LLLL, and regularly read  professional 
journals.  This satisfies them, but I am lying by  omission--unless I 
specifically specify my degrees are in French, International  Relations and Development 
Economics.  Like so many of us, I got to  IBCLC-dom circuitously.  Nothing to 
be ashamed of, certainly, and in many  ways, it probably helps me; 
nevertheless that and $4.50 doesn't buy me a grande  double-decaf mochachino soy-skim 
latte whatever at Starbucks. 

Indeed, Pam, I believe you are right:  There is a big sticking  point, as you 
put it.  Even ILEAC's efforts, noble as they are, I don't  think, are going 
to be viewed as sufficient by  licensing boards, health  professions councils, 
other healthcare providers and insurance companies  
who need to be reassured before reimbursing a consultant who is not a  
something else. As good as we might be, and as much as we tout the "gold  standard", 
it really just isn't enough.  
 
Why?  In a nutshell, certification can be bestowed by anyone for  anything. 
Simplifying it somewhat, the fact of the matter is that I can  open Barbara's 
Dog Walking School, set up a board, charge a fee, give an exam,  issue a 
certificate, and the graduates can call themselves "board certified dog  walkers".  
I can even guarantee continuing competence by recertification by  exam.  I 
could, in fact, if I had the money, energy and put in the effort,  even be 
certified NCCA, join NOCA, and become the gold standard of dog walking  
certification organizations.  I know this sounds terrible, disrespectful  and flip, but it 
is true.  If you research certification, you will find  this to be accurate.  
Certification is only one part of the complete  professional picture. 
 
Pam said that she feels that the IBLCE Board could be more active in  seeking 
recognition of the credential as a stand alone certification.  I  agree with 
this, and I don't.  Being a fairly young profession, in some  ways I feel that 
IBLCE should only concentrate on developing and administering  the exam.  
Developing the data bank, updating the security of the  administration of the 
exam, the policies and procedures of the organization, the  operations of the 
Board and other internal issues desperately need  attention.  On the other hand, 
she says the organization could take a more  active role in seeking 
recognition of the credential.  I believe it should,  and tried to do that while I 
worked there.  But, the fact is, IBLCE is too  small, too poor and the staff is too 
overworked to do that.  And besides,  is that not a role, truly, for the 
profession's professional association?   I think some education is required 
regarding the different roles of the  certifying agency and the professional 
association.  The roles are not  identical.  For example, if you want to become a 
doctor, during medical  school, you take boards, after graduation, internship, 
residency, and  fellowship, then you seek licensure, and you set up practice.  
At some  point, you may take special exams to become a specialist in a 
subfield.  At  some point, you may join the American Academy of Pediatrics, the 
American  Academy of Psychiatry, Neurology or another association representing your  
specialty.  These organizations inform the public, offer education,  
conferences, lobby for your interests on Capitol Hill, at the state government  level, 
and charge dues to do so.  They do NOT examine you, they do NOT  renew your 
certification or license, although they might offer continuing  education 
opportunities. 
 
Now, not to lay blame, and I want to make that VERY CRYSTAL CLEAR (sorry,  
but I mean it)  ILCA is as young as IBLCE, and for a long time, both  
organizations have been run by volunteers with lactation credentials only and on  
minuscule budgets, and both organizations were operated with Boards with little  
business acumen.  Inevitably mistakes were made.  A confusion of  roles, lack of 
progress in some areas, duplication of efforts and other issues  arose at the 
expense of the creation of a new profession, remarkable progress  and 
innovation, and the unfathomable benefits to millions of mothers and  babies.  I think 
we all recognize that these pioneering professionals have  made a tremendous 
contribution to our profession, to each of us personally, and  to mothers and 
babies.  They deserve our admiration and our thanks.   Despite our current 
annoyance, anger and frustration, we need to keep that  fact in clear view. 
 
Nevertheless, so now we have a serious, if not earthrocking mess, with  the 
SOP issue.  It's no wonder.  Everyone, on Lactnet anyway it seems,  is out 
there twisting their guts, absolutely tortured about how this affects  their 
practice, whether or not to recertify, how or if to report to physicians,  whether 
or not to be or not to be RNs, etc....remember Lactnet is only about,  what 
3000 (Rachel, ?) of the about 20,000 IBCLCs worldwide, some of whom, even  in 
the US, have NO IDEA this is happening.  Think about that for a minute,  will 
you?  It all depends on where you sit.  Is it that  earthrocking?  Are there 
issues that are not equally important, if not  moreso?  
 
 
[Some of you will recognize the following, as I have sent it to friends in  a 
different discussion.  Sorry for the repetition.] The SOP has been  withdrawn 
from the IBLCE website, but technically they are still  'reconsidering' it.  
We don't yet know what happened at the board meeting,  as of now, as far as we 
know, I think, they are still planning to meet with ILCA  on the topic.  
IBLCE still could withdraw the whole thing and go home with  their tail between 
their legs.  I don't know how likely this is, but it  might happen. 
 
Now, as to how this whole SOP nightmare got started, I have been  thinking.  
IBLCE does a role delineation study about every 5  years. From the role 
delineation study before last, done in or about 1998 (when  I lived in Australia,  
was a voluntary participation exercise) only a  couple of results have emerged. 
 One was the requirement for the "related  background in" courses for 
non-health care professionals.  The courses in  anatomy and physiology, counseling, 
child development and the like.   Because of the length of time it takes to 
compile and analyze the information  and for the board to act, this whole SOP 
thing could also be an outcome of that  RDS.  What I'm saying, in fact, is that 
somehow they may have extrapolated  from the data that their version of the SOP 
was necessary.  If you  think about it for a minute, we don't know the sample 
size, and "n" was  self-selected.  What if the information they used was 
largely composed of  originally LLLL IBCLCs with no background in health care?  
Would it make  sense that they'd come up with this?  Could this thing be a huge 
research  error?  Could there be no "evil intent"?  Yes, we would certainly 
hope  not, but that is as possible as the fact that IBLCE might not have 
realized or  have indeed forgotten that ILCA had issued a previous SOP just as ILCA 
had  forgotten to date their SOP.  I have no doubt that the majority of  the 
board had no idea that it existed, but I question why the ILCA rep on the  board 
didn't speak up loudly enough to be heard while this SOP was being  discussed 
and voted on.  Did she not know ILCA already had an SOP?  I  posted on this 
earlier, and to my surprise, no one, not even the ILCA rep or an  ILCA officer 
commented.  Why not?  Again, I repeat my message.   In the board's discussion 
of the new SOP, why didn't this happen?  Of  course, these hypotheses are pure 
conjecture, based largely on my knowledge of  the past and my carefully  
honed deductive skills after watching years of  Law and Order.  
 
It is time for both ILCA and  IBLCE to be operated as  businesses.  I 
certainly am not saying to get rid of the lactation heart of  the ILCA and IBLCE. 
Absolutely not.  I  think the Exec Dir of  IBLCE should be an IBCLC.  I think the 
Exec Dir of the IBLCE should be the  public face of the organization--a 
person who is constantly out there--speaking  at conferences of all allied health 
care professionals, showing the flag so to  speak, promoting our profession, 
lobbying for our cause, working hand-in-hand  with the IBLCE Board Chair, ILCA 
president and ILCA exec dir to get the job  done.  I would much rather see a 
charismatic, public leader who can bring  us attractively, positively, 
knowledgeably, and enthusiastically to the  public and make the insurance industry, 
legislators and the public sit up and  take notice than someone who can balance 
the books and manage the office as the  next Exec Director of IBLCE.  The 
analogy I can best draw comes from my  former profession as a diplomat.  The 
Ambassador is the President's  personal representative to the foreign country.  He 
does the public  stuff.  He makes sure that the foreign country understands 
what the  President's view is, what the US thinks and needs from them, and what 
the US can  do for them.  His deputy stays home in the Embassy and tends to the 
 mission--she supervises the administrative needs -- oversees the balancing 
the  budget, making sure the place runs like clockwork so the ambassador can  
accomplish the big picture without having to worry that the place has enough  
toilet paper.  That's what I did and I can tell you it works. (And you can  
send your campaign contributions me at Grand Central Station, PO Box 555, New  
York, NY  10001.  LOL!)  
 
Seriously, right now, both Boards are not composed of business  people.  They 
are full people who know lactation, professors, and  pediatricians.  The 
public member of the IBLCE board has almost always been  a person interested in 
lactation but again, someone with little, if any,  business acumen.  At IBLCE, 
until recently, as I understand it, the  staffing at both the international and 
regional offices is the same.  While  I have no business training myself, I 
can tell you my feeble efforts to open the  organization to the concepts of 
advertising, hiring consultants to handle what  staff could not, and expanding 
contacts with people who could help us (e.g.,  lobbying the insurance industry, 
lawmakers on Capitol Hill) were met with  opposition, if not downright 
disdain.)  I have no doubt that these are the  some of the reasons  the board reaches 
the decisions they do.   Revamping the by-laws to include business people in 
addition to lactation people  will take years, if they were to occur at all.  
Undoubtedly, they will be  met with opposition, as is all change.  Many 
Lactnet members have said they  also want IBCLCs from the trenches included. That 
may be a good idea, too,  but I would also like to remind Lactnetters that they 
larger the board, the more  unwieldily, and the more unwieldy, the more 
expensive to operate (which, in my  past experience with IBLCE it was already, 
eating a very large chunk of the  budget, for, in my opinion, very little payback), 
and the more unlikely to reach  timely decisions. 
 
Currently, the IBLCE meets twice annually.  While I can't speak for  ILCA, 
and have no idea of their practices, I do know that it is critical for  board 
members to work diligently between meetings, by phone, e-mail, and as  
opportunities present for face-to-face interactions.  From my past  experience as a 
former IBLCE employee (and not, as some people mistakenly  believe, NOT as a 
board member), the people on the board are stretched thin  with many other 
professional and extracurricular lactation  responsibilities.  
NeverthelessNevertheless<WBR>, it is critical, and if they  cannot do this, they should not  And it 
is equally  critical for the two boards to communicate frequently and to 
exchange  representatives; a one-sided exchange is unacceptable.  It has to be all 
or  nothing.  The organizations are  not at odds.  Their missions are  not 
identical.  To have a one-way relationship, to me, is vaguely  suspicious and 
requires an explanation, one I never was able to extract during  my time at 
IBLCE. 
 
I want to reiterate that my opinions and statements about operations about  
IBLCE are based on when I worked there from 2002-2005.  I do not have  contacts 
there now, and do not know how things operate there now, beyond  information 
provided on the website. It would be completely inappropriate  to assume 
otherwise.  I post information to Lactnet from the IBLCE website  because I often 
read it out of desperation for information  and curiosity as to when it will be 
updated.  I consider it a  service to all of you, also, because I just have a 
gut feeling it doesn't get  that many hits.    
 
I believe it is high time for IBLCE to end its silence -- so far we have  
lots of excuses, but no website updates, no newsletter, and no responses to the  
many IBCLCs who have written and called is unacceptable, at least in terms of  
good business practice. 
 
While they are currently without an executive director, and there is  no 
indication of who is the acting director on the website, I look forward  to IBLCE 
to take the high road, tell us what is going on, and if they feel  that they 
made a mistake, admit to it, and move on.  All we know for sure  is that at 
least one former board member reads Lactnet. Maybe staff or  a current board 
member does too.  Maybe if we all back off, let them  get it together, and 
somehow, via the website or something, they will publicly  respond, and then we can 
all get on with something else.  Nothing else has  worked, right?  God knows 
IBLCE, ILCA and USLCA have a lot of other issues  to work on, and if they need a 
list, I and probably all of you would be happy to  help.  
 
Barbara Ash

 




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