I think this area of transition means that there is a vital and
important distinction between acting and working as an IBCLC, in a
professional role, legally accountable observing the standards and
expectations laid down by us, and supporting as a lay volunteer
counsellor. (please bear in mind that my background here in the UAE is
that lay supporters have no insurance, a 12 hour basic training course
and assist with telephone support only, and we are part of a mother's
association that has no legal status.) I am aware that LLL and ABA have
rigorous training and insurance so I acknowledge that their standards of
practice and accountability are much higher but there is still a real
and important distinction between the accountability and professionalism
expected of IBCLC's. As for payment of fees I imagine that very few
IBCLC's would ever deny a consultation to a woman in need, unless they
were tied by paperwork that was out of their control. There is a vast
difference between offering a free service to a needy person, from your
clinic and still observing the standards of professionalism and legal
accountability, and offering free "student" LC consultations in your
living room. Mothers cant be expected to gauge whether the help you are
offering them is most appropriate or not and then refer themselves onto
an IBCLC. By offering free "student" consultations we risk undermining
the role of the IBCLC with an unfair advantage. Who would choose to pay
for support and breastfeeding suggestions when they can receive it for
free?

The local LC's here have empty offices while unlicensed and unqualified
people in the community establish themselves as pseudo-qualified
lactation advisers. This just is not right. The IBCLC's here pay a huge
proportion of income to their employers, which covers their insurance,
their clinic, their equipment and reflects their status as a valuable,
accountable  and well qualified member of the health team.  Given that
few mothers seem to believe breastfeeding is possible and that  problems
often have a reason and can be addressed, they may be quite content
receiving help that may or may not be appropriate, but with loads of
contact and emotional support that doesn't cost a cent. And if the
information was later found to be not quite right, I imagine most mums
would feel hesitant about accusing a person who never accepted or
requested payment and who stated up front that they were not fully
qualified.

This is an issue that plagued my group and we now do not do housecalls
or see mums..just phone support with a  very limited scope of practice.
We were getting exploited by mums as a free, home visiting service that
appeared professional and competent just by the virtue that we were from
an association and carried a book. We believe that mums and babies
deserve the best help possible and without delay, and we acknowledge
that IBCLC's are these people. We feel that the risks are too great that
a mum will lose confidence and a baby be harmed if we  intervene for a
long period of time until our knowledge and experience are exhausted.

The transition issue is a very real one for me as I attempt to qualify
with a credential that is not recognised in this country (unless you are
a nurse first).  If I gain the IBCLC qualification I can only work/act
as a lay supporter and just this week I have been confronted with how
difficult this situation is as I hear mums speak of suspicious symptoms
of hypothyroidism, or wanting to hire a pump because a doctor put them
on antibiotics for a sinus infection and told them they absolutely must
not breastfeed, indefinitely.   I must respect the qualification and to
do that I must operate within the standards of practice and code of
ethics that will be expected of me if I qualify. I cannot do that if I
see women for free in my living room, with the phone ringing and my kids
wandering in and out.

The problem the IBCLC profession faces as I see it is that unless
breastfeeding medicine becomes a university degree then we make it
difficult for the candidates of the future to gain the consultancy hours
and experience they need without overstepping their boundaries as lay
supporters or official  breastfeeding association leaders.   We need
safe and supervised avenues to gain experience with real mums and babies
with complex or simple issues without usurping or undermining the role
of qualified IBCLC's. I think this could best be done in a university
setting, not in the home. Please don't flame me and misinterpret what I
am saying about the value of lay support.I am the coordinator of the
only UAE lay BF support group..i believe in lay support with a passion
and have devoted myself to it for many years now as a full time job with
no payment, but I support very carefully and I refer on very quickly. I
believe that breastfeeding, and the potential risks of harm, are too
important for me to risk assisting in situations that I am not qualified
or licensed to be in, and the fact that I don't charge does not reduce
these risks, if anything it increases them because I am making it MORE
attractive for a mum to stick with my help and information instead of
seeking qualified help.

I apologise for the length and that my posts are never as poetically
written, or as well thought out as so many on LActnet. I am in panic
mode at the moment.

Meg Kingsley , lay supporter

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