At the risk of undermining my own IBCLC credential I'm going to disagree, respectfully, with Judith Gutowski on the need for an IBCLC to see every baby. I would like IBCLCs in policy-making positions for writing hospital procedures affecting breastfeeding, though, just as I'd like all employees in the maternity services to comply with Baby-Friendly Initiative standards AND have the possibility of referral to an expert when they run up against a BF problem that requires more than basic knowledge. A few well-placed IBCLCs in ministries of health and the bodies who oversee care wouldn't be bad either. And I guess in places where normal birth never happens, you could argue that every baby starts life in need of the specialist expertise of an IBCLC. While I am flattered as an IBCLC by what Judith writes about our perspective and the way we take birth events, maternal history, and the other things she mentions into account when looking at breastfeeding, I am not convinced we are the alpha and omega of breastfeeding. Also, as a midwife, I like to think I have all the same perspectives in mind, because I think I did consider all those things before I was an IBCLC too. Granted, many midwives are only cursorily interested in anything happening after third stage of labor, but not all of us are that limited. Where I live, most babies see a pediatrician for less than five minutes in the second 24 hours of life, and unless there is something glaringly wrong with them, they don't see a pediatrician again unless they are admitted to hospital later in childhood for some new, serious, health disturbance. Pediatricians are not part of the primary care team for normal healthy babies, period. They do the newborn physical exam and that's the end of it. In such an environment, that is, one in which infancy is considered a chronological stage rather than a primary diagnosis, I find it hard to argue that an IBCLC should be involved in the care of every baby. I've come to appreciate the difference between being classified as a baby rather than a pediatric patient. I prefer to view breastfeeding through the lens of nurturing/attachment theory, or perhaps love of eating, and reserve the health care provider approach for the cases in which it really is a medical issue. Most people manage to feed themselves without a health care specialty supporting them - so, too, with breastfeeding. I delude myself that it is easier to present BF as something doable by pretty much any mother with her baby if we can remember that all of us alive today are the descendants of countless generations who figured out how to keep their offspring fed and healthy, and then a handful of generations who figured out how to cack it up almost beyond recognition before organizations like LLLI and all the other mother-to-mother support groups appeared and turned the tides so that the basic survival skill of breastfeeding was not lost to us forever. I know that babies were lost in times past because of BF problems no one understood. But we who are here now come from the ones who survived, either by our foremothers figuring out how to feed their babies or finding someone else who could. If we paint a picture of breastfeeding as something complicated, requiring high-level specialist expertise in nearly all cases , I'm not sure we are doing breastfeeding or ourselves a favor. I understand from Judith's post that she works in a heavily medicalized setting, which of course colors her view, just as my work setting colors mine. (Oy VEY how it colors mine, don't even get me started!) I sympathize and empathize with, and respect her. But I would settle for just knowing that all staff will refer to the next level of specialized care without delay when they find mothers and babies struggling and they are unable to help them with their own knowledge. That way, everyone has a share in the success of breastfeeding in the institution, rather than it becoming the sole property of the IBCLC, because the back side of that shining medal is that everyone else can just wash their hands of it. That's how it used to be where I work, and writing as the person who 'owned' everything having to do with BF within a ten km radius of my hospital, I can say it's much more comfortable, and feels much more right, to have joint custody with everyone else on staff and with all the kind, generous women who work as peer supporters, paid or otherwise, to help other new mothers get started in this richly rewarding process. Sorry for monopolizing the soapbox for so long. Who's up next? Rachel Myr Kristiansand, Norway *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome