Dear Lactnetters: I understand that frustration has reached a high point on Lactnet recently with the lack of physician knowledge of lactation management. This is an unofficial post, but I share your frustration and want to offer some thoughts. In fact, that frustration and desire to "make a difference" for other women is what has fueled my energy to represent ILCA in public affairs for the past several years. Let me tell you of some of the progress "at the top" and of some suggestions for more grassroots work that might capture some of the fire of YOUR energy for change, too. (In fact, I know you all are doing a lot already!) Beginnings of change: The AAP since 1990 has faithfully acted at the Breastfeeding Promotion Consortium at USDA to encourage progress in all professions to learn and incorporate good breastfeeding information. Their representative worked with me as cochair of a Health Professional sub committee which began work on suggested consistent lactation management messages for mothers. The physicians who know and care most about breastfeeding formed the Academy of Breastfeeding Medicine to try to fill the gap in physician education. The AAP formed a special committee on breastfeeding which has produced a bold statement that is working its way throught the system for publication. Dr. Gary Freed has published research showing the need for further education. Wellstart International continues to offer opportunities and curricula for physican education. BestStart is developing a kit for health care professionals to go with their FCS sponsored Promotion Campaign. These examples are those that come to mind spontaneously. As you know, breastfeeding is not high tech or high dollar. It is labor intensive and interpersonal. The cost of NOT breastfeeding has been hidden until very recetnly. So really the progress is pretty amazing. In fact, I unashamedly beg your support of ILCA's representation at public fora that encourage these efforts. Please renew or initiate your membership in ILCA. Supporting this kind of representation is part of what your dues go for. Speaking for thousand of lactation consultants carries an impact. (By the way, the ILCA Board has made a remarkable recovery from last year: the conference was very successful, expenses have been slashed, the new management company is a delight to work with, and there is a CPA/IBCLC overseeing all the finances now. You can be confident in your support of ILCA.) Anyway, besides supporting your professional organization, what about some other ideas for all that energy: How about a goal of 10% that is, just 10% of the physicians in our local area of practice to have basic knowledge and skills? AAP has a state coordinator of breastfeeding in each state now. Many of them attended a conferrence last April. Maybe get something going, such as a joint presentation at chapter meeting with and MD/LC team. (NABA has an up to date list of breastfeeding contacts state by state.) Choosing a goal or activity that is "do-able"...that is, going through the doors that are ajar, instead of smashing into the ones that are slammed... easiesr on the cranium! What about calling together a task force with multiple professional representation to decide on the consistent management messages for mothers in your commuinity and then publish and distribute them. What else? If anyone has had some success with building physician referrals (mutual) or offering physician information or if any of the physicians on Lactnet could share some ideas of how to better approach this frustrating situation ... please post. I heard that 75% of new pediatric residents are women now. One of them is my god-daughter who grew up in a "breastfeeding culture" of LLL Leader families. She doesn't even knkow how much she knows. There is hope. While we are waiting ... what can we do? Nancy Schweers ILCA Consultant for Public Affairs