Marie and Barbara have brought up issues that have been discussed at length in many forums, but I want to clarifiy this ONE MORE TIME. Peer counselors, LLL Leaders, and IBCLCs are NOT interchangeable. An IBCLC is certified to do, and to know, things that are beyond the scope of practice and knowledge of a peer counselor and LLL Leader. Consider other models: Certified Childbirth Educators are not Doulas; Doulas are not Midwives; and Midwives are not Obstetricians. All assist birthing women, in different ways. Peer outreach workers are not Licensed Social Workers. Licensed physical education teachers are not necessarily Certified swim coaches, and vice versa. Some childbirth educators also have doula training. Some midwives were, or are, childbirth educators. Some RNs are also doulas, childbirth educators, or midwives. Or lactation consultants, LLL Leaders, and/or peer counselors. Or certified swim coaches. One individual can wear several "hats" without implying that the professions/occupations/scopes of practice are interchangeable. The JOBS are not interchangeable. Institutions developing policies and staffing guidelines must be absolutely clear about the differences in these roles, for legal, ethical, and financial reasons. I'm all for cost-cutting, but I sure wouldn't want a doula to be hired in place of a Certifed Nurse Midwife and tasked with her duties! It takes Peer counselors, IBCLCs, LLL Leaders, IBCLCs, RNs, RDs, MDs, and a lot of others to properly support breastfeeding women. Knowing our professional and personal limits is essential for EVERYONE. The roles are NOT interchangeable. Linda J. Smith, BSE, FACCE, IBCLC Bright Future Lactation Resource Centre Dayton, OH USA http://www.bflrc.com