The comparison of midwifery to the LC is an interesting one. Midwifery is the world's oldest (or second oldest) profession whereas having someone designated specifially as a breastfeeding helper seems to be a recent phenomenom. The medicalization of the birth process, however, does have parallels with what is happening with breastfeeding. I do think that the emergence of the CNM has been a good thing for birthing and midwifery in general in that it has made the possibility of a midwife-assisted birth much more of a reality for a much larger number of women in this country. Previously, most women were just not comfortable seeking out the services of a lay midwife who operated on the fringes of or totally out of the local obstetrical community. Insurance coverage was also an issue. Now, many practices offer the services of midwives so that the whole idea of having a midwife-assisted birth has become much more acceptable to the average consumer. Once the foot is in the door, other things become possible as well.
In the same way, getting IBCLC's in the hospitals is getting that proverbial foot in the door, although many times a lot of compromises have to be made in the beginning. The fact that the RN is the pre-eminant qualification for LC positions in many hospitals and private practices remains a big stumbling block for many non-RN LC's and even for the hospitals themselves which have immediately lessened the pool of available candidates by this requirement. Most of them will also not hire lay midwives, either, for similar reasons I think. One of the problems that I see is that more and more IBCLCs are seeing the nursing degree as a necessary part of the process of becoming an LC, if they realistically want to become employed. If the process towards becoming a truly recognized stand-alone profession goes along too slowly, it may become a moot point by default. But I know that things can only move ahead so quickly.
I do think that IBCLE is moving in the right direction with the present and future requirements for certification. I don't think that these requirements mean that we are trying to "medicalize" the process of breastfeeding. It does provide a frame of reference for those outside our profession who are trying to assess the body of knowledge that an IBCLC possesses. I think that someone with those credentials should be prepared and able to work comfortably in any setting with any baby, healthy or sick, just as a midwife should be prepared to address any situation that presents itself during the birth process. Birthing and breastfeeding have already been co-opted by the medical establishment - we need to operate within that reality while at the same time trying to change it. From what I see coming out of the medical establishment lately, that unfortunately remains a monumental task for the foreseeable future. We can only do that by pulling together. And I don't think that it is unreasonable to acknowledge the grief that many nurses feel for the steady loss of hands-on time and responsibility for their patients or the resentment that some may feel towards having yet another person besides them interacting with their patients. While I don't believe that these feelings are universal, they do exist and I have had some interesting conversations with nurses (non-OB) about this very subject.
Sorry so long again. I do think that our profession is at a juncture where a lot of these uncomfortable issues need to be dealt with as we move ahead, if we are to move ahead together. Lactnet is such a great forum for this dialogue and I remain eternally grateful the the Lactnet "moms" who started this up in the first place.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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