Dear Lactnetters,
    Many of the issues raised on Lactnet in the last few days about the IBCLC profession are included in my article published in the International Journal of Self Help & Self Care last year (1).  [References below]  These issues include the background to the new profession, the backgrounds from which IBCLCs have come (both in the early years and the late-1990s), work settings of existing IBCLCs, reimbursement difficulties for lactation services (especially for IBCLCs from backgrounds other than nursing or medicine), and where the roles of the certified IBCLC and the breastfeeding counsellor overlap and where they differ.  In writing the paper, I consulted leaders in both the LC profession and in LLLI and ABA.
    Basically, in my article I agreed with the assertion in Riordan & Auerbach (2) that the main difference is that the IBCLC is the short-term clinical trouble-shooter, whereas the breastfeeding counsellor (or others who work primarily as mother-support people) provides long-term, ongoing support.  In other words, that the IBCLC can provide the clinical skills in difficult or unusual situations (which some of the more experienced LLL or ABA counsellor also do well).  This can help, as a previous Lactnet post said, to correct the breastfeeding problems set up by medicalised interventions in childbirth, and which often need clinical expertise to resolve.  Once the situation is normalised, the mother can gain a great deal from the support of a breastfeeding counsellor (BFC) and mother-support group, in learning what is normal, how to prevent problems, and how to deal with new problems that occur.
   The mother with a normal course of breastfeeding may need a BFC for support (in a bottle-feeding world), but does not really need an IBCLC.  If she chooses (as some mothers recently are doing) to have her "own" IBCLC after hospital discharge, that is not so different from the well baby having his/her "own" paediatrician.  (In Australia 30-40 years ago, most healthy babies didn't have a paediatrician, a specialty that cared primarily for sick or preterm babies.)  My impression is that mothers with a normal situation who want their "own" IBCLC are only a tiny minority, most using other services or the excellent ABA breastfeeding helpline for reassurance.
    In the 2000 article, I also address areas of tension and misunderstanding between the people who assist the breastfeeding mother, and how the roles differ - and complement - each other.  A mother and baby who have an IBCLC to sort out a bad start and a BFC to provide support on an ongoing basis, are getting the care they need at particular times.  Many of my referrals over the years have come from BFCs, who know the particular mother needs a little bit more than they can offer.  I am happy to encourage my Mums to attend a local ABA group, for the support they can give so well.  My article may be of use to anyone coming up for a job interview, who needs some ideas for those tricky questions.
     Most importantly, we have to remember who "owns" breastfeeding. As I wrote in an earlier article (1990), "No one owns breastfeeding, except, properly, the mother/baby dyad." (3)  I concluded my recent (2000) article by stressing the importance of volunteers and IBCLCs working in a complementary way, because "the beneficiaries of such an approach are the mothers and their babies we all serve."  That's what it all comes down - providing several levels of service, so that the mother can use whatever she needs at a particular stage.
    If most hospitals were Baby-Friendly, the need for an IBCLC as a trouble-shooter would be diminished, but IBCLCs could still find a role as educators, to provide the induction new staff require under BFHI, and continuing education for existing staff.  Even so, there will always be babies with specific problems preventing them from breastfeeding initially, and some mothers who need special assessment and input.
     The recent dialogue on Lactnet is, in my personal opinion, useful as it brings out a lot of thoughts and feelings, giving people a chance to see the experiences of others, and how they think and feel on these issues - and on reimbursement.  Bringing a diversity of opinions out into the open can be fruitful, and can deepen understanding of, and respect for, the situations of others.  It is good to see people being respectful of each other in this discussion.
        Virginia
         in Brisbane
References:
1. Thorley V. Complementary and competing roles of volunteers and professionals in the breastfeeding field. International Journal of Self Help & Self Care 1999/2000;1(2): 171-179. [The journal is pub. by Baywood]
2. Riordan J, Auerbach KG. Breastfeeding and human lactation. Boston: Jones & Bartlett, 2nd edn, 1998, p. 725.
3. Phillips V. [Thorley V]. Lactation consultants and voluntary breastfeeding counsellors: complimentary roles or conflict? Breastfeeding Review 1990;2(2):92-94.

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