First, I want to preface this note with the fact that I do have a great
deal of respect for nurses who are also IBCLCS and vice versa and those who
work a hospital setting. I think they play an important role in supporting
breastfeeding during a particular window of the breastfeeding
relationship. I do also think it is a good idea to send reports to
pediatricians in an effort to educate them and certainly when there is any
significant problem with an infant.
Nevertheless, as an international public health nutritionist who spent 20
years on breastfeeding issues in other countries prior to becoming an
IBCLC, I have to say that the predominant perspective that I ahave been
reading here on LACTNET lately is but one very narrow slice of the picture.
I am quite disheartened by, what I feel is a heavily United States
clinically-biased approach to looking at how we can develop the IBCLC as a
profession. I do understand that there are a few token representatives
from other countries on the committees that make decisions, but it still
seems to me that the bulk of the representation is US hospital-based. Quite
frankly, in my experience as an international public health nutrition
specialist, I hardly consider the United States model for breastfeeding
promotion a success. I think we actually should look to our colleagues
from other countries, including developing countries, that have far greater
success rates that we have here. I am still shocked by the hospital
practices in this country that are a good 20 years behind some of the
practices I have seen elsewhere.
Many of the discussions about how to approach the ethics are from a nursing
perspective whereby one must always defer to the pediatrician. I suggest
taking a look at several other allied health professions. The reason why I
suggest this is because we have something incredibly valuable to offer that
is very different from TREATMENT provided by a pediatrician.
For instance, I really hope that those who are on the committees that think
about these ethical issues, take a good hard look at how psychologists
manage their practices. At first, I was thinking that I could get my point
across that a psychologist would not report every single psychoanalytic or
therapeutic session to a psychiatrist, even though he or she might need to
refer to the psychiatrist for medication. This would, of course be an
absurd requirement. My husband, a psychologist actually pointed out this
analogy is incorrect. The more appropriate analogy would be requiring a
psychologist to report every single psychoanalytic or psychotherapeutic
session to the client's internist. First of all, this would be even more
absurd and second of all my husband says you would NEVER do this without
the client's permission. And you certainly would not coerce them into
giving permission either. Similarly, I doubt that nutritionists would send
a detailed report of every last thing they do in a session to the client's
internist either.
Can we not consider the possibility that we could actually elevate the role
of IBCLC to something that is considered a profession in it of itself? One
in which we are competent enough to have the discretion when a pediatrician
really should be informed and when it is not necessary or even worse
trivial from a pediatrician's perspective? (e.g. when I see a client who
is weaning a 2 year old?)
Sincerely,
Susan E. Burger, PhD, MHS, IBCLC
Its late and my husband is pointing out that I have several unrelated
topics in this, but the computer is in our bedroom and he has to get to
sleep so it will have to stand as is.
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