I don't want to be part of the silent 3000 either.  I did write much of this to
ILCA earlier.  I have been a nurse for almost 30 years, a public health nurse
for 20 and IBCLC for 7.  I have been a breastfeeding supporter all that time
and if you had asked me, I would have said I was helpful.  Now I am appalled at
all the bad information I gave before starting to study for my IBCLC.
I plan to leave my public health job in January and start a practice in
association with a new IBCLC, she is not a nurse, but a long time LLL leader. 
I send information now back and forth to health care providers, some relatively
informed about breastfeeding, but none of them with my level of expertise. 
Do I contradict doctors and the nurses in the birth centers, certainly.  It is
my job to give the most accurate information possible to my clients. 
I actually think that it is not the doctor's job to be an expert in lactation. 
I certainly don't have their level of knowledge on other subjects.  I am not a
doctor, a pharmacist, a PT, or other practitioner and need to know when to
refer.  I often tell clients that lactation is normal mammalian behavior and
that I want my own doctor to be most knowledgeable about illness.  I can barely
keep up with Lactnet, JHL and LLL material. I actually need my doctor to focus
on diabetes and bone loss and etc and she only has so many hours in her day.  
I am also a certified carseat technician, another narrow band of information
and
no one expects their medical provider to check their seat and show them how to
install it in their vehicle.  If a medical provider tells a client that it is
okay to put their infant forward facing at under a year, I have no qualms about
telling the client that this is incorrect. 
I feel exactly the same way about giving clients correct information about
lactation.  
Currently I send doctor's orders to be signed, I generate the order and the
doctor has the choice to sign or not.  I don't always send them, partly they
are sent because we need documentation for payment, but they are primarily a
method of communication for me.  
I am also quite unhappy that we have a new scope of practice that I have not
received any copy of, nor does it look like I would get one till 2009 when I
need to retest.  If not for Lactnet, I would not have any clue that I could be
stripped of my certification for telling a person accurate evidence based
information.
My IBCLC is pretty much an expensive hobby for me, born out of my passion for
healthy infants.  So it would be a savings for my family if I didn't recertify,
didn't belong to ILCA, didn't go to workshops, didn't buy expensive videos and
books and so on.  

Pat Thomas PHN IBCLC 
Winona, MN

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