Dear Friends:
    This SOP topic is too vital to avoid comment and  thoughts.
    Another body of knowledge and practice similar to  lactation work is that
of childbirth education. There is no standard way to  become a certified
childbirth educator. One can be a medical professional and go  to a weekend
course, and pass an exam. Or one can spend a year or more doing in  depth study, and
then pass an exam. The exams are not standardized, and the  initials aren't
the same. One can be LCCE, or CCE, or CBE; there are probably  other
collections of letters as well. Or one can be a person with desire and  just do it in
the community, sans letters. Each organization has its own take on  professional
practice and there is little or no regulation of individual  practitioners as
a whole, although individual organizations may have their own  way of
regulation.
    Lactation consulting is similar. There is no  standard exam to earn
certification. While IBLCE is held to be the optimum  standard, it is not essential
for practice to have earned those letters. One can  study and pass a test and
earn a variety of letters: IBCLC, LLL, CBE, CLC,  NMC....or be a licensed
healthcare professional and not get any lactation  letters at all.  (Kittie
Frantz, Chloe Fisher and Lennard Righard are  but three of the giant and luminous
names that illustrate  this.)
    Both IBCLE and childbirth education offer  certifying examinations.
Certifications are voluntary, and not  required.....except in the US, where one has
to have initials for reimbursement  from insurance companies. I don't know
about other countries.
    Lactation work is unusual in that so many  practitioners are already
licensed as healthcare professionals in some other  discipline. As the licensed
practitioners seem to be running the show, the push  seems to be to require more
medical/collegiate preparation to sit the  IBLCE-exam. But what about the
grassroots practitioners, the hairdressers and  mothers that love working with
other mothers and do a lovely job?
    As in all human endeavors, there is no way to  ensure the highest level
of practice, regardless of educational/experiential  preparation. We all know
professionals, even licensed ones, whose practice makes  us ill.
    To me it seems that lactation consultants are  trying to act licensed
while being certified. Perhaps that is another source of  difficulty, when an
organization tries to set a standard of practice?
    Another challenge is that lactation practice is new  and late on the
scene. Physical therapists and social workers had to go through  many obstacles on
the way to licensure in a health services delivery system  that was easier to
manage at that time. There was no HIPAA nor malpractice  concerns in the way
that we have now. We, in the US at least, have more hoops to  jump through.
    What a mess.
    Certainly, as breastfeeding helpers are dealing  with mothers, babies,
and the milk, they have to have education and experience  to adequate. Perhaps
this is something that can't be covered under one scope of  practice, because
there are different countries and rules and points of view  about what a
breastfeeding helper does/can do.
    Perhaps a national approach is best, with several  international
organizations meeting to share thoughts and perspectives and  issues, much as
midwifery does? The struggle to have one organization represent  a global perspective
may be too much. Perhaps the lactation  world could model itself on the WHO,
where 181+ member nations sit and  discuss universal needs and practices?
    I apologize for this long post, and wanted to  add my 0.6 cc.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Lactation Consultant,  Philadephia Department of Public Health
Maternal-Child Adjunct Faculty, Union  Institute and University
Film Reviews Editor, Journal of Human  Lactation
www.breastfeedingalwaysbest.com

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html