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
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