I so agree that birth is way overmedicalized and most women benefit from
having a skilled birth attendant but not necessarily a doctor. I also agree
that normal breastfeeding can be supported by lay or peer "counselors" or
just other mothers who  have been there, done that.
However....it is unfortunate that (at least in the USA) many births do occur
in hospital environments and pregnancies are managed medically. There are
also alot of less than healthy mothers and babies all around. Until and if
the tide ever turns to "normal" birth and breastfeeding, I think there is a
real need for LCs who are somewhat "medically trained."
I work in a small rural hospital about 1000 births per year. Virtually all
mothers are low income and on public assistance. Breastfeeding rates are
quite low, especially bf continuation, and moms usually return to full time
employment at 6 wks. Yesterday my case load was thus:
1. 35 wk infant feeding fairly well, experienced mom -- going home on day 2,
should do well -- will get early followup visit.
2. 35 wk infant, primip, not eating well at all; going home anyway on day 2.
will need followup - pumping - etc
3. infant with respiratory distress and probable sepsis, in special care
nursery on oxygen, IV, antibiotics
4. infant born at 34 wks gestation, mother with insulin dependent diabetes
and PCOS, skin tags, hirsutism
5. 34 wk infant not gaining, came in for 48 hr followup, ineffective,
lenghty feeds - yes pumping too but mom decided to do more bf.
6. antenatal visit with mom with infertility x 6 yrs; PCOS

Would peer counselors or LLL Leaders be comfortable totally "managing" these
mothers and babies? Without a physician conferring? I am truly curious
because I realize every country and culture is different and healthcare
systems are vastly different. Or do you think an LC with didactic and
clinical experience with sick moms/babies would be useful. We get alot of
moms with pregnancy induced hypertension, pre-eclampsia too. Perhaps this is
why ILCA has added USLCA becue the healthcare system and the health of folks
in the USA is so less than ideal. I admit we are not the model of good
health.

Respectfully,
Laurie Wheeler, RN, MN, IBCLC
rural MISSISSIPPI - s.e. USA

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