(Fellow Lactnetters, this is a long post and has not been proof read.
Please excuse in a advance any typos or grammatical errors. ~kgc)
 
Heather, thank you for taking the time to engage in this dialog.  I knew
from the start when I posted about my idea that it would not go over well!
I admit that what I'm proposing is radical and is not suitable in every
culture or society.  But, I do believe it is viable and suitable in mine.  I
have responded more below:

HEATHER:  "You are right about LLL, but *not* about peer support,
Karyn-grace. 
As I described in my post, peer support  (at its best)  meets the 
challenge of reaching the people who are hard to reach - at its best, 
peer support programmes reach out to train women who can then  reach 
out in their turn to mothers in their own neighbourhoods.

Peer support programmes work best when they are flexible enough to 
cover one-to-one  support ('buddying up') as well as group support 
(*not* in someone's  home, but in a community venue) and when  they 
work with the existing health/social care services."
 
KARYN-GRACE:  And here is a great example of the weakness of using an
international forum in which to discuss a national issue.  I am sorry if
this has caused confusion or angst among Lactnetters.  Please understand
that I live in Canada and at this point what I am recommending is
specificially for Canada and for my Province of British Columbia.  I am not
suggesting something global (well...at least not at this time!).
 
I have already stated that I agree with and whole-heartedly support peer
support.  In my community, and I expect all across my nation, the ONLY peer
support services that are available for breastfeeding mothers is La Leche
League.  I am aware that there have been some efforts to get the 'buddy-up'
system of one-on-one breastfeeding support available in some communities,
but I am not aware of any particular successes.  Also, in many of our
communities across the country, public health does host some breastfeeding
support groups, but, if they are anything like what I myself attended when
my now-12 year old was a baby - those groups come no where near to what LLL
groups offer.
 
I mean no disrespect to anyone here when I say that I find it laughable to
have a discussion about how we need more peer support and how that is the
key to increasing breastfeeding rates to six months.  It is not possible!
Last time I checked, peer support services were run by VOLUNTEERS, and their
numbers are dwindling!  It is another discussion to determine why this is
happening, but for now we must recognize that to best serve ALL women who
give birth to a live baby, we must look else where.  I am not saying close
the doors to LLL meetings...quite the contrary!  
 
I am saying, let's give EACH women lactation care from BEFORE she has her
baby until she weans her child.
 
I am saying, let's encourage these women to attend LLL meetings, which would
mean less lactation management for her.
 
I am saying that if more women breastfeed, more will attend peer support
groups, more will become peer support leaders, and the breastfeeding rates
will increase.
 
I am saying that peer support is not enough at this time, to increase the
exclusively breastfeeding rates to six months.  If it was enough, we would
not have the dismal stats that we have.  In my province, the one with the
highest breastfeeding rates in our nation, only 3 in every 10 babies is
breastfed exclusively to 6 months.  I'm sorry folks.  I do not think that is
something to rest our laurels on.  Those other 7 in every 10 babies deserve
our attention, and if it needs to radical attention, than so be it.


HEATHER:  I couldn't disagree more :) Breastfeeding is massively influenced
by 
role models - there is an impressive literature showing exactly that 
- it *matters* when a mother's own mother, friends, sisters and 
others breastfeed, and this has an enormous influence on whether she 
chooses to do it, and how long she does it. The healthcare 
professionals she comes into contact with can facilitate this 
influence, or undermine it, but they will not change it.

Please don't let's ever capitulate to the medical model for bf 
support - some lactation situations benefit from medical model 
interventions, of course, but most do not.

KARYN-GRACE:  I think what has happened in our culture (and I'm specifically
talking about North American culture, but it may be similar in the UK and
elsewhere is Europe) is that we DO have role models and live our lives
according to them.  However, we have moved away from being a culture that
values that little things, and honours the everyday heros, and that looks to
our mothers, our neighbours, our sisters, to show us how to live.
 
Instead, we use role models who we feel are worthy of our adoration.  I
believe we live in culture of IDOLATRY, not of true, every day role models.
Those we idolize become our role models.  We can idolize our mothers, our
sisters, our doctors, Britney Spears, Madonna, Dr. Jack Newman, or the seven
founders of La Leche League.  But idolize them we do, and mimic them we
will.
 
I'm not saying that peer support as an intimate source of role modelling is
valid and doesn't happen every day.  It does!  But, it is not enough.  If it
were, everyone baby would be breastfed exclusively to 6 months at this
point.
 
We must also realize that role modeling works both ways...and for every
woman that models exclusively breastfeeding, there is another two or three
who are modelling bottle feeding or supplementing, or what not.
 
I am sorry.  I simply do not believe that peer support for breastfeeding
success for ALL babies is enough.


HEAHTER:  This is not the case everywhere, though. Very few people in the UK

have even heard of lactation consultants, or LLL(they might have 
heard of NCT). But in any case, it doesn't  matter. Why would you 
worry about the healthcare community treating LLLLs on an equal 
footing? Diane's point, and mine, is that volunteers *do a different 
job* from the healthcare professional.
 
KARYN-GRACE:  Two reasons why I think the medical community's regard of LLL
is important:
 
1.  The ability to share information about lactating women and to have
opinions respected, whether they come from 'just' a LLLL or whether they
come from an "B Sc, MD, IBCLC, RN, PHN, etc, etc."
 
2.  Doctors, nurses, dentists, non-LLL IBCLC, etc. will NOT recommend a
service that they do not respect.  The fact remains that most health care
professionals will only recommend LLL to a mother who ALREADY shows a
propensity to exclusively breastfeeding, or to one who asks for more
support, or to one who is breastfeeding past 6 months, or to one who
presents with an issue that they do not care do deal with, such as
co-sleeping or babywearing, or when they themselves are not available.
 
This I know for a FACT.  I live on a small island.  There are 5000 people
who live here, and about 18 babies born every year.  We have public health
nurses come over once every month to do a health fair - well baby checks and
vaccinations, etc.  These nurses know me because the agency I work for
sponsors the health fair and because I attend those fair also, they know
that I am LLL, they know that I am an IBCLC, they know that I am available
for home visits post birth, and that I will educate, support, and do
whatever I can for each and every baby born here.  When do I get calls from
the mothers here?  Only when the PHN's cannot come over themselves or when
they get a call for help and it's the weekend.  So, I am ONLY the fall-back.
Though I know far more about long-term breastfeeding then 90% of those PHN,
they believe that they can and should handle the care of all lactating
women.  But, it's not enough.  Too many women from my little island do not
breastfeed more than a few weeks.

HEATHER:  It will  never happen that every mother will have her own IBCLC,
and 
more importantly, nor should it.
 
KARYN-GRACE:  Perhaps not.  But, I think the issue begs to be explored.

HEATHER:  Most women do not need specialist medical-model lactation support.

 
KARYN-GRACE:  Agreed.  There is a huge difference between basic
breastfeeding issues, and issues that deserve special attention.  Any IBCLC
who is works in basic lactation management would simply refer to a
specialist for area out of her area of expertise.  No different than now.

HEATHER:  Most women do need friendly encouragement and a normalisation of 
breastfeeding. 
 
KARYN-GRACE:  Agreed.
 
HEATHER:  That is probably best achieved by volunteers or 
para-healthcare professionals working in a non-medical model way.
 
KARYN-GRACE:  Disagree for the reasons stated above.  
 
Blessings!
 
Karyn-grace Clarke, IBCLC, LLLL
Gabriola Island, BC, Canada

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