Well, now.  Let's not throw the entire capitalist- and market-driven economy out with the bathwater.  And let's not compare apples and oranges.

How lovely it would be, here in the USA, if the *government* funded universal health care, so that families could get the lactation (and other) care they need, while the IBCLCs doing the work got a decent wage for their work.  Then we Americans wouldn't be worrying about getting paid a decent fee to provide our services as allied health care professionals, who are able to bring a high level of professional expertise to bear.  Then we wouldn't have to worry about "reimbursement" as a measure of our worth as health care providers.  Then we wouldn't have to turn to retail or commercial avenues to augment our meager fees (assuming, of course, that we select ethically-correct ventures).

This is entirely different from the issue of whether we, as IBCLCs professionals, can "give it away for free."  The answer is -- of course we can.  It's called pro bono service.  We can always elect to serve a mother at low- or no-cost.  Please remember that your ethical responsiblities (getting consent; informing other HCPs as appropriate; follow-up care) are still required, even if you don't get a red cent for your time.

And this is entirely different from the issue of offering *support* to a breastfeeding mother -- who may simply be traveling the pot-holes of new motherhood -- and offering expert consultative advice to a mother who needs someone who truly understands human lactation (think breast surgery, frenulum issues, PCOS or infertility history, premie baby, to name a few).  I'd say any IBCLC worth her salt can offer any mother BF *support.*  But is the reverse true?  Do mother-to-mother counselors have the clinical training (and professional liaiblity insurance!) to offer care plans for those complex situations?

And this is also entirely different from the issue of the world at large -- mothers, family members, doctors, nurses, midwives, public health officials, childbirth educators, etc -- being largely ignorant of the differences between an IBCLC, a La Leche League Leader, a certificate-holder from a three-day lactation course, and the neighbor who nursed her kids.  That is our challenge for the next 25 years of our 25-year-old profession:  marketing our *credential* so that it is understood, valued, and utilized -- no matter what form of compensation and health care coverage our countries of domicile provide.


Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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