Dear all:

In some ways I could look back and say what I underwent is unfair  I had doctoral level training in maternal and child nutrition, with some of the best researchers on breastfeeding.  I had all the courses that are now required.  I SUPERVISED large scale public health programs in developing countries that had a heavy emphasis on breastfeeding.  When I tried to certify, I went around and around in circles with the IBLCE because they would not count any of my hours from my former work because I WAS the supervisor -- I had no supervisor.  My immediate superior was the then President of Helen Keller International and was completely clueless about any of the technical programs and would routinely raid the budget from one program to fix holes in another program.  He was the one who wrote me a letter when I asked where I could pump milk, stating that I was not allowed to breastfeed my baby at work (which I had not asked for).  The IBLCE accepted 0 hours of the public health nutrition work I had done working with officials in developing countries on materials development, training, evaluating activities directly related to breastfeeding.  

Despite having this background I had to have 2,500 practice hours at that time to certify.  My supervisors were under the impression that I was eligible for 2 hours for every 1 they had supervised because of some prior rule that had subsequently changed.  I was a mere 300 hours shy of certifying a year earlier.  At the same time I sat for the exam, I took the exam with someone else who had started later than I did and even had she worked FULL TIME she could not have received enough hours to have sat for the exam unless someone fudged her hours.  There were others who did work in hospitals and it was clear that they had not received direct supervision, any hours they spent on the postpartum ward were counted whether or not they were helping with breastfeeding. 

While I could spend a lot of time feeling resentful, I do not.  I know I have become a better lactation consultant because of those extra hours than the lactation consultant who bent the rules.  And it made me more cognizant of the rules.  Sometimes rules are arbitrary and unfair and need changing and modifications.  At the present time the lack of affordable training opportunities is one of the major roadblocks for those who are not in a hospital setting.  Since most of breastfeeding occurs outside of the hospitals, it seems to me that we should all be focusing on how to take the next steps to improve access to those who will be out in the community working with mother long after those few days in the hospital.  In the United States, the ratio of time spent in the hospital versus the recommended duration of breastfeeding of 2 years is 0.4%.  In fact, the amount of time women are exposed to potential education about breastfeeding is far greater than that.  How can we expect to make changes in breastfeeding rates if most of those who are trained to help mothers only have access to 0.4% of the time women should breastfeed?

So,  rather than focus on the details of the Catch 22 situations, I think looking at the bigger picture of how would we create a training program that develops a profession with greater potential to help women is more important. Who would we ideally recruit to reach women for the long haul.  I see nothing wrong with the courses that are in the new requirements, but what else SHOULD be included and how would we create an environment where the education is accessible and affordable?

Best, 

Susan E. Burger, MHS, PhD, IBCLC

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