Dear all:

The question about experience should not just be about the length of experience, but the breadth of experience.  I mean absolutely no disrespect to hospital IBCLCs when I say this, but I do find that the fact that the vast majority of IBCLCs work in the hospital has really screwed the care and advice given here in Manhattan.  Several of my private practice colleagues have started to work part-time in hospitals and we are all very aware of how hospital policies can distort the care given and the emotional environment for working with babies.  One of my dearest sweetest colleagues, found herself feeling resentful of mothers when she was given short time intervals and too many patients to see.  She recognized this which goes a long well toward developing coping mechanisms.  Nevertheless, if this has been the only working environment that one has experience with, I think it can be incredibly challenging to set up policies and care directed towards assisting women to come closer towards exclusive breastfeeding for six months, let alone continued breastfeeding for two years.  

I think part of the problem is that when you only work in one setting, be it just the hospital or the other end of the spectrum of only exclusively breastfeeding mothers who are holistically inclined, you tend to end up in a self-referential position.  EVERYONE has drop outs.  People who don't like your style, your personality, how you dress, how you talk, the advice you give etc.  We do tend to focus on our successes and those who like our style, personality, dress, mode of speaking advice.  And we should not focus on the negative to the point of discouragement, but I do believe it is important to have experience with the other -- whatever that is.

Since the last time there was data available on how many IBCLCs work in private practice and my recollection was that it was under 10% (I could be wrong on this, but not by far), then I'd say the experience most lacking is out of the hospital experience.  And for a level 2 clinic which I assume will be working with older babies, I really firmly believe that anyone hired for such a position should have "OUT OF THE HOSPITAL" experience. Furthermore, that person should have knowledge of maternal and child nutrition and feeding patterns for older children.  I cannot tell you how frustrating I find it when older babies fail to thrive because someone told them to feed the baby only four times a day.  This is just as much a public health issue as drinking soda and not breastfeeding at all -- because in the long run, I do believe that premature weaning is our biggest problem right now.  Initiation rates are high, exclusivity rates are abysmal and I know women misreport on exclusivity because they simply don't even think about the bottle of formula given on night 2.  It takes a lot of probing to suck that bit of info out of them in conversation.

Furthermore, I do believe that out of the hospital experience is very important for attaching babies.  Often I can tell why an IBCLC recommended something in the hospital for positioning that then simply doesn't work at all in the home.  But I also believe that a least one hospital in Manhattan last held training for their nurses about 30 years ago.  There is one hospital where there are no IBCLCs.  They do run a prenatal class run by an IBCLC who recommends only feeding on one breast every three hours and no sooner -- coerces women into being the guest breast in order to have a consultation without a signed informed consent for being an object of training in front of expectant parents, both male and female.  

I just had a second experience of a colleague visiting a hospital -- actually one of the better ones -- and finding that they had never had training even in Rebecca Glover style attaching, let alone Suzanne Colson's description of self-attaching.  This colleague has a CLC and is in training with me.  She actually had them oohing and ahhing and calling her into every room to show her magical attachment method.  There was nothing magical about it.  It was just about a year's experience with me in a group clinic.  Common sense, pragmatic assessing of body positions of both mom and baby.

And the other side is important as well for the pittance of us who work outside the hospital.  My sweet colleague who just started working part-time in the hospital about a year ago really is an important reminder for those of us who have the luxury of spending time with our clients.  The frustrations we have are minimal compared to working conditions in which you must triage constantly.  

As far as I'm concerned, the number of years of experience is about as relevant as the number of minutes a baby stays on a breast.

Best, Susan Burger

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