OH, Lisa. I am on SO your page! I am over 60 with a real threat looming in my future that I will no longer be able to practice. I have self-educated on these topics but would SO love to see the profession develop in the way you describe. I have had so many mothers have to wait MONTHS before getting treatment or seen or even listened to about their issues that affect breastfeeding. I looked at the proposed curriculum for lactation consultants and I see room for things like applied occupational therapy, speech therapy, physical therapy, nutrition therapy, massage therapy etc. But reality here, unless lactation consultants are PAID adequately for their skills, there is no way we can afford to pay for the advanced education, IMHO. I work for the hospital. I get paid the same as the RN on the floor. My hospital will reimburse me for re-certification, but not for continuing ed. These are tough times and I don't see it getting better.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Lisa Marasco IBCLC
Sent: Sunday, March 28, 2010 9:49 PM
Subject: Re: prescribing
I've given a lot of consideration to what prescribing means. In the most
legal sense of the term, it refers to writing a script for a substance that
can only be legally acquired with this script. In a much looser sense, the
term is commonly used to refer to the recommendation of anything for any
kind of a condition. If I were to tell a stressed-out friend that she needs
a girl's day out, it could be said that I "prescribed" play time for my
friend even though we are not in a professional relationship status. Thus,
you will find multiple definitions of prescribing which are inclusive of
both the legal meaning and common vernacular use.
In the lactation profession, this is, of course, a sticky wicket, and I
think that our dialogue is extremely important. I recently had a *physician*
ask me what medication I would prescribe in a particular situation. I was a
little taken aback (is this a trick question?) and told her that I'm not a
doctor so I can't prescribe... and she said "of course, but what would you
recommend...." So I told her my thoughts on what might be appropriate
according to my knowledge and experience.
What this little conversation was all about was her feeling like she didn't
know as much as I did about this situation and so asking me for my
professional input. I sure love relationships that involve mutual respect of
our individual experience and knowledge base!
I read a really interesting tongue-tie article today (Wallace 2006). The
final sentence said, "Ideally, in the future, lactation consultants will be
suitably trained and qualified to perform the simple procedure (frenotomy),
*thus reducing delay and hopefully increasing the numbers of infants
successfully breastfeeding with all the advantages this brings."* And do you
know that in Lisa Amir's hospital in Australia, they actually do train and
certify their LCs to clip tongue-ties?
We are a young profession struggling to figure out how we can be most
effective. One thing I'm learning is that the health care providers I
interact with on a daily basis simply don't always have the time and/or
interest to keep up on the things that are so important to the care of our
breastfeeding mothers. This is our area of expertise. It is my hope that we
develop our profession with an eye to the future. How feasible is it to
adequately train all those around us, in every locale, who we hope will help
our mother or baby? Or might it be better if we instead turn our attention
to acquiring these skills ourselves instead of waiting and hoping? On the
plate are things like CST, herbs, homeopathy, suck assessment/training, even
tongue-tie clipping (though in the US, pretty difficult!). I hope that we
fight for a professional model that, in the end, serves to "reduce delay and
hopefully increase the numbers of infants successfully breastfeeding..." as
so eloquently stated above. I hope that we aim high, and not low, and that
we set up training and competencies for these skills and knowledge.
~Lisa
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