Ahh, Norma.   These pontifications are better had over a cup of great
coffee/tea, or a good glass of wine (with dark chocolate, regardless of
libation).  Are IBCLCs medical professionals ... or family/parenting
consultants?   Why do so many mothers who want to breastfeed face the "booby
traps" so famously described by one well-regarded
blog-and-mothering-advocacy organization?

I trust, first of all, that you have brought your thoughtful, constructive
criticisms (about photo placements and messaging) to the attention of the
member organization involved.  We Lactnetters tend to "preach to our own
choir," but if we hope to effect change beyond Lactnet, it is only fair to
clue in the folks whose activities we are calling into question.

I am a private practitioner, too.  I would not be able to sit the IBLCE exam
today.  Well -- more accurately -- I would see that to do so would require
about two years of college-level education in medical/biology coursework.  I
would not have had a *clue* as to where I could get clinical training in
lactation care .... unless I went and worked at a hospital.  If I had faced
those hurdles in 1997 when I first took the exam, I would not have bothered
to pursue this profession.  I came to IBCLCing via the mother-to-mother
counselor route (Go NMAC!).

The entity that has been doing all the tweaking and changing in our
profession in the past several years (requirements to take the test,
requirements to maintain certification, re-writing ethics and
practice-guiding documents) is the certifying organization.  If initiation
into and maintenance of certification trends toward embracing the medical
model ... I guess my pontification across the coffee cup is, "How did we get
here?  And is it a good idea?"

I remember being absolutely dumb-founded when I heard a speech by the
then-Pres of the member organization, describing the 2000 IBCLC exam.
 Something like 95% of the test-takers around the world that year came from
a medical background.  5% had come from a mother-support background.  My
memory of the numbers may not be precise -- but the huge majority of
IBLCE-exam-takers was NOT coming from a counselor background anymore.  I
know in 1985 (the first year) 55% of the exam takers were from a counselor
background ... primarily from La Leche League (and probably NMAA [now ABA]).
 I don't know when counselor-trained numbers fell below 50% ... but my guess
is it was not too long after the initial certification exam.

Like it or not, IBCLCs are considered members of an "allied healthcare
profession."  We have huge challenges.  Most private practitioners cannot
make **a living** doing just their private practice work.  Those who choose
to work in a hospital often find themselves up against hiring rules that
require IBCLCs to ALSO be RNs or other medical professionals.  That is wrong
on its face ... but if that is the rule at the place that is hiring this
week, that is the rule.  Those IBCLCs who work in public health (think WIC
or similar clinics; those at policy-making levels) similarly find that
job-security is very shaky, since public funds for healthcare are under
fire.  Licensure -- as a certain means, I am convinced, of securing better
reimbursement for services -- is clearly built on a medical model.

Here's how I handle it.  When I am in an advocacy role, I Talk the Necessary
Talk.  Want a business to open a lactation room? Describe how their bottom
line is favorably impacted.  Want a hospital to hire a non-RN IBCLC?  Show
how IBCLC certification standards meet and exceed the assurances
traditionally looked-for in licensure.  Want to keep IBCLCs on staff in a
public health role?  Pull out the research that shows IBCLCs improve BF
initiation, exclusivity and duration rates, and how life-long health impact
accrues to both mother and baby ... with increased BF initiation,
exclusivity and duration.

But when I am with a mom, it is all about what one researcher calls
"mother-centered care."  I suggest skin-to-skin and laid-back positioning in
the hospital all the time.  There is not a peep about "... the research
shows ...."  Instead, I am asking her to tell me about her birth.  I keep my
hands off mom and baby as much as I can.  I point out the baby's cues and
signals.  I praise mom every step of the way.  I discuss how the baby loves
to be "velcro'd" to mom's chest, happily BF'g, even for an hour.  I show
this mom, who is holding her own baby, all the wonder (as you so elegantly
put it) of "one of the most intimate human relationships, nurturing a baby."


Because I absolutely agree: "THAT is the message I wish to convey."
-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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