My comment here is long.  I've edited this from an earlier response to a post on Facebook's Lactnet page, with requests there to post my comment separately so as to be more widely read.  Due to its length, I've divided this up into three posts.  I have been an IBCLC since 1998.  

Part I:  

I strongly believe that until the day that IBCLCs are chronically overworked and understaffed in both rural and urban settings, and until we uniformly urge IBLCE to create a lesser credential to help with an increasingly heavy work load, that IBLCE should NEVER offer a lesser "stepping stone" credential.

I also know that IBCLCs in the U.S. will not intentionally become chronically overworked and short-staffed during my lifetime because the lactation consultant is in a narrow specialty, in contrast to the pediatric nurse practitioner, for example, who will work with patients from birth to age 18 with a tremendous range of health care needs.

I want to share my path toward becoming an IBCLC in 1998 and maintaining my credential since that time. I sought that certification from IBLCE, since it was long touted by IBLCE to be The Gold Standard in professional lactation support. My perspective is that of a registered nurse who eventually became an IBCLC in a small West Virginia town after starting the lactation part of my career with WIC as a peer counselor, then spent the bulk of my IBCLC career in Washington, D.C. and the greater metro area.

In 2013, I relocated to Florida to help both elderly parents during my father's terminal illness. WIC is an active presence here, as is La Leche League, although Florida Medicaid does not yet consider IBCLC services as worthy of reimbursement. Here in Marion county, Florida, 75% of all births are currently covered by Medicaid, and Florida was one of a number of states that shamefully turned down federal monies for Medicaid expansion a few years ago. While the majority of Marion county is comprised of many tens of thousands of retirees, this county is also heavily agricultural, growing and shipping much food out of the state. There's a very high rate of NAS here and elsewhere in the state - - so many babies going through opioid withdrawal.

I first heard of the IBCLC credential when meeting Sarah Coulter Danner in the early 1990s. By the spring of 1994, I met Sue Owen, a wonderful LDRP nurse in my home state of West Virginia, who mentioned that she was studying to take the boards that summer in lactation consulting. I asked her about the field, and after her brief description, I immediately replied, "I want to do that." (After passing the IBLCE boards in 1994, Sue continued to work at the same small rural hospital as an LDRP nurse, and several years later, became a highly respected Certified Nurse Midwife.) In early 1995, a co-worker at a nearby small college handed me a brochure from Health Education Associates of Sandwich, Massachusetts and said, "This is something you would be interested in." The brochure was advertising an all-day workshop in Morgantown, West Virginia that May, with Karin Cadwell and one other speaker presenting. I held onto that brochure for four months and waited with bated breath to attend the event. The workshop was also attended by many WIC staff from around the state, and by the end of the day, I was passionate about furthering my education toward becoming a lactation professional. Within three months, a neighbor who worked for WIC as our county's only breastfeeding peer counselor mentioned that she was leaving the position, knowing I would be interested. I started that position as our county's only breastfeeding peer counselor in October 1995, working 15 to 20 hours each week at their $5.52 hourly wage. To supplement my very low WIC income, I continued to work outside of WIC as a registered nurse.  (West Virginia is a very poor state, ranking near Mississippi in lowest per capita income.)

At that time, the IBLCE path to sitting the exam for bachelor's-degreed folk included 2,500 clinical hours of practice, in addition to the other education requirements. The small hospital where I provided WIC inpatient rounds is Davis Memorial Hospital in Elkins, West Virginia, with only 600 births annually and a Level I nursery. It's the only hospital in the county and serves a seven-county area. Three of the adjacent counties have no inpatient obstetrical services of any kind, and the nearest Level III NICU is 75 miles away over mountain terrain at West Virginia University Hospital in Morgantown. When I made lactation rounds at Davis Memorial Hospital, I had received permission to round on all nursing dyads, regardless of WIC enrollment, out of my desire to help as many dyads and families as possible, particularly due to the low population. Statewide breastfeeding initiation rates were at 43% when I started working with WIC, and the initiation and duration rates in our county increased markedly during my five years there. Because there were only 600 births a year at that only hospital in the county, I was never as busy as I hoped to be then, although I helped many families during my five years in that role. When I return to visit the area, I still joyfully run into families I met as a nurse and lactation consultant during my years there.

Parts II and III will follow as separate posts.

With best regards,

Debra Swank, RN BSN IBCLC
Ocala, Florida
More Than Reflexes Education
http://www.MoreThanReflexes.org

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