I, too, appreciated the letter Margery shared from the OB RN/LC commenting
on the reasons why hospt. care should be provided by nurses.  I am all for
the continuation of any discussion which seeks to clarify what an LC needs
to know and helps define the pathway to get there.  Knowledge of the
operation of equipment designed to monitor and treat ill infants is
certainly a plus in a hospt. setting.  However, hospt. stays (while vital to
successful initiation of bfg.) are relatively short.  There are months of
issues arising from bfg which will occur in the community.  I have observed
and referred back to their physicians years worth of babies with the kinds
of problems described in the letter.  Non-RNs can be trained or can learn to
assess infant state, observe hydration status, etc.  Many times I have been
the first person to observe a feed carefully enough to pick-up swallowing or
respiratory dysfunction in a nursing infant.  Our expertise as LCs consists
in many things, all of which could be taught in a curriculum if we could
agree on what it would/should look like.  As someone who has trained RNs for
years, I can tell you that their curricula is not rich in bfg. theory and
technique.  The wonderful and dedicated RNs practicing as LCs have
essentially learned what they do the same way non-RNs do:  through courses,
self-study, apprenticeship, and by experience.

It seems to me that the field of lactation consulting as an independent
discipline is by no means assured.  My dream has always been that the LC
would have a distinct identity so that bfg. would have a recognized advocate
and expert within the health care team -- the same way that a RD would be
called in if a special dietary plan to maintain health was needed. It is
specifically this issue which has been a philosophical barrier for me
personally each time I have contemplated going back to school to get a
nursing degree. Having  specialists in lactation doesn't negate the need for
MDs and RNs and other people to also be trained in lactation support.  But
it would recognize the fact that in special circumstances, assisting bfg in
a problem situation is going to take time and focus which may be outside the
normal schema of both nursing and medicine -- even though the LC would still
be in close contact with the MD -- as would be the case if an MD referred a
patient to a physical therapist.  The MD doesn't need to know how to do
physical therapy.  H/She just needs to know that the PT is adequately
trained and liscensed to develop a safe and acceptable plan to satisfy the
MDs expectation that  the patient's physical functioning will be
rehabilitated.   Normal moms and normal babies don't need much beyond some
initial help with positioning (which in my experience is still abysmally
understood and taught to new mothers.)  Some enthusiasm for bfg and a
connection to community  support groups will usually be sufficient
thereafter.  Not every mom needs an LC.  When one is needed, it would be
great if there was satisfaction for consumer expectation that consistancy of
information and skill were in place to protect them and their baby.  IBCLC
status is the beginning of satisfying that expectation.  What would be
better in my opinion, would be a undergrad or grad program topped off by
sitting for the exam.

I realize that it may turn out that the professions of nursing or medicine
or of OT will subsume lactation and that non-medical LCs will no longer be
allowed to practice.  For those of us who have spent 20 yrs or more working
in the field this will be hard, but an LC friend shared the observation that
perhaps we can still feel satisfied with our effort if we can at least share
what we have learned with others in a teaching capacity. Passing along the
wisdom gleaned from supporting lactation from hospt. discharge through the
weaning process will be important.  Even more important will be tapping into
this knowledge to create the academic pathway which quanitifies all that an
LC needs to know.

I think the pathway should include:

Risks of artificial feeding/benefits bfg
Anthropology of breastfeeding (including history of bfg support movements)
Anatomy and physiology of breasts and lactation
Over-view of infant oral-motor function/feeding as a system
Infant state assessment
Child development over-view
Psychology of post-partum/Basic counseling skills/grief counseling
Theraputic touch/basic massage techniques for infants and mothers
Infant red flags for health problems which affect feeding
Maternal red flags for health problems which affect lactation
The weaning process
Equipment over-view/alternative feeding methods
Drugs and herbs during lactation
Problem solving (with case studies)
Basic management stategies for common problems
Basic management strategies for special situations
Case planning
Case reporting and record keeping
Ethics of practice
Clinical practicums

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html