I have to agree with some of you that these initials are quite confusing.
I do disagree, however, that after you've received these credentials that
you can't set up a private practice.  Perhaps I should don my
flame-retardant suit now, but I certainly feel qualified, with my
experience and credentials, to help women manage the normal challenges they
may face with lactation.  Sore nipples, plugged ducts, mastitis, return to
work issues are certainly within my scope of practice as an RNC and a CBE.
It's been my experience that parents prefer to see someone they have
already established a rapport with which they do with me prenatally through
childbirth and breastfeeding education.

I was also taught by Debi Bocar in the course I attended that we are not
qualified to practice as lactation consultants.  I tell women who are
needing assistance that I am not an LC and that I am a CBE and what my
limitations are.  If I find a woman has a complex breastfeeding situation
that needs an LCs assistance, I certainly refer to an IBCLC and I let women
know that up front as well.

I see professionals with the CLC/CLE/CBE credential as being a crucial link
in breastfeeding education and support.  Not everyone wants to live and
breathe lactation as the IBCLC does (myself for one).  However, I do
believe it is my responsibility as a perinatal health professional to have
a high level of expertise in lactation related issues and to promote and
support lactation throughout the childbearing year and beyond.  I think the
CBE gives me more credibility as an expert on normal lactation issues and
the knowledge  to know when I am over my head.  Being an active participant
in our Lactnet discussions keeps this knowledge flowing and up-to-date as
does attending BF related continuing education programs.

JMHO, we need more of these types of providers in our communities on the
maternity units and in health departments to fill in some of the gaps that
exist (at least in the US).   Sure, we still have problems with HCPs that
do not keep up to date, a society that doesn't support breastfeeding,
formula companies and media messages.  LLL also helps fill in some of the
gaps but LLL isn't in every community where perinatal health care is
provided though MDs, CNMs, RNs and LPNs are there.

I'm certain that if a few RNs and LPNs from each hospital that does
perinatal care could spend 3-5 days at a course like this, a huge
difference could be made on breastfeeding practices in their hospitals.
They could help fill in some of the gaps and have some influence in BF
practice, a few more voices for breastfeeding in areas where we can really
make a difference.  Just in the Iowa, Kansas and Oklahoma area alone, we
have 4 BF conferences with nationally known speakers coming to speak on
these issues August through October 1998.  (e-mail me privately if you want
more information on when and where).  For the number of contact hours that
are provided toward relicensure (not to mention the BF education received),
they are a bargain that can make a difference in breastfeeding practices in
urban and rural areas.

Wow, this was long.  I'll hop off my soap box now.

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources  http://www.childbirth.org/bbfr
Manhattan, KS  USA
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