I've purposely, over the time i've been on Lactnet, stayed out of this debate
but feel a need to weigh in now, before the list mothers tell us to cease and
desist. Carol, I believe, writes:

It's
> been my experience that when a hospital-based RN/IBCLC offers free services
> and my services in my private practice are associated with fees that
> sometimes the public gets confused.  I'd be interested in hearing people's
> opinions on this matter.  How do you suggest we handle these issues as a
> separate entity; namely as lactation consultants?

I'm sure the public gets confused, but my guess is that a post partum home
visit is covered by the family's insurance. I know if I were a hospital
administrator who was required to hire an RN for a post partum home visit, I
surely would hunt high and low for one who also held the IBCLC credential.
Breastfeeding is probably the highest skill a mom needs to attain post
partum.  Those hospitals that include this as part of the visit are doing
more than just giving lip service to the importance of breastfeeding and we
should applaud them. The RN is not giving her IBCLC services away for
free--she's being paid by the hospital. A way to explain it to patients is
that this is part of the service of the hospital or coverage by the insurance
company. Some of us have HMO's where all medical care is supposedly covered,
but must be obtained from a particular medical group, some of us have PPO's
where there is some limited choice and some of us pay more and can obtain
medical care wherever we want.  These mothers are not receiving free
services, someone has to pay for it. When the pediatrician visits the mom and
baby post partum and the family doesn't receive a bill,. it's not free--it's
just covered by someone else.

I think if we hold an IBCLC credential we should not give away our services
for free. Recently a friend asked me to counsel a friend about a very complex
breastfeeding issue. I thought long and hard about asking her to come into
our lactation center where she, or her insurance company, would receive a
bill. I finally decided that that was exactly what I would do, because I knew
that I could not even adequately  assess what was going on without spending a
fair amount of time with her and her baby. The other salient point is, that
as a professional, I felt I should not give my services away for free
although a big part of me wanted to help this friend of a friend. We would
never call our MD friends or RD friends or chiropracters and ask them for
free treatment for a friend. We need to hold ourselves to the same standard.

And to bring this back to the RN/IBCLC debate, Laurie states that at times
she would like to drop her RN. I think we need to realize that everything
we've done in life helps us to bring something to the table. I know I use my
RN assessment skills I've attained from 30 yrs. of working with sick babies
all the time in my IBCLC practice. Sure I have to jump through the same silly
hoops that she does--training that has nothing to do with my job-- but so do
a whole lot of the other nurses in the hospital.  My knowledge of
breastfeeding was obtained by training with a volunteer organization and then
by using those skills every day as a staff nurse. This enabled me to move on
to my position now as a hospital based IBCLC.  Others have entered through
different avenues but all of our background and training is valuable and
comes into play--including years and years of experience as an IBCLC.

Kathy Boggs, RN, IBCLC
>

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