I have been so impressed by the 100+ pages (can you believe it)? of eloquent comments, suggestions, and just plain expressions of exasperation and disbelief about the SOP over the past weeks. But, I have also been  very happy to see so many posts by IBCLCs who rarely join in Lactnet debates.  To me, this is a reason for optimism.  But it is pretty much the only one.
 
I've jotted down lots of notes, and thoughts, and I may or may not write them up and post them, but for now, I have only one, huge nagging question.  Why?  The damage has been done.  What professional credentialing organization would make such a gaffe?  Indeed not one, but a series of gaffes, and maintain whatever shred of credibility it had?  
 
For example,  the past few months newsletter (if there were one), would read like the cavalcade of can-you-top-this disasters:
 
1.  A 96% pass rate on the national certification exam (including the hundreds of non-English as a first language speakers and test takers who study materials that are not written in their own language)?  I haven't done any research on this, but my gut tells me that the pass rate is a bit lower for other allied health care professions licensing and credentialing exams.
 
2.  The premature and incomplete presentation of an additional credential (to my mind, a very important and huge step forward), yet botched so badly and explained so poorly in person at ILCA and not at all on the website that only a tiny fraction of our colleagues seem to truly grasp the nature and intent of the program.  When the proposal for the second credential was announced, little explanatory information accompanied it.  Even now, there is so little information on the website, that many IBCLCs do not have a clear understanding of what community the credential would serve, why it is not a threat to IBCLCs, the benefits it will offer low income women who cannot afford IBCLC care and who live in areas where IBCLCs neither live nor practice.  When the proposal was drafted (by me) it included draft SOP, clinical competencies, training and testing procedures, supervision requirements, eligibility for work environments, eligibility pathways, even sample exam questions.  Along with these materials were explanatory handouts describing the program, comparing it to other such credentials as the CLC, CBE, etc., and explaining the pros and cons of the IBLCE proposal.  While everything was in draft form, and the board had not yet approved what I submitted when I left, I cannot imagine that all of this material was not used either by the board in its decision making process.  Nor can I understand why at least some of it was not used to help IBCLCs understand the proposed format and raison d'etre for this credential.  
 
 
3.  A role delineation study that by accounts of several of my colleagues (alas I was not one of the lucky few randomly chosen to complete the survey) and well as a growing number of Lactnetters, was desperately in need of professional design and editing before being released, has not met with an enthusiastic response, and perhaps, worst of all, was not offered to all credentialed IBCLCs. Yet, it is a critical piece of research used not only to update the blueprint, but also to define the very nature of our work at a time when IBLCE is clearly struggling to do this very thing.  I might also add that this survey is done so infrequently  (2 or 3 times to my recollection, although this might be incorrect), and each time it does not survey all information needed for a true, accurate and complete picture of the profession (education, work requirements, salaries, and other data) I found that it was, for  many purposes, useless.
 
4.  The reorganization of the CERP system (which desperately needed an overhaul, but not with 8 weeks' notice), will cost thousands of dollars to course providers (a critical source of income for IBLCE) and untold confusion and cost to next year's exam takers who were counting on one big course to earn the 45 CERPs they needed to sit for the exam.
 
5.  And, finally, the scope of practice.  Where to begin? First of all, how could 20 years have passed without  the common knowledge that one existed?  I, for one, am embarrassed that I didn't realize one existed.  In a recent post, Marsha Walker says one does, and I am anxious to see it.  Now we have one.  I suspect it was written largely if not entirely by Board members, some of whom hold the credential, but for the most part, are not practicing IBCLCs.  They are physicians and others who have an interest in lactation, but no not earn a living as an IBCLC.  
 
ILCA says that they were offered a chop on the document but their suggestions were not incorporated.  Fair enough, it wasn't ILCA's document to approve.  The greater question for me is where was the rest of the IBLCE board who did not write this document during the discussion of it? Did the majority not see the inherent inconsistencies, legal and ethics dilemmas, and potential negative effects?   In my opinion, it's too "reconsider" or "amend" the scope of practice.  It's too late to rescind it.   It's out there. Mrs. O'Leary's cow is out of the barn and Chicago has burned to the ground.  
 
When one publishes a document as essential as to a profession as a Scope of Practice, going back  and saying, "darn, we should have said this instead...we messed this up....  We're going to take it off the shelf and and fix it up because our professionals are really mad."     We, as a profession, look like a bunch of amateurs playing at being professionals.  What scraps of credibility we had with the medical community--in some countries--physicians, ENTs, other allied health care providers, will disappear when this escapes outside the bubble of LACTNET, ILCA, and IBLCE.  And it will, if it has not already.  If professional lactation consultants can't even publish a  scope of practice, clinical competencies, and code of ethics that are consistent, how can we expect to be taken seriously in our work?  Adding to the struggles we have already faced, will you be surprised when it becomes even more difficult to secure third party reimbursement, establish meaningful degree programs, or hospital-based lactation programs that don't rely on boutique sales to self-fund their existence?
 
Would the credentialing body for speech pathologists, dental hygenists, occupational therapists, massage therapists, or any other allied health care profession make such a monumentally historic mistake?  What little credibility we have had, I believe, has, been obliterated by this ill-considered, unchecked swipe of the Board Chair's powerful pen.  Something is very wrong here.
 
The fact that this Scope of Practice was written and approved by a group largely comprised on physicians, despite their support of breastfeeding, should make us all question the very by-laws, committee structure and organizational and structure of IBLCE.  People say if it ain't broke, don't fix it.  If it's broke beyond fixing, then what do you do?  We, as IBCLCs, don't really have any way to to fix it.
 
I care very deeply about this profession, and anyone who knows me, knows that working with mothers and babies, working on the administrative side on lactation, teaching, mentoring, research, and promoting standardized lactation education is my calling.  I loved working at IBLCE, and was very sad and unhappy to leave.  But now,  am profoundly saddened by recent events at IBLCE, and I am not sure how, or if, I will continue to work in this field, at least with mothers and babies as a certified LC.  And, I can understand why so many of you feel the same.  I am embarrassed for our profession.
 
Barbara Ash
Lactation Professional
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