I think that some of the differences in looking at where things are going in the profession may stem from what we were expecting when this all started.  As a LLLL, I had no expectation of doing lactation for a living.  I loved helping moms and learned as much as I could as I went along.  Then along came IBLCE and ILCA.  It was such a revelation to meet all these other people in lactation who were not just going the LLL route and who had so much knowledge that I did not.  There was an expectation in the beginning, at least for some of us, that maybe it would be possible to be one of those lucky people who make a living doing what they love the most.  Now, we're fifteen years down the road, and things look a little different.  We have all learned a lot and done some incredible work around the world in support of breastfeeding mothers, but the dream that many of us had in the beginning is looking mostly like just that - a dream.  We are getting older and fighting the good fight is getting harder.

It may be that IBCLC will never be more than an advanced certification for lactation consultants.  And maybe that is OK.  I love both parts of consulting - helping the average mom and baby do what comes naturally and just standing back and smiling and also using every bit of knowledge and skill I have accumulated to help a dyad that is having serious problems.  For those of you bemoaning the medicalization of breastfeeding by professionalizing IBCLC, please reread the posts and you will see that we all agree that the great majority of moms and babies should NOT need the services of an IBCLC.  In the beginning, I remember having conversations at ILCA conferences where we talked about our eventual goal of not needing IBCLCs at all any more because we would be back in a breastfeeding culture where help was everywhere and confidence was high.

Unfortunately, I do think that IBCLCs are just window dressing in a lot of hospitals.  It's a service they provide when its economic or convenient for them, but it is often the first thing to go when it gets busy.  The hospital I teach at can boast of having four IBCLCs on staff.  But we are only supposed to put in 4 hours a day, which includes seeing all the inpatient moms - including special care - doing follow-up calls with all the moms after they go home and seeing dyads as out-patients.  The lactation office has been moved more times than I can count, including one time down in the basment near the loading dock.  Deep down inside I think that most doctors and nurses do not value breastfeeding the way that they say they do.  They really do feel that formula is just as good (and getting better).  And I wholeheartedly agree that the childbirthing situation is at the root of a lot of this and I am at a loss trying to get moms to start looking at it differently - it is even more frustrating that the breastfeeding stuff.  If there is no real push from the medical power structure or from the consumer, then we may be forever spinning our wheels.

I applaud all the people who have been in the trenches pushing this thing forward all these years.  I approve of the direction that IBLCE is going in with requiring more and more in order to get this particular certification.  And I love Lactnet and the sharing that goes on here on a daily basis.  It really is wonderful.  Wherever this all ends up, it is nice to know that while we are all travelling there down many different paths, still, we are all together.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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