>no easy answers...

That's for sure.

I think there are two issues for me, separate but linked.

1)  I want everyone who advertises herself as being a breastfeeding helper
(through initials or reputation or affiliation or job description) to act as
a *conduit* for breastfeeding help, not a bottleneck.  We need oodles and
oodles of helpers at all levels of expertise out there cheering mothers on,
facilitating good latches, helping with the basics, helping mothers turn
their personal mountains into molehills, expressing confidence.  I don't
much care what title these helpers use so long as they're conduits, so long
as they connect with others, so long as they don't try to operate in a
vacuum.

But last year a woman called me for help in drying up.  Neither the
lactation consultant at the hospital, nor the lactation consultant at the
pediatrician's, nor the lactation consultant at Public Health was able to
help her get her baby to latch on, and she sure wasn't about to let a fourth
lactation consultant have a go at it.  She knew very well that everything
possible had been tried by the experts she'd already seen.  Thing is, none
of those three facilities has a certified lactation consultant on staff.
Only one of the people she saw actually had any kind of formalized training
at all.  And among them, they used up all her emotional energy without
referring her to someone with more training.  They were bottlenecks in her
route to successful breastfeeding.

2)  I want everyone who helps mothers to have a window on the wider world of
breastfeeding information, and some of the courses and organizations don't
seem to offer that.  The woman who works as a breastfeeding helper
absolutely  doesn't need to know everything that's in Ruth Lawrence's book.
Of course not!!!   But she needs to know the book exists, and she needs to
know who has it.  She needs to have heard of the journals, to have seen
flyers for the conferences, to have ferreted out the more experienced
breastfeeding helpers in her area.  She needs to know *how* to plug herself
into more information if ever she wants to, and maybe most importantly she
needs to know there's a whole lot into which she *could* plug herself.

I think the women who end up as bottlenecks rather than conduits simply have
never seen that window on the wider world.  They honestly don't *know* what
they don't know.  They've come to believe (through poor instruction or no
instruction or through a lack of professional inquisitiveness) that the
skills they have are a world in themselves.  I can't imagine that there's a
single bottleneck personality on Lactnet;  Lactnet is the biggest window
there is in the profession, and people access it *because* of professional
curiosity.  We really do represent a continuum of skills all working
together as a conduit.  What an amazing model!

A local graduate of a 5-day course tells people that IBLCE certification "is
another form of certification that I chose not to pursue".  Makes my teeth
grind.  But it's largely the fault of her instructor, who for unknown
reasons didn't open that window and *make sure* all the students looked
through it.  I thought of the vast machine that is IBLCE and ILCA and
conferences and Lactnet and networking, and thought how little this
well-meaning woman must know about *any* of it.  Almost like insisting that
the earth is flat.

Come to think of it, that may be the problem with some 5-day grads:
*they got all their CERPs at a one-stop shopping center.*  No need to mull
over conference brochures, deciding which ones flesh out a knowledge base or
have someone you especially wanted to hear.  No need to hear conflicting
opinions, realize not everything is set in stone, and look for additional
information.  Maybe a lot of the tensions among various groups would be
relieved if an exam-taker *had* to get her 30 CERPs from a minimum of,
say, 3 or 4 sources.  Those with too little initiative or curiosity simply
wouldn't take the time.

You know, LLLI has its own bottlenecks.  The Leader Handbook has very little
information on lactation consultants and no suggestions at all on how and
when a Leader should help a mother find a good one.  There's a whole
protocol for contacting another Leader with at least a little more
experience, but none at all for helping a mom find someone locally.  I grind
my teeth over  Leaders who haven't looked out the window just as I grind
them over anyone with initials who hasn't.

Even midwives and doulas can be breastfeeding bottlenecks, believing that
there isn't much to know.  Locally, our midwives all seem to be conduits,
the doulas... well, I'm going to do a workshop for doulas on breastfeeding,
and try to help them understand their limits, their resources, and the
hazards of bottlenecks.

I don't think all this would matter as much if the *public* were better
informed.  But they're just as unaware of the resources out there as some of
the breastfeeding helpers.  Imagine calling for an ambulance, and having the
EMT say, "Looks as if you're going to need surgery.  Where's your sharpest
knife?"  Any fool would know enough to keep that person out of the kitchen!
We have a pretty fair notion of what medical resources are available and who
can reasonably offer them.  Not great, maybe, but pretty fair.  With
breastfeeding?  Anyone who claims to be at all knowledgeable is assumed to
be fully knowledgeable.  And so the "conduit effect" hinges on the common
sense of the helpers themselves... and those who combine a lack of
professional curiosity with an "official" course that fails to impress on
its students the range of knowledge and resources that it *isn't* covering -
those people become bottlenecks rather than conduits.  And bottlenecks come
with all kinds of titles, including LLLL and IBCLC.

For me, it's two linked issues:  conduits and knowing that other knowledge
exists.  I guess in the end they're the same issue.

Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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