"I must say I am a little confused because to my mind this document would
be better titled 'Standards of practice' than 'scope'.  Scope of practice
refers to what we actually do; it delineates what is our domain, which
actions and techniques may be part of our repertoire.  This document
contains very little about what IBCLCs do, but an awful lot about the way we
ought to do it, and in this case they seem to have emphasized the ethical
standards more than the standards for what skills we should have. "

Like Rachel, I was thrilled to see the "must not's" taken out, and like Rachel I've been confused by the differences between Standards of Practice, Code of Ethics, and Scope of Practice.

I'm still chewing them all over, but have started by determining what these terms mean for *me* in *my* little world.  For me, there isn't much difference between my Standards of Practice and my Ethics.  I try to leave the mother's life at least as orderly as I found it, preferably better (washing out the flanges for her before I leave, for instance, or leaving her with a fresh glass of water at hand) because it's just a nice thing to do (Standard of Practice) and because it's the "right" thing to do (ethics).  After mulling and pondering, I'm comfortable putting that in both categories, though I'm sure the profession overall isn't going to require that glass of water.  Referring mothers as needed?  For me in my world, that's a standard of practice, an ethical mandate, and recognizes the limits of my Scope of Practice.  These things may be sorted out differently on a grander scale, but for me, there is inevitably lots and lots of overlap, and I don't think that's a problem.  Doesn't matter what I *call* a guiding principal, so long as it guides me, and I'll leave it to wiser heads to list them under the right headings for the profession overall.

"Scope," in my dictionary, means "the range or extent of action, inquiry, etc, or of an activity, concept, etc (the scope of a book); room or opportunity for freedom of action or thought, as in free play.  Those strike me as being much more about what we *may* do than what we *mayn't* do, so I think the new approach is much more appropriate to the term "scope of practice."  But anything that gives a range of motion *implies* where that range stops.  It makes a whole lot of sense to me to start with a scope that's, if anything, too broad.  It can always be tightened up here and there as we go.  We've already seen what happens if it starts out way too tight.

And I'll continue, in my own corner of the world, blythely to assign the items on my personal list mostly to my personal code of ethics.  I do them because they seem like the right thing to do, whether I'm trying to help protect my client from germs, an underfed baby, fatigue, those around her, unwanted weaning... or from me.

Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY  USA
www.normalfed.com

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