Susan hit a nerve on a topic I was just looking into myself a couple of
months ago. She said:

<<I mean NO offense to the vast majority of IBCLCs who are RNs and work
in hospitals --- 
this is one important avenue for lactation.  However, I have to admit
that I am quite 
shocked by how severe the imbalance is among IBCLCs.>>

I agree completely; three cheers for the nurse-LCs doing the work that
they do in the hospitals, BUT....that is a huge imbalance.

Susan again: << I do not see that in the statistics that follow:

74% of IBCLCs are RNs
6% are MDs
1% are LPNs

64% of IBCLCs are working in hospitals
3.5% are working in a physician's office
5% are working in private practice>>

I came up with similar figures. According to IBLCE, there are 11,104
IBCLCs in the Americas, 9,503 of whom are in the USA. 64% of all of them
are hospital-based. 82% of the nurse-IBCLCs work primarily in hospitals.
What also disturbed me was that of the 9,503 IBCLCs in the USA, 320 work
for WIC. That's 3.3%, folks.  According to the USDA WIC serves 45% of US
infants - in fiscal year 2004 they served 2 million babies.

45% of all infants in the U.S. have THREE PERCENT OF THE LACTATION
CONSULTANTS? What's wrong with this picture????  How are we supposed to
raise the duration rates in this country if nearly half of our babies
(and the poorest half at that) only have access to an LC while in the
hospital? WIC moms in general cannot afford a private practice LC, so if
they don't get one from WIC, they're not getting one, period.

Part of the problem is salary - WIC does not pay as much as hospitals
do. One can't blame an LC for choosing what's best for her and her
family. But this definitely needs to be addressed if we are to make
further progress. 

Then Susan addressed the medical/non-medical angle:  <<We need OTHER
professions to enrich how we practice --- we NEED more IBCLCs outside
the hospital --- we NEED more than a medical model because so much of
breastfeeding is about interacting with the mother infant dyad and
assisting them to develop a healthy relationship to feeding.>>

It has been quite beneficial here at WIC in Miami for some of our WIC
PCs to be able to become WIC IBCLCs. For a woman to go from being a WIC
participant to being a WIC Lacation Consultant makes for one heck of a
fine IBCLC, one who can serve that population particularly well, knowing
it as they do from the inside.

Another way of looking at this is from the perspective of our rates of
breastfeeding initiation, intensity (exclusivity) and duration.  Per the
CDC by 6 months of age only 41% of US infants are still breastfeeding at
all - only 11% exclusively. And yet initiation is 74%. Why? I'm starting
to think that one of the reasons is that that's where our LCs are.  Put
3/4ths of your profession at the front end of breastfeeding and guess
what? The front end of breastfeeding is going to go a lot better than
the other 99% of it....
 

Regina M. Roig-Romero, BS IBCLC 
Senior Lactation Consultant 
Miami-Dade County Health Dept WIC/Nutrition 
Breastfeeding Program 
7785 NW 48 ST, Suite 300 
Miami FL 33166 

(786) 336-1333 x162 
(786) 336-1345 fax 
(786) 336-1336 Breastfeeding Helpline 

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