I personally think much of this has to do with semantics: pure and simple. 

I also think that depending on how some LC's go about questioning this 
whole issue (and I am not saying anyone shouldn't question), I can see us 
doing the whole lactation consultant role a TERRIBLE disservice in the 
long run. As we work to attain greater professionalism, this kind of 
dissention makes us look far LESS professional. 

As far as the MD/IBCLC role goes (Jaye's post),why would one assume that 
the MD has to "change roles? The MD/IBCLC diagnoses a tongue tie and knows 
it needs clipping...................she/he then gets a CONSULT with an ENT 
MD colleague (a common occurrence), the TT gets clipped and hopefully, 
there is improvement. That actually occurred at my hospital last evening 
(as it frequently does).I know this is a simple example but I use it to 
show how these two roles are complimentary and one hat doesn't have to
come off before another goes on.

That was exactly what I meant when I said that those of us LC's with the 
additional healthcare licensure (whatever it is) sometimes have an 
advantage (fair or unfair) over those who may not have access to the same 
services as easily.I am not at all intimating that those who have the dual 
licensure are better. They are just different.

If I was dissatisfied with the fact that it is not within my personal 
practice to "diagnose," it would be up to me to take myself back to 
medical school. It would not be my place to just blatently critize or try 
and change the existing structure just because I thought I should be able 
to diagnose. I guess what I am saying is that those of you who are 
dissatisfied have the opportunity to get additional schooling (if you feel 
the need) or stay where you are within the framework that will be 
designated for you (regardless of the outcome). Although I have many
of the clinical skills I need to be an advanced practice nurse (because of 
all my years in OB/L&D), I cannot perform in that function because I am 
not a nurse practitioner. The onus will be on me to go back to school if 
this restriction bothers me or makes me feel inferior. That's life......

Although I do agree that the SOP document is maybe not worded as clearly 
as it could be and that there are definite contradictions within it, I am 
wondering if the general purpose of the new guidelines is to protect both 
the LC, and the clients (legally). Everyone today (including healthcare 
providers) is so hypervigilant about lawsuits that everyone is doing as 
much as possible to cover their you-know-whats.

As an RN, I also have to practice within the nurse practice act of my 
state. We all are bound by restrictions, regardless of our professions.

At what point do all of us put the ball back in the consumer's court? Why 
are we feeling totally responsible for a person's breastfeeding 
experience? You give evidence based information and let the consumer take 
responsibility for the individual outcome.

Betsy Riedel RNC, IBCLC

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