I have followed with interest the thread about whether non-IBCLCs should be
voting members of ILCA, and read with sympathy Judy's post about feeling
disenfranchized.  I believe we really have to talk about these issues, but
sorting through them is not going to be easy, because I believe we still
don't have, as a profession, a sense about what we are and where we are going.

I believe there is an essential difference between what many call an "LC",
and  what Allison Hazelbaker recently described as a "lactation therapist".
As a longtime LLL Leader, who was always proud of what I did as a Leader, I
was around when the LC field began.  As Leaders, we worked mostly over the
phone, and while manyLeaders were quite up on lactation science, many saw
their role as primarily mother-to-mother support.  Our mantra was to share
information, not advice.  It was clear there needed to be a corps of helpers
who would do hands-on work in the special situations which were beyond what
Leaders could commit to in terms of time,and  equipment, and who were
prepared to assume the responsibility to give advice.

A lactation consultant, as I see it, SHOULD be a specialist.  Her/his
expertise should combine the discipline of lactation physiology with
counseling, and there should be basic knowledge of infant oral-motor
function.  The role of such a specialist is to assist intelligently in the
situations where enthusiasm, basic breastfeeding knowledge, and moral
support are not enough.  The reason why I have such prickly opinions about
who should be calling themselves an LC stems from the fact that if everyone
who is enthusiastic about bfg. calls themselves one, it devalues the term,
and will ultimately require us to go back round and re-invent the profession
again under another guise.

 If we do, I vote for starting with a clearer pathway to achieve the status
designation.  At present, the current number of clinical hours are so beyond
the reach of non-RNs that they over-emphasize the influence of that
profession in lactation specialization.  This would be fine with me if it
were by any means certain that there had been or is now beginning to be
specific professional education in lactation in nursing schools, or evidence
of on-the-job training with good lactation management mentors in most hospitals.

This is not a slam against nurses, any more than my remarks about enthusiasm
not being sufficient are slams against peer counselors.  I want however, to
distinguish our profession from all the other professions and to make sure
it really becomes a profession.  That is going to mean continued
clarification of role deliniation and scope of practice parameters. We are
all going to have to consider where our primary committment lies.  If it is
to nursing, fine.  If it is to counseling, fine.  If it is to
mother-to-mother support, fine.  These are all good.  But if we are
committed to being LCs, we have to figure out what that means.

 Judy made the remark that it would take 15 years to make the doctors in her
city change their opinion about LCs.  Yes.  It took about that long in
Austin. And you will have to work scrupulously to change all their minds,
one doctor at a time. I can't believe how differently LCs are now viewed in
Austin than was true all those years ago.  Thanks to very dependable work by
some of this city's LCs, we are a valued part of the health care team.
Which is all the more reason to continue to be rigorous in our standards so
the term will continue to mean something.

 It may look like snobbish exclusivity to say that you can't vote in ILCA if
you aren't IBCLC, but I subscribe to and read PEDIATRICS.  I don't expect
that gives me the right to be a voting member of the Amer. Acad. of
Pediatrics. It may also appear that some LCs are over-medicalizing
breastfeeding, but I submit that our mandate is not with normal situations
(which can be handled admirably by Leaders, other lay counselors and peer
counselors.)  Our mandate is with difficult and very special situations
which require a background knowledge quite unique from that of other
specialties.

Judy may well have a point about the rest of the world being so different
from the US and Canada and Australia that perhaps ILCA has lost the
international focus.  If that is true, more thought has to go into
supporting our international members in terms of developing educational
opportunities which provide the specific training hours so they can
demonstrate the specialized skills required for certification.  The internet
may be a boon to that.

Ultimately, the higher our standards both for our organization and for
ourselves, the more our profession can earn the chance to be included in
health care.  That makes us available to mothers and babies.  And that is
what we are about.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html