From when I decided I would take the exam til when I took it was just over a
year.  But I had already been working with breastfeeding mothers as a staff
midwife for about 12 years, and had been a very active member of the mother
to mother BF support organization here for 15 years as well.  

I realized how lucky I am to be able to keep my skills honed at work when I
read some of your work situations.  On a typical clinic day I spend about 7
hours on my own in a room with someone who is breastfeeding and having a
problem with it.  Sometimes there are more than one at a time but mostly I
am able to do a complete observation of a feed from start to finish, and
talk to the mother, and check the baby in the time I have.  I see about 9
mothers with their babies on a typical day; there is a break in the
appointment book at noon and that's when we do the breastfeeding class for
the women still in hospital.  No wonder I feel like I am always surrounded
by lactating breasts.

When I work on the ward I spend at least half my shift doing direct
breastfeeding support/troubleshooting.  At least!  There is never a shift
when I don't consult on a case from another team on the ward, involving an
observation of a feed or the like, in addition to running herd on the
mothers and babies in the rooms I am looking after.  

I kept up with the literature as a member of the BF organization, and found
it helped me be a better postpartum midwife.  My systematic preparation for
taking the exam turned out to be subscribing to Lactnet and participating in
discussions there.  Of course I got myself a standard text and a study
guide, but what really got things to jell for me was joining this group.
For the first time I had not just one, but literally hundreds of people to
bounce ideas off of.  I'd been practicing in a void for a long time.  Now
there are two other breastfeeding specialist midwives where I work, though
neither one will likely take the IBLCE exam due to cost and language
constraints.  We also have several really outstanding maternity care
assistants who have enhanced their own skills in breastfeeding support by
short courses through the National Center for Breastfeeding.  We can
collaborate, and it's a lot better than being the only one in the whole
region.

There is a difference between IBCLCs who started in voluntary organizations
working for breastfeeding or who just got passionate about breastfeeding
when they had their own children, and IBCLCs who realized that the
credential would be a good idea in their jobs.  Some of the latter get
passionate as well, but the ones for whom it is never more than some letters
after their other alphabet soup, are not the ones I'd want my best friend to
go to.

Rachel Myr
Whose best friend is actually an IBCLC, come to think of it

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