I have given a lot of thought to the discussion about SOP on Lactnet. 
There are some things here that confound me. First, how is it that we 
are assuming the IBLCE is the legitimate body to write a SOP? Secondly, 
why would we assume we are bound to abide by it? I did not choose to 
become an IBCLC under any such absurd guidelines. There are so many 
legal and ethical nightmares in this whole thing that we seem to be 
ignoring. No human being, in any profession, should ever be expected to 
act without personal integrity. I do not believe a single one of us 
could maintain any modicum of integrity if we abided by the IBLCE SOP 
as written.

  For another thing, we have bought into the idea of “evidence-based” 
practice, which is really quite a joke, since no OB I know of in my 
community practices this way, nor do most peds, since it would have to 
be a violation of such practice to act in any way that undermines 
breastfeeding. We are basing our discussions on a false 
premise—behaving as if the medical model MUST surely be the compass by 
which we gently tweak the SOP—I consider that an invalid premise.

  I wanted to address the issues raised about the right of IBCLCs to 
contradict HCPs.

Pam wrote:
  “However, unless they change the scope of practice to be more relative 
to real IBCLC work, I do not see the point of working toward licensure. 
If IBLCE cannot put together a realistic scope of practice, I do not 
see the value in licensure. The real possibility however is that each 
state in the US with a licensure body would create a SOP even more 
restrictive and then the credential stays as it is...restriction of 
proper care to mothers and babies and protecting the hcp who gives 
improper information at the expense of breastfeeding. When a mom can go 
online and find article after article that supports what we are saying 
to her, who are we to deny her access to the information? What is the 
hcp going to do? Forbid the mother to read? “

  Umm…this is what has happened to midwives in the US. State licensure 
is a double-edge sword and I do not support it at all. In almost all 
cases, the medical establishment has the political clout (and the will) 
to render any practitioner who might “contradict” them impotent.

  Pam: “The only thing I can come up with is that in a hospital setting, 
a nurse is not allowed to contradict an order. It doesn't matter what 
the order is, she follows it. Yes, yes, it is not true, she is supposed 
to refuse, but realistically that is not the work world and she will be 
unemployed or whatever if she doesn't go along with the status quo. So, 
along comes the private practice non nurse IBCLC who can indeed share 
the correct information with the mom and now the mom is questioning her 
health care provider. "

  I know that RNs on this list think we in private practice are ignorant 
as to the reality of their interactions with doctors, but that is not 
entirely true. I know for a fact that some nurses are huge advocates 
for their patients and go to great lengths to educate the patient as 
well as the HCP. I know some babies have much better births and 
breastfeeding outcomes for that reason. I know some hospitals are less 
hostile to mothers and babies for that reason.

  OTOH, I have worked in hospital and have seen the restrictions that 
both RNs and IBCLCs have to contend with.

  Pam: “I do not see how it would be possible to be an IBCLC and not 
contradict a doctor unless you live in breastfeeding utopia and I would 
so love to live there, but I do not. I live in the USA where money 
rules and very few get that breastfeeding is the normal and needs to be 
protected. In my area formula is given routinely as a cure for 
everything. “

  Yes, AIM is treated like medicine rather than the very risky medical 
intervention it is.

  Pam: “The Scope needs to fit the reality of practice or it's only 
usefulness is to stop private practice non medical licensed IBCLCs. I 
still think that is their ultimate goal. "

So do I.



Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC
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