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From:
Sharon Knorr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 9 Dec 2002 19:40:18 -0500
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To All,

Been away from my computer for a few days and just skimmed Lactnet.  Felt the need to add a bit to this discussion.  My professional/lactation background is a registered medical technologist(28 yrs), LLLL(22 yrs) and IBCLC(15 yrs).  I have been an LC in private practice and in the hospital.  I feel that the IBCLC is at a real turning point.  Although the certification is an entry level one, it must denote an across-the-board competency that potential employers can count on.

A hospital hiring an IBCLC should be able to rely on her to have a basic understanding of what goes on in the hospital with moms and babies - common procedures, drugs, treatments, etc; she must be able to recognize normal postpartum behavior in moms and babies; she must understand charting, terminology, commonly used abbreviations.  She must know how to interact with doctors, nurses and other health care professionals in the hospital setting.  Once on the job, she will learn the details of how that particular institution operates - where stuff is, coverage expectations, who's who.  She'll naturally improve on all of her basic skills as time goes on and if she stays just in the hospital, will become a real expert on newborns and all of their related issues and how to get the most done in a short period of time.

A woman going to a private practice LC has a right to expect that she has a basic understanding of doing in-depth counseling and running that kind of a business.  She has a right to expect that the LC has knowledge of babies at many stages of development.  She has a right to expect that the LC knows how to contact and communicate with other health professionals in the community.  She has a right to expect that the LC is organized enough to be able to keep track of her case.  If the LC is also doing retail, she has a right to expect that the products she is selling are of high quality and that the LC knows how they should be used and in what circumstances.  In time, a private practice LC sees most train wrecks as a challenge and a way to use the many skills she has accumulated through the years.

I think that all LCs need to have excellent counselling skills.  They should at least be familiar with and have a basic understanding of complementary medicine such as herbs, homeopathics, chiropractic.  All of this assumes that the LC is also competent in all of the areas presently tested for on the exam.

Most health professions require a period of clinical practice and specifies what kind of practice and for how many hours.  For instance, in medical technology you rotate through all of the different areas and sometimes between different hospitals.  I think that if we are to be truly credible, IBCLC must also include such a requirement, and not just a certain number of hours with moms and babies in any setting.  We must be in hospitals, clinics and private practices.  This is the hardest part of the puzzle to work out.  I know that in medical technology, it is getting harder and harder to find hospitals that will take interns - they do not want to spend the time and the money on the program.  Many areas do not have private practices which could provide the hours needed. I see med techs that come from other fields and learn on the job - it works to a certain degree, but it takes a long time and there are big gaps in their knowledge that are often never filled.  So while I think that it is a strength that we come from so many different backgrounds, at some point we must come together and I think it must involve more than just taking an exam.  If we are to be a true, stand-alone profession it must involve some type of degreed college program and clinical practice.  Will this ever come to be? I don't know.  It will require a lot of work.  And I think that there are a lot of LCs out there who don't really feel the need.  Many RNs feel that they have already legitamized their position by virtue of the nursing degree.  Many LCs are content to run a small practice and feel they have as much legitimacy as they need already to do that.  Some LCs are against the idea of being a health professional at all, wanting to follow a more organic or holistic model.

If the IBCLC moves towards the degreed, health professional model I could see a split similar to midwifery, with IBCLCs and lay LCs (in addition to nursing mothers support groups).   I think that no matter what we do, it will be difficult in this field to prevent anyone from hanging out their shingle.  The really big issue is third party reimbursement.  The fact of the matter is that private practice LCs will never be able to make much of a living if they cannot qualify for reimbursement.  It is all well and good to say that moms should be willing to pay for our services, just like a plumber or a mechanic.  But the fact is that at least in the USA, people expect to have medically related services covered, at least in some small part, by their insurance, especially services that are seen as essential (leading to the assumption that breastfeeding is somehow not really essential or it would be covered.)   I think that the very fact that we cannot get reimbursement underscores the fact for many MDs and patients that we are not really a legitimate part of the health care team.  I know that in some places there is reimbursement, but it remains rare.  In our area we seemed to be getting there this past year, and then all talks ceased and it seems to be a dead issue for now, as far as the carriers are concerned.  I appreciate the work that ILCA is doing in this regard.  Until we get the reimbursement, the only LCs really making a decent living will be in the hospitals, where they may also be required to be RNs.

So who will decide where we go next?  It will be interesting to see where our future IBCLCs come from.  Those with degrees will still have to get hours. Getting hours will usually involve working in the hospital (probably as a nurse) or as a volunteer counselor of some kind.  Volunteers with hours and without degrees will have to go to school.  Will the nurses win out by virtue of their built-in college courses and time on the floors?  Will volunteers go back to school to get the courses they require?  And since we are an international certification, how does this play out around the globe?  And how do all of us get to play a part in this process?  Is it through ILCA or IBLCE?  Do we write letters, convene a special conference devoted to this topic?  What do we do next?  I don't know.  I would certainly love to sit down with my colleagues and hash a lot of this out.  Any ideas out there?  We keep having this discussion, but I think at some point it needs to go somewhere.

Well, this is certainly way longer than it needs to be, but I'm too busy at the moment to edit.  I will stay tuned for further developments.








Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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