Dear Karleen,

There are several issues here as far as what is the mission of IBCLC and how much should one expect to earn being one.  We(IBCLCs), for the most part, have staked out the position that we are health care professionals.  IBLCE is trying to set a minimum standard of qualification that will, in the end I think, put us on equal footing with many other HCPs as far as educational and clinical experience.  Someone who invests that kind of time and money into a career should expect to be able to earn some kind of decent wage.  I certainly expected to earn a wage when I became a medical technologist.  Nurses expect to be paid, as do physical therapists, etc.  That expectation certainly does not demean those professions in any way.

I guess that one of the things I wonder about, is how did all those other professions get started and why/when did the larger medical establishment (doctors, mainly) decide that they were necessary for their patient's care?  Did they start out as nursing functions which eventually split off or did they spring up independent of the nursing profession right from the start?  How did they evolve into a profession requiring a college degree or at least a standardized, specialized field of study?  This is still one of the big, and important, differences between LCs and other HCPs - we become IBCLCs by passing one exam.  There is no standard of study at this time.  You can't go to university and major in lactation studies.

I do know the history of medical technology as a field.  It was started by physicians who wanted to standardize the testing that was being done on urine, blood, etc. and also certify the people who were doing the testing - a motley group at that time (1928) who may have gone to college or may just have been personally trained by one physician to work in his office (kind of similar to the many backgrounds of LCs at the beginning of IBLCE).  By 1933, this group (Society of Clinical Pathologists) had decided that lab techs needed to have completed at least one year of college including some specified courses (such as chemistry and biology) plus clinical training and then must pass both written and practical exams.  The requirements continued to escalate until a bachelor's degree was the minimum requirement to be a medical technologist.  I think that medical technology was one of the first auxiliary health care professions to come into formal existence.  I think that all of the health care professions started with a wide base and grandfathered people in for a while, but fairly quickly settled into requirements that included a specific field of study at a college or university and the passing of a special exam and/or obtaining a license to practice.

This is where we seem to be bogging down.  The IBLCE has been around for over fifteen years now, but we still have no recognized course of study at the university level.  I know that we are moving in that direction, but very slowly, and there are many LCs who still very much resist the idea of having this more rigid pathway into the profession, preferring the more broad kind of "anything goes" approach.  And I think that part of it goes back to the feeling that one could spend a lot of time and money getting a "lactation degree" and still not really be a part of the health care establishment or have a fairly good chance at landing a job.  Others believe that breastfeeding will be medicalized if one must go through such a rigorous course of study in order to become a lactation consultant.  But without a recognized course of study and a degree, IBCLC will slowly degenerate into just a certification showing that someone has special knowledge in the field of lactation, but that will not necessarily make that person a health care professional in the way that most of us understand it to be.  We will never be a stand-alone profession, so to speak.

And that is OK, I think, for many LCs who don't necessarily want to be a part of the health care establishment.  LCs who aren't really looking for any significant monetary reward, those who harken back to the old women helping women model - being the local breastfeeding crone, as I put it in an earlier post.  I think this is very similar to the split between lay and nurse midwives.  Which brings us back to the RN/IBCLC possibility as an end result if we do not soon establish ourselves as a totally separate entity.

As for myself, I see the IBCLC designation as being much more specific than it is now, requiring advanced learning including many of the topics that we discuss here on Lactnet.  I think that an IBCLC should have in-depth knowledge of the anatomy and physiology of the mother and infant, including the kind of stuff that OTs who specialize in infant feeding learn.  We should have a good working knowledge of techniques that can be used to help babies with severe problems.  We should be able to clip frenulums.  We should be able to carry on a knowledgeable dialogue with the doctors and nurses who are caring for infants who are very premature or very sick or with severe deficits of some kind.  And we should also be required to have advanced counseling skills.  In other words, I don't think that just anybody who wants to help breastfeeding mothers should be an IBCLC.  They can be lay breastfeeding counselors or instructors or any of the other certifications that are earned after varying courses of study.  But I think that an IBCLC should be given after a very rigorous course of study and they should be hired for their demonstrated knowledge and expertise in helping babies who cannot be helped through the usual channels.  As an example in another field....  A woman could go through a program and become a certified masseuse.  She could be exactly what some people need to solve their problems and that is great.  She could develop a loyal following in her community and even make some bucks providing this worthy service.  But she is not a physical therapist.

I think that this model may serve to get away from the medicalization of breastfeeding as a whole.  How many discussions have we had on this list about how most women do not need an IBCLC to solve their breastfeeding problems?  I think that that would be even more true if an IBCLC was truly a specialized medical professional.  There would be a lot fewer of them, perhaps (perhaps not), but they would all be at a certain, fairly high, skill level right from the start.  Yes, some might become even more specialized in certain settings, but there would be a definite skill set present at graduation that everyone could count on.  Experience would then hone those skills, just as it does in any profession.  But right now, just reading the posts on Lactnet, it is obvious that even with passing the exam, there are huge gaps in the knowledge and experience of many of us with the IBCLC certification next to our names, gaps which really should not exist, not if we want to be treated as true health care professionals and hired and paid in that capacity.  I also think that some of the tension between all the differently trained and certified lactation folks would ease if IBCLC was truly a very different and specific path to take in the lactation world and then perhaps a less rigorous, separate designation could develop for those who don't want to go through a full university program, but want some type of more in-depth training and certification.  And maybe more people would turn back to organizations such as LLL or similar volunteer paths.

Well, this got really long and I'm sorry and I promise not to post anymore on this thread, except for maybe some very short replies.  Is anyone else thinking along these lines, or am I completely off my rocker?  Don't worry about offending me, the flames on this list are never really that bad, IMHO.  Hoping to hear from anyone who is not yet tired of these questions.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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