As someone at the starting end of the IBCLC credentialing process, I don't 
think that a harder exam or a college program are the answer. As a non-
clinical PhD, I would not be interested in much more formal schooling, and 
I think I have the skills to pass an exam no matter how much more 
difficult it was (not boasting, just a good test-taker).  However, what I 
would like to see is someone else vouching that I have the necessary 
skills. It does bother me that I can take a 40 hour class, do private work 
as a CLC or maybe volunteer at the hospital or do my WIC work or whatever 
it takes to get my hours, and nobody will ever have to watch me working 
directly with a breastfeeding dyad for me to get my IBCLC. 
I liked the idea of Pathway F, and I think it's been a good step in the 
right direction. If someone has excellent knowledge and skills, are 2000 
hours really necessary? Or, if someone needs a lot of work, maybe 500 
isn't it enough. These are hard questions. But I think the component of 
being observed by someone is essential - and observed multiple times on a 
wide variety of skills. Just like medical residency, or nursing clinical 
competencies, or any other profession where there is direct patient 
contact. I do hope that IBLCE is giving more thought to emphasizing new 
pathways that require checking competencies. Now - who does the checking? 
Will there need to be a IBCLC-Training certification given? Will it just 
need to be someone who has recertified? Will they receive any 
compensation? (the advantage of an institutional program is that your 
instructors do get paid...) For now, maybe the Pathway F mentorship model 
is the best answer - because I do believe (as was posted) that "over-
schooling" the education misses out on the value of the apprenticeship 
process - and agree about medically educated midwives. How do we combine 
the necessary medical knowledge and training with that "feel" for the work 
that only comes with time and experience???

I like this discussion - and look forward to hearing more. (Even if I do 
confess that I like hearing Bette Midler's advice to Britney Spears 
too...) I know that IBCLE is working on this issue - maybe someone from 
that organization could enlighten us on the alternatives being discussed?

Kirsten Berggren
www.workandpump.com
Vermont Breastfeeding Promotions Coordinator, WIC Program
Faculty, UVM School of Nursing
Taking the Healthy Children CLC course in October
Jack of All Trades, Master of None

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