Dear all: Because I come from a public health background, I was used to looking at breastfeeding in the context of the larger society and promoting it within the entire health care system. I doubt I'd ever survive for more than a day in a hospital because I couldn't tolerate the day to day grind of having to educate over and over again those who might have control over the policies that might affect what I would be allowed to do. Its so much easier to have patience when you're working from the outside as I used to do, with Ministers of Health, District Health Officers, and Community Health Workers. At least then, the years that it takes to slowly win them over to better practices for supporting breastfeeding, didn't have an immediately negative consequence on my day to day activities. If they disagreed, I didn't have to worry about losing my job, I'd just plug away at them slowly over the years. So, for those of you working in hospitals, I have developed an enormous amount of respect for what you do. I must confess, however, that I find some of the concerns over the split between "medicalization" and "lay" counselors is probably due to the fact that most lactation consultants in the United States do come from a hospital setting where it is only natural that the medical concerns are far more emphasized. When I had my son, I thought that lactation consultants would primarily come from a nutritional background because of the long-term relationship that is developed while breastfeeding, rather than the short-term initiation in the hospital. This obviously comes from the bias I have about my own background. I think there is a lot of room for building bridges across professional backgrounds within the LC and lay communities. We each share a perspective that is extremely valuable. I do feel that the situation in breastfeeding is topsy turvy from the developing country health care systems. For many years, developing countries suffered from a lack of community health workers. They did have some secondary and tertiary care facilities, but most people had no access to these expensive facilities. Moreover, there were not enough facilities to go around. Hence, there was a big push to get the sort of primary care that most people need out to where it was needed. So now the primary care systems in developing areas of the world far more developed than 20 or 30 years ago (while it is deteriorating in the US). Primary: I look upon the "lay" counselors as the front line of people who are helping women breastfeed. There should always be more "lay" counselors because they will have closer access to women who need help for the entire duration of their nursing experience and they can reach more women. Similar to the primary health care workers in developing countries. I feel that La Leache League provided the primary care to keep breastfeeding going on some level in backward developed countries such as the US (as opposed to Norway). While it may have been considered "subversive" by those who consider these wonderful dedicated women to be "breastfeeding Nazis", they kept breastfeeding from entirely dying out during the era when medicine thought they had outsmarted mother nature. So, while I'm sure we'll all agree that breastfeeding rates weren't what they should have been, La Leche League and other lay counselors made sure it didn't dieout. Secondary: I see lactation consultants as the secondary care system that is just getting going. For two generations of women in backwards developed countries, if you had a clinical problem that couldn't be managed on your own or with lay counseling, that was it. You were encouraged to give formula. The profession is new, just developing its standards, and still struggling with recognition. I heartily endorse the comments of those who have said that we cannot water down our qualifications. We MUST work on getting respect and that means maintaining high standards and having those standards recognized. And as professionals, we should be maintaining bridges with the primary care system - the lay counselors who are always going to reach more women than we could ever hope to reach. They should feel confident referring women to us who need clinical care. And we should be recruiting new members because are numbers are still woefully inadequate to truly support women in backward countries where breastfeeding is not fully supported, such as the US. Tertiary: I see breastfeeding medicine specialists as the tertiary care system. This area has been even more neglected than the secondary care level. All the women who happen to be the asterisks in the breastfeeding books - the women with PCOS, tubular breasts with inadequate glandular tissue, messy infections who don't get proper treatment, etc. These are areas where the IBCLC needs an MD (or and IBCLC MD) to back them up with appropriate treatments for these women. Its appalling that there is only one breastfeeding medicine specialist that works in a city the size of Manhattan - and a handful of obstetricians who dabble in this area. I found it terribly arrogant and disturbing when one of the endocrinologists at the ABM meeting last year bascially said there is no treatment for endocrinological issues that cause low supply. In a country where we have specialists for every single body part down to our toenails and you can reshape your breast into any form you think is beautiful, it is ridiculous that women can't get help when they truly have some primary problem with the true function of the breast in producing milk. The support system for women trying to breastfeed is incomplete without all three areas working well and working together with each other. So, whereever you are on the spectrum from lay counselor to specialized breastfeeding medicine specialist, think about how to build bridges to the others whose skills you may not yet be confident about - but may either be better than you think or might florish with appropriate dialogue. Susan E. Burger, MHS, PhD, IBCLC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html