I so agree that birth is way overmedicalized and most women benefit from having a skilled birth attendant but not necessarily a doctor. I also agree that normal breastfeeding can be supported by lay or peer "counselors" or just other mothers who have been there, done that. However....it is unfortunate that (at least in the USA) many births do occur in hospital environments and pregnancies are managed medically. There are also alot of less than healthy mothers and babies all around. Until and if the tide ever turns to "normal" birth and breastfeeding, I think there is a real need for LCs who are somewhat "medically trained." I work in a small rural hospital about 1000 births per year. Virtually all mothers are low income and on public assistance. Breastfeeding rates are quite low, especially bf continuation, and moms usually return to full time employment at 6 wks. Yesterday my case load was thus: 1. 35 wk infant feeding fairly well, experienced mom -- going home on day 2, should do well -- will get early followup visit. 2. 35 wk infant, primip, not eating well at all; going home anyway on day 2. will need followup - pumping - etc 3. infant with respiratory distress and probable sepsis, in special care nursery on oxygen, IV, antibiotics 4. infant born at 34 wks gestation, mother with insulin dependent diabetes and PCOS, skin tags, hirsutism 5. 34 wk infant not gaining, came in for 48 hr followup, ineffective, lenghty feeds - yes pumping too but mom decided to do more bf. 6. antenatal visit with mom with infertility x 6 yrs; PCOS Would peer counselors or LLL Leaders be comfortable totally "managing" these mothers and babies? Without a physician conferring? I am truly curious because I realize every country and culture is different and healthcare systems are vastly different. Or do you think an LC with didactic and clinical experience with sick moms/babies would be useful. We get alot of moms with pregnancy induced hypertension, pre-eclampsia too. Perhaps this is why ILCA has added USLCA becue the healthcare system and the health of folks in the USA is so less than ideal. I admit we are not the model of good health. Respectfully, Laurie Wheeler, RN, MN, IBCLC rural MISSISSIPPI - s.e. USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]