A lot of this comes out of how the IBCLC started in the first place, which was with a group of La Leche League Leaders who saw the need for breastfeeding support that was beyond what could be consistently given by volunteers. These women came from a great variety of backgrounds and gained their advanced lactation skills through experience, sharing with their peers and self-education. And while at the same time they wanted to retain this diversity of backgrounds (avoiding overt "medicalization" of the profession), they also wanted to be recognized as allied health professionals - get referrals from HCPs, be covered by insurance, etc. The issue was, all other health care professionals graduated from a recognized, degreed college program and getting recognition as professionals without that step was problematic, and remains so to this day. In an attempt to rectify this situation, the pathway towards becoming an IBCLC has become more closely aligned to what is seen in other health professions. One of the most vexing problems is the lack of a clinical phase which is part and parcel of any health professional's training - how can you really judge a person's abilities without actually watching them practice on a daily basis? Because only those already in a health profession (nurses, mostly) have easy access to this kind of supervision, those who are not already nurses are left scrambling for access to mentors and still are unlikely to gain access to hospitals in order to participate in the care of immediate pp women. IBLCE is actually suggesting to those that call in for help with this to become LLLLs because it will likely be the only way they could ever get the number of hours necessary to qualify to sit the exam - not sure how LLLI feels about this. And this could become problematic because neither LLLI or some of the other organizations listed as acceptable actually fulfill the stated requirements of IBLCE. IMHO, the lack of mentorship by experienced IBCLCs has been the root of many of the problems that we see with those who have the credential, but not really the skills - they passed the test (and there is no dearth of programs to help you do this), but don't really have the deductive nor counseling skills one should expect when consulting with an IBCLC. I applaud the IBLCE for trying to tighten things up by not allowing applicants to use previous experience as countable hours and the supervising IBCLC having not been newly certified herself. I don't think that the philosophical divide between looking for respect from the medical profession while still looking for diversity of backgrounds (and a non-medical pathway) has been resolved. It has long been a fear of mine, and probably others, that the medical profession would eventually co-opt the whole process and make lactation another nursing specialty that could then circumvent the whole IBCLC issue entirely. I do see that happening now. Considering that the only IBCLCs that are actually making a working wage (for the most part - there are always exceptions to the rule) are those employed by hospitals, clinics or physician groups, that would eliminate income for all those folks, unless they were already nurses (many of them are) and can simply acquire the new credential. Please do not misunderstand that I do not have respect for RNs who are IBCLCs - many of my close friends back in NY fell into that category and we worked together for many years helping the women and babies in Rochester. However, there is also no doubt that in the past many nurses who did not have a strong background in lactation were nevertheless able to obtain the IBCLC credential by taking advantage of the pathway that was available to them. I do not have a good solution for any of this. I do think that if Healthy Children is in any way making it easier for folks who are not IBCLCs to present themselves as equivalents, then that is a big problem that the IBLCE needs to address immediately for the sake of our profession. Those who are teaching CLCs need to make the distinction very clear and there needs to be follow-up on those who may be abusing their credential. I am of mixed feelings about licensure. When licensing became mandatory in the past few years for medical technologists in NY, I saw no benefit to the profession - it simply put more money into the state pockets. However, we were already recognized professionals, graduates of a four-year university program, do not generally work solo, so the analogy may not be appropriate. For a profession trying to get recognition and to put themselves apart from the many other lactation folks in the field, it could be beneficial. Would it really give us better standing with physicians? I don't know, would like to hear more about that. As for insurance companies, that is also a dual-edged sword. So, those are my thoughts on this, for what it's worth. I do think that it is remarkable that we (IBCLCs) exist in the first place and that we have persisted through all these years - it is a testament to the hard work and tenacity of those who have led the IBLCE and ILCA through the years and to all of us who have continued to practice and promote the credential as we help mothers and babies. We need to pull together and not let all of these important, but difficult, issues to force us apart. I do think that issues pertaining to the credibility of our credential are very important and do deserve our attention. I don't think that giving that attention necessarily means that other issues, such as Nestle, will not also be addressed or that those concerned about the credentialing issue should in any way be chastised or demeaned. We do know how to multitask. Sharon Knorr, IBCLC Colorado, USA On Sun, Mar 11, 2012 at 12:34 PM, <[log in to unmask]> wrote: > The discussion I have read this week is exactly why some physicians do not > take lactation professionals seriously. Whether by IBLCE, State Licensing > or some other method, you need to take control of your profession, or the > MDs will! > > Nancy > Nancy E. Wight MD, IBCLC, FABM, FAAP > Neonatologist, San Diego Neonatology, Inc. > Medical Director, Sharp HealthCare Lactation Services > Sharp Mary Birch Hospital for Women and Newborns > > *********************************************** > > Archives: http://community.lsoft.com/archives/LACTNET.html > To reach list owners: [log in to unmask] > Mail all list management commands to: [log in to unmask] > COMMANDS: > 1. To temporarily stop your subscription write in the body of an email: > set lactnet nomail > 2. To start it again: set lactnet mail > 3. To unsubscribe: unsubscribe lactnet > 4. To get a comprehensive list of rules and directions: get lactnet welcome > *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome