Saturday, April 30, 2011

What I missed

You know you were (are) a Google Reader addict when you get back on after giving it up for Lent, and it's stopped counting new posts after "1000+". If I was going to be really true to my Lenten vow I would have marked them all as read and started afresh. But I did skim some of my faves. So while these links are probably old to everyone else, here are a few that jumped out at me:

Navelgazing Midwife on Touring L&D suites around the country and wondering what they say about what patients want...or are supposed to wait. I commented about how often hospitals seem to advertise "private rooms"... even in pretty dingy public hospitals I have yet to work with a doula client who got anything but a private room, whether L&D or postpartum. Is this just an advertising gimmick?

The Academy of Breastfeeding Medicine on audio galactagogues for mothers of babies in the NICU. I want to hand out little MP3 players to all the pumping NICU moms I see! It made me wonder whether a Hypnobirthing/Hypnobabies type of track targeted especially to NICU moms to listen to before or during milk expression would be helpful.

Alanna at Blood and Milk on how "helpful" postpartum visitors are a lot like "helpful" aid organizations.

Via Motherwear Breastfeeding Blog, a NY Times article on the deadly consequences of cultural beliefs that deprive babies of breastmilk in developing countries.

Thursday, April 28, 2011

AmeriCorps doula job posting

As I noted in my post on AmeriCorps doula opportunities, I don't generally have any info about what's currently out there. AmeriCorps programs and positions are constantly changing and I don't even know what's happening with my old program, much less anyone else's! But I have a friend looking for AmeriCorps positions in Seattle right now and she sent me this posting:

Member Duties : Two positions are offered for members who will train as a Birthing Doula with Seattle Midwifery School. Members will then serve as part of Seattle's MSS Department providing pre and post labor education as well as labor support to clients who lack a support system. This position requires independence, sensitivity, a willingness to work independently, and the ability to handle a demanding on-call schedule as well as bilingualism in Spanish and English. To learn more about the role of a Doula visit IN ORDER TO COMPLETE YOUR AMERICORPS APPLICATION, PLEASE COMPLETE AND SUBMIT THE SUPPLEMENTAL QUESTIONS LOCATED ON THE SEA MAR WEBSITE. These questions can be found by clicking to, then pulling down the menu "Jobs", clicking on "AmeriCorps" and clicking to "How To Apply".

Program Benefits :
Childcare assistance if eligible , Education award upon successful completion of service , Health Coverage , Living Allowance , Training .

Terms :
Permits attendance at school during off hours , Permits working at another job during off hours .

Service Areas :
Community Outreach , Education , Health

Just reading the job description brought back such wonderful memories of my work as an AmeriCorps doula! I still describe that job as, hands down, the best job I ever had. If you're interested, go for it! (I promise my friend won't be competing with you... she's more interested in estuarine ecology.)

Wednesday, April 27, 2011

Reply turned post: Bottle feeding, breastfeeding, and the NICU

I vent a lot (maybe too much... trying to stay open to positive possibilities for education and cooperation) about the NICU & breastfeeding.

Because of those challenges, this post on My OB Said What caught my eye today: "You’ll get him home sooner if you just bottle feed," – NICU nurse to breastfeeding mother of a NICU baby. Many commenters chimed in to rightfully assert that the mother's breastmilk is much better than a bottle of formula, especially for a NICU baby, but I think this is not quite what the nurse meant. This was my comment:

"This is sad but true... the requirements for the NICU babies to go home is to take all feeds PO (by mouth), maintain their oxygen sats on room air, and maintain their temp. The PO feeding requirement leads to a lot of bottles because they are the easiest and fastest way to declare the baby capable of all-PO feeding. I have met very few moms able to avoid any bottles in the NICU. It basically means insisting on gavage feeding for every feed at which the mother is not present, and it is hard for the mother to be present 24/7 because the NICU is not set up for that. So it absolutely can mean that the baby stays longer. It is very frustrating because direct breastfeeding is best and least taxing for these babies."

It's a real catch-22. The way to prove the baby can do OK on all PO feeds is for the mother to breastfeed him/her around the clock. But there is often nowhere for the mother to sleep after she's discharged from the hospital herself. So to be with her baby 24 hours a day to breastfeed, she has to agree to bottle feeds to "prove" her baby can effectively take all feeds by mouth. The bottle feeds can and do cause issues with breastfeeding, but even for the most motivated mom, it can be a very difficult choice between agreeing to many bottles, and waiting extra days to take her baby home.

Recently, I saw a baby born at 32 weeks go to the NICU, have nothing but breastmilk and never have a single bottle touch her lips, and eventually go home feeding exclusively at the breast. Her mother was highly educated and motivated, had excellent family and community support, and really advocated for herself and her baby. As LCs, we were all so amazed and impressed by what they did. It was truly an accomplishment in a NICU environment... and it took bucketloads of privilege. Very few people are able to accomplish that without support from the staff, which the nurse quoted above was definitely not providing. Staff support is a huge issue. I have even heard a NICU nurse say "If they don't want to bottle feed, I just tell them 'We can put a tube down your baby's nose instead' [referring to gavage/NG tube feeding] - that changes their mind!'" A really inappropriate thing to say just to scare parents, given that this way of feeding may be necessary for certain babies who aren't able to safely do PO feeds.

In my perfect fantasy world, NICU babies who are ready to do PO feeds are moved to private or semi-private rooms that have a space for mom to sleep, so she can be with the baby 24/7 and breastfeed easily. She can stay there until the baby is ready to go home. Bottles are only given with explanation and consent, used appropriately, and stopped quickly if they begin to cause breastfeeding issues. Is this really such a crazy fantasy?

Friday, April 22, 2011

Short but sweet on why dads/partners should love doulas

Trying to convince a reluctant family member of your need to have a doula? Try this quote on them, from an OB-GYN I know who had a doula at her first birth: "I can't say if having a doula shortened my labor, but it definitely lengthened my marriage!"

How people find my blog

I was looking through my stats tonight and thought I'd do a runthrough (as I've seen and enjoyed other bloggers do) of some interesting search keywords/phrases that lead people to my blog. Some of them are pretty interesting, some just...puzzling.

"doula newspaper"
This made me think of how fun an all-doula newspaper would be, imagining breaking headlines like "Hospital X gets telemetry monitors!" and an advice column with questions like "My friends are tired of me talking about birth all the time, but I just want to educate them! Who is right?"

"was getting an MPH a mistake"
It is for some people, but I'm afraid Google's not going to help with the answer for you personally.

"should I get an MPH"
You should probably talk to the above person first!

"counting from 1 to 10 while pushing"

"public health insomnia"
Pretty sure that's what I have when I lie awake at night constructing new prenatal education programs in my head.

"is breastmilk best for babies with downs syndrome"
YES! (As breastmilk is best for ALL babies, save a rare few with unusual metabolic disorders.)

"Why do nurses supplement formula to breastfeeding infants"
Pick any combination of the following: ignorance, misguided good intentions, hospital policy, habit, maternal request, laziness, active dislike of breastfeeding.

"doula unqualified neonatal nurses"
Act as a doula to unqualified neonatal nurses? Should unqualified neonatal nurses be doulas? This is one of the puzzlers.

It's Good Friday (just barely) which means 2 more days till I'm back reading blogs! I will confess I broke it just a teeny bit today to check up on Gina's labor/birth at The Feminist Breeder. Very happy for her and so interesting to see the liveblog as it unfolded! Go check it out.

Tuesday, April 19, 2011

Mollie's birth story

My lovely friend Mollie just had her baby last week and I am so happy for her! She just posted her birth story on her blog. Before she had it written, she e-mailed me a teaser:

Chris is dozing in the room, I'm in the hall with the Doula, midwife had gone to lie down. We walk down the length of the hall, back to the other end, about half way back and then...
Chris tells it as "I was about to doze off, and then I hear her yelling, 'I can't do it, I can't do it, I'm pushing, make it stop, something came out!'"

Doesn't that make you want to read the whole thing? (Plus you get to see photos of that cute little baby.)

Stay tuned for a guest post by Mollie on how she went about choosing her care providers and place of birth, laying the foundation for a positive (and exciting - in the good way) birth experience!

Thursday, April 14, 2011

Michael Latham, breastfeeding advocate

From the NY Times:

Michael C. Latham, an expert on international nutrition and tropical health who waged a long campaign against the use of infant formula and for the practice of breastfeeding in developing countries, died on April 1 in Boston. He was 82 and lived in Newfield, N.Y.

The cause was pneumonia, his son Mark said.

Dr. Latham, who directed the Program in International Nutrition at Cornell University for 25 years, first encountered the problems of nutrition in the developing world while practicing medicine as a young doctor for the British colonial service in Tanganyika (now Tanzania).

After the country had gained its independence, he stayed on and was appointed the director of the nutrition unit of the public health ministry. He became alarmed at efforts by Western companies to expand their marketing of infant formula to underdeveloped countries, where high birth rates promised a growing consumer base, and he became one of the first and most forceful public health scientists to sound a warning.

In many poor countries, he pointed out, mothers mixed powdered baby formula with contaminated water, leading to diarrheal diseases. To make the formula last longer, they often used too little of the powder, depriving their babies of vital nutrients.

Bottle feeding was “incredibly difficult and extremely bad,” Dr. Latham wrote in a 1976 report with Ted Greiner, but “the media onslaught is terrific, the messages are powerful and the profits are high.”

“High also is the resultant human suffering,” they wrote.

Dr. Latham’s cause, taken up by several health groups, led the World Health Organization in 1981 to develop a set of guidelines, the International Code of Marketing of Breast-milk Substitutes, which was intended to govern the behavior of private companies. He was a prominent figure in the boycott of NestlĂ©, a leading manufacturer of infant formula, which agreed in 1984 to abide by the marketing code.

Read the rest here.

Sunday, April 10, 2011

Link time! Research & investigation style

In the news and/or my e-mail inbox:

* A new book "Sanctioning Pregnancy: A Psychological Perspective on the Paradoxes and Culture of Research" by Harriet Gross and Helen Pattinson. From their description: "Sanctioning Pregnancy offers a unique critique of sociocultural constructions of pregnancy and the ways in which it is represented in contemporary culture, and examines the common myths which exist about diet, exercise and work in pregnancy, alongside notions of risk and media portrayals of pregnant women." Google Books preview here.

* The FDA will be investigating nutritional claims by infant formula manufacturers.

* When do breastfed babies need extra iron?

* The Full Spectrum Doula Network (FSDN) has several members conducting research who are looking for participants - from the FDSN newsletter:

* FSDN member Ryan Pryor is conducting a study and oral history project of queer and gender non-conforming birth workers (link here)
* FSDN member Laurel Ripple Carpenter is conducting interviews of full spectrum and radical doulas for an ethnographic study at Burlington College and Mesa State College (link here)
* FSDN member Monica Brasile is conducting an online survey of doulas for her PhD research in Gender, Women's, and Sexuality Studies at the University of Iowa. She's especially interested in representing the voices of radical and full spectrum doulas. (link here)
* Erica Varlese is conducting interviews of doulas who offer pro-bono or volunteer services or who work specifically with marginalized groups of women. (link here)

I did an interview with Laurel and it was a great experience (and I'm really looking forward to reading her final product). If you're a doula who falls into one of these categories, please consider helping out!

Friday, April 1, 2011

Thoughts on IBCLC training, reimbursement, and where the profession is headed

I don't remember when I first realized that the profession of "lactation consultant" existed. I must have encountered it at some point doing research for my undergrad senior thesis, which was (to make it very brief) a literature review and mixed-methods study on infant feeding decisions. The following year, when I did AmeriCorps, was my real introduction to the world of breastfeeding support: I did a 3-day training to become a Certified Breastfeeding Educator (taught by an IBCLC), began doing breastfeeding support in the clinics, and did some shadowing with in-hospital IBCLCs. That experience made me realize that I wanted to be an LC. One of my absolute favorite parts of the job was doing breastfeeding support, and I liked what I saw the LCs that I worked with getting to do. I enjoyed the one-on-one interaction, the clinical problem-solving, the feeling that you were working to help the mother achieve something that was important to her, and the satisfaction when something you suggested worked and - click! - for the first time, mom and baby had a successful feeding.

At the time, though, I looked into becoming an LC and couldn't imagine a way to get enough hours. At the time, IBLCE (the certifying organization for LCs) required thousands of hours of clinical practice to be eligible to sit the exam (for an interesting historical overview of IBCLC eligibility requirements, check out this presentation - opens as a PDF). When I was looking, the requirement was 2500 hours of clinical practice, which I would have to find a way to get independently (since apart from my one-year AmeriCorps term which was already over, I didn't have a job where I could get hours that would count towards my eligibility).

And I really considered how to make it happen. For years, I wanted to become an LC, and I would investigate ways to do it, and then I would give up again. And in this post I'm going to talk about why.

I've been putting off, mulling over, composing and revising this post for a long time. The seeds were sown when I first heard about the new requirements to sit the IBCLC exam, and when I read debates on Lactnet and other listservs; I've gotten e-mails and read other people's posts about this issue; but it's taken a while for me to figure out my thoughts about it.

The impetus to finally put this out there was sparked by some conversations I had at the Breastfeeding & Feminism conference with IBCLCs and IBCLC-wanna-bes. The wanna-bes talked with me about the difficulty of finding and funding training, the IBCLCs talked about their awareness of that difficulty, the limitations of the LC community in addressing the shortage of good training, and the issues with the current pathway system.

This is my current thinking and I'm very curious to hear what others think about it. I apologize for the length - it's quite possible it could be shorter and more succinct, but if I spend too much more time revising it will never get posted!

To start off, a little background about how you become an IBCLC: historically, there have been different pathways to qualifying to sit the exam. They have changed names and requirements more than once, but in my understanding they've all fallen under more or less two different routes:

1) Becoming an IBCLC already having some kind of medical/nursing/clinical degree. To qualify to sit the exam, these people have to have some lactation-specific education (although it is not standardized - hours from a vast array of providers and topics can count), and they also have to meet a minimum number of hours spent working with breastfeeding dyads. Importantly, these hours do not need to be under the direct supervision of an experienced IBCLC and can happen as part of the professional's regular work. So a nurse on a postpartum floor, a pediatrician, a dietitian at a WIC office - all of these people may be able to get their minimum hours through their work. (Pathway 1 in the current system.)

2) Becoming an IBCLC without having any kind of clinical degree. To qualify to sit the exam, these people have to also have lactation-specific education, and they need to meet a minimum hours requirement. However, their minimum hours need to be completed under the mentorship of one or more IBCLCs who have recertified at least once. (Pathway 3 in the current system.) These people can also do an educational program approved by IBLCE (Pathway 2), which provides the mentoring, hours, etc. all in one package, and requires somewhat fewer minimum hours, but those programs are few and far between.

Starting with those who will sit the exam in 2012, IBLCE is changing the requirements. From their information page on the upcoming changes:

IBLCE has identified eight subjects in which all first-time candidates must have completed the equivalent of one semester of higher education. These 8 higher education courses are:

* Biology
* Human Anatomy
* Human Physiology
* Infant and Child Growth and Development
* Nutrition
* Psychology or Counseling or Communication Skills
* Introduction to Research
* Sociology or Cultural Sensitivity or Cultural Anthropology

In addition, all first-time candidates must have completed continuing education in 6 subjects that health professionals typically will have studied as part of their professional training and/or are required for ongoing maintenance of their professional credentials. These 6 additional general education subjects are:

* Basic life support (e.g. CPR)
* Medical documentation
* Medical terminology
* Occupational safety, including security, for health professionals
* Professional ethics for health professionals (e.g. Code of Ethics)
* Universal safety precautions and infection control

The discussions I've seen online have covered a range of reactions. A lot of people are very upset about the new requirements. They argue that requiring all this essentially requires you to become an RN if you want to become an IBCLC (almost all of these are either required in nursing school or required prerequisites for nursing school). Some individuals from other countries have noted that there simply is no way for them to take these courses - they don't have community colleges or schools where you can just take a few credits here and there - unless they actually do enroll in a full-time academic program to become a nurse. Additionally, some people feel that lactation consulting is already becoming overmedicalized and is moving away from its unique roots in peer counseling, focus on empowering the mother, and in helping mothers find their own solutions vs. prescriptive "treatment", and this is accelerating that trend.

Other people are very supportive of the new requirements - even some people who came up through old, non-clinical pathways. They argue that if IBCLCs want to become respected as a clinical practice specialty, they need to have requirements that parallel other clinical degrees. MDs, RNs, OTs, PTs, etc. etc. - none of them begin practice, and most don't even begin their training, without taking basic courses in biology and anatomy, nor should they. An IBCLC who doesn't understand fundamentals of nutrition shouldn't be counseling a mother about appropriate complementary foods, and an IBCLC who can't read and communicate in medical terminology and documentation won't be respected by other clinical professionals that s/he is expected to work with.

IBLCE addressed some of these concerns directly in their FAQs page about the new requirements:

17. With these new requirements, it seems to me that IBLCE is discouraging those of us who are not health professionals from becoming IBCLCs. I know of several IBCLCs in my community who are not health professionals and they are well respected. Why has IBLCE placed so much focus on the new general education requirements?
IBLCE continues to support the long-standing practice of welcoming and encouraging practitioners, who are not health professionals, to prepare and become IBCLCs. The ability to actively listen and take the time to collaborate with mothers in developing an appropriate care plan and the dedication to supporting families beyond the early postpartum period are some of the well-developed competencies of candidates who are not health professionals.

As the lactation consultant profession has matured, it has become clear that it is necessary for all IBCLCs to be well-grounded in those subjects that are typically studied by health professionals. A strong foundation of knowledge in the health disciplines that are typically included in health profession curricula will position all IBCLCs to function as well-respected members of the maternal-child health team. In addition, employers and policy-makers will have increased confidence in the IBCLC credential. With this increased confidence in place, initiatives such as licensure, reimbursement and more jobs for IBCLCs are more likely to be successful.

22. I'm an experienced IBCLC and hold no other credential in the health professions. If I were not already certified, I would not be able to qualify for the 2012 exam without returning to school. This does not seem fair and it appears that IBLCE is discouraging non-health professionals from applying. Did the IBLCE Board take this concern into consideration before making the changes?
Yes. The IBLCE Board gave quite a bit of consideration to your particular concern. In fact, there are a number of Board and staff members who are IBCLCs that hold no other credential in the health professions. The IBLCE Board holds the mother support background in such high esteem that the IBLCE By-laws require that no less than 51% of Board members have experience in mother support leadership. In spite of concerns similar to yours being expressed, the consensus of opinion was that improving the quality of the IBCLC credential was of utmost importance. The Board voted overwhelmingly to support the changes.

I see both ways on the new requirements piece. Unfortunately there are a lot of LCs out there who don't know what they're doing. And unfortunately I don't think it has very much to do with their educational backgrounds.

The way I see it, there are bad LCs out there who have medical backgrounds and never bothered to do more than count up their contact hours with mothers/babies and study for the exam, without doing any training with other LCs to improve their skills/knowledge base. There are also bad LCs out there who don't have medical backgrounds and did their training without understanding important basics of anatomy, physiology, how to read research, etc. and who have never pushed themselves to improve their skills/knowledge. (There are also bad LCs out there who have great education/experience through whatever pathway and are just bad. There are also bad doctors, nurses, etc. etc. - being able to get through a rigorous educational program and pass a test does not, unfortunately, necessarily make you good at your profession. Sigh.)

But I believe that all the challenges these new requirements pose for IBCLCs-in-training - in the U.S. at least - have less to do with the requirements themselves, and more to do with the educational pathways available. And in the end, it all comes inevitably back to licensure and reimbursement. How? Let me explain:

It may be standard and reasonable for RNs, MDs, PTs, etc. etc. to have these courses as prerequisites or as part of their professional education. However, they are generally not expected to come up with the entirety of their professional education on their own. They have educational programs which provide at least some of their educational requirements, along with things like student loans, work-study positions, fellowships, or other structured financial assistance that helps students get through their education without having to pay for it all up-front, out-of-pocket.

This is not true of IBCLCs-in-training. Along with all of these distribution requirements, they need to pay for 90 hours of IBLCE-certified lactation education (under the old requirements 45 hours). This education - which can be conferences, online courses, in-person workshops, etc. - is not cheap. Finally, they often have to pay private IBCLCs for mentorship (if they can even find one – frequently a very challenging undertaking, one of the main reasons being that the private LC is essentially training her own competition). Understandably, mentor IBCLCs need to be compensated for the extra time and effort they put in for teaching. This is another chunk of change.

When you look at all that, you are looking at a significant amount of $$$ to become an LC. (You are also looking at the exact reason that even though becoming an LC was my dream from the moment I met one, I never did it on my own. We'll get back to this in a moment.)

There are a very small number of IBLCE approved educational courses that provide a really standardized, all-in-one education the way a medical or nursing school does: you get your clinical education and your clinical rotations in a package. If they're through an accredited institution, you might even be able to get student loans to help pay for it.

This type of program was how I managed to finally get IBCLC training, because one happened to get started at my school while I happened to be there. This is why I was so excited and honestly in awe of the fact that I was getting to become an IBCLC. Why was it so amazing to me? Why did I hold off pursuing this dream?

And this is where we get back to licensure and reimbursement. (I know this is U.S.-centric, but the U.S. has a pretty large percentage of LCs and I think that LCs face this issue to varying degrees around the world. It's also one of IBLCE's justifications for changing the requirements.) Many people who look at the new requirements have said something along the lines of "Then I might as well go ahead and become a nurse". Why would they say that if they want to become LCs? Because nurses get paid. Nurses are part of standard care in a hundred different practice settings, they are licensed, and what they do is reimbursable through insurance. This is among the reasons that non-RN IBCLCs are not generally hired by hospitals, pediatric practices, etc. and among the reasons that private practice IBCLCs have trouble making a living. (The US Lactation Consultants Association has an excellent white paper on reimbursement - particularly relevant are pages 14-15).

There was no way I could justify, to myself, sinking thousands of dollars into an education that would take years and lead to a profession that could probably never be my sole source of financial support. I most definitely couldn't justify paying out-of-pocket for all that education or figure out a way to do it without decimating my future financial health and again - for what?

I think that the solution to all of these problems - training, education, experience, or lack thereof - is to have more standardized educational programs available through accredited schools. But I imagine schools, if/when they consider offering IBCLC training programs, will have financial concerns similar to the ones I had when contemplating the certification. Will they really have enough students willing to pay the amount of money needed to sustain those programs, now that these programs are about to get a lot more expensive?

The bottom line to me: you can get people to pay for years of nursing school, med school, etc. because they know they can pay back those loans eventually, and support themselves. The same promise is not there with LC work and until it is, more and more stringent educational requirements make it harder and harder for people to get into the profession without having some other professional credential that will get them reimbursed fairly for their work. An MPH student (not an RN) asked me at the conference whether I would recommend her doing the IBCLC course next year and because the cost of it has risen so much since I took it, I honestly couldn't give her a strong "yes" unless she is willing to commit to a life of private practice. She pointed out that I have a hospital position, but I assured her that I got it basically through sheer luck and those positions are few and far between.

I get that IBLCE is aiming for that eventuality of licensure and reimbursement and that they're hoping that changing the requirements will be a step in that direction. They say as much in the FAQs:

15. These new requirements will make becoming an IBCLC even more expensive. Are the IBLCE Board members concerned that the new requirements will reduce the number of applicants who are eligible to become IBCLCs?
The new requirements may result in a decreased number of exam candidates in the short term. However, the reason for making these changes is to increase the value of IBCLC certification. The IBLCE vision for the IBCLC credential is to "increase the number and improve the quality of IBCLCs."

IBLCE is the global authority in lactation consultant certification and raising the educational standards for the lactation consultant profession is crucial to the future growth and value of the IBCLC credential. While there may be a short-term drop in the number of prospective IBCLCs, the increased value of the credential will make IBCLC certification more highly desired by not only first-time candidates but also by recertifying IBCLCs.

But what’s not really acknowledged here is that a profession that was already fairly inaccessible without great financial privilege will now be almost totally inaccessible. A lot of IBCLCs have said to me, "Oh, we're so glad to see you! We see so much gray hair at LC conferences, we need young people in the profession!" But young people can't afford to go into the profession, to say nothing of other groups that may have greater financial and family struggles. I go to LC conferences and see almost all white faces. IBLCE acknowledges that fewer people may sit the exam under the new requirements, and they promise a future pay-off. But how far into the future?

So that's what I'm thinking right now. And one final slight tangent: the other thing that writing this post has made me realize really bothers me is the current requirement for practice hours for clinical professionals. I think the need for all this RN-like training especially digs at some people because those who come through non-clinical pathways train for hundreds - and, under previous pathways, sometimes thousands - of hours under experienced LCs (and paid for those hours). However, RNs get to count up hours they spend as part of their jobs - no LC supervision necessary - and then take the exam. I’m not saying this experience is not valuable, but we don’t say to nurses “Hey, you do a lot of things that are related to what doctors do – pass the medical boards and you can practice medicine!” And IBCLCs spend a lot of time talking through anxieties and emotions with their clients, but can’t just count up those hours, take an exam, and become licensed as therapists.

Let me clarify here that I am NOT saying that all, or even most, RN IBCLCs are unqualified! I have gotten my training almost exclusively from RN IBCLCs who I respect profoundly and are fantastic LCs. Several of them have, however, told me how lucky I am to be able to mentor with LCs because when they got their certification they had never worked with another LC and had to learn on their own a lot of what they're teaching me now. To my mind, if non-clinical professionals are now being asked to spend time and money getting the coursework that the clinical people already have, the clinical professionals should be required to spend the time and money on finding and using direct LC mentorship. I think that would be at least as big a step towards improving the quality of the profession as these new requirements.

And that's my more-than-two-cents! Other thoughts out there? Especially from prospective IBCLCs?