Lactation Guidance- What’s in a Name? Pt. III
Orignially Posted June 23, 2011
To begin this third post of this series, I’d like to take a moment to say something very explicitly: I believe that most IBCLCs are extremely well trained and are passionate advocates for women, children and their breastfeeding relationships. IBCLCs bless all lactation professionals with their contributions to the field and we are lucky to have their leadership and dedication. But there is a disturbing trend within some IBCLC leadership circles to lift IBCLCs up above all other lactation professionals. I am troubled by this unchallenged belief in the superiority IBCLCs- hence this blog series.
Why is it so very important for both professionals and the general public to accept that IBCLCs and CLCs are basically equivalent designations?
It is becoming clear to lactation professionals that we have done a good job of promoting breastfeeding in the US. The 2010 CDC Breastfeeding Report Card shows a 75% breastfeeding initiation rate in US hospitals which meets our Healthy People 2010 goal (http://www.cdc.gov/breastfeeding/data/reportcard.htm). Where we are still falling short in this country is in protecting and supporting breastfeeding mothers in the weeks and months after delivery. The CDC Report Card shows a marked decrease in the breastfeeding rate even after just afew weeks. Certainly, many women who begin breastfeeding are not meeting the AAP’s recommended 6 months of exclusive breastfeeding and continued breastfeeding for at least a year and aren’t coming close to the WHO’s recommendation of breastfeeding for at least two years.
We also know that a little over 4 million women gave birth in 2010- this means that approximately 3 million women initiated breastfeeding immediately after birth. How many IBCLCs do you suppose were available to assist these women in the weeks after delivery? There were 22,000 IBCLCs in 2008 (the last year I can find figures for) which means there is less than one IBCLC available for every 1000 women who begins breastfeeding in the US. There are simply not enough IBCLCs to do the work that must be done to help women prolong their breastfeeding experience.
These first few weeks and months after delivery are the time when women most need support to continue breastfeeding their infants; this is when women should be accessing any and all breastfeeding assistance in their communities- both peer support groups and leaders like Le Leche League and professional lactation guidance if needed. The IBCLC ‘gold standard’ myth may prevent women from seeking help from other qualified professional lactation guides in their communities by convincing women that only IBCLCs can really help them. But the offense goes beyond simply promoting a specific type of lactation assistance- some actually imply that any lactation professional who is not an IBCLC is a pretender of sorts and may even be dangerous to breastfeeding women and children. Consider this blog post on Best for Babes.org www.bestforbabes.org/are-lactation-consultants-too-pricey (which is generally an outstanding resource for breastfeeding support, information & advocacy.) Notice especially the Editor’s Note at the end of the piece:
To locate an IBCLC near you, go to http://www.ilca.org, click on “Find A Lactation Consultant” and plug in your zip code[…] Ask your support person if they are an IBCLC, helping you to know that you are getting the very best in breastfeeding expertise. (emphasis mine.)
If seeing women and babies succeed at breastfeeding is truly the most important thing to lactation professionals, it is time to ‘open up the field’ and to make room at the table for those with other professional lactation credentials. IBCLCs and CLCs have similar training. It is not possible to tell from the credentials what kind of experience, abilities or education a particular lactation guide has. Both IBCLCs and CLCs want to help women and babies breastfeed successfully and work to promote, protect and support that goal. Instead of making marketing materials that do NOTHING to further breastfeeding and only work to uselessly divide lactation professionals according to the initials that follow their names (http://uslca.org/documents/Who%27s%20Who/Who%27s%20Who%20Bro-FINAL.pdf), we each should strive to see the passion, the mind and the experience behind the letters- see the woman who chose to work on behalf of mothers and babies in our communities. And we must encourage new mothers to reach out to any qualified individual to get the help she needs wherever she is most comfortable.
If some want to continue to argue that IBCLCs are the ‘gold standard’ of lactation care, I would like to see the research to prove that. When I inquired at the United States Lactation Consultant Association’s Facebook page for studies proving that IBCLCs are MORE effective than other lactation professionals, I was given this link: http://www.facebook.com/pages/United-States-Lactation-Consultant-Association/301446675423?ref=ts#!/note.php?note_id=200826679963094 which is a wonderful testament to the work that IBCLCs do, but which didn’t really answer my challenge. There is ZERO evidence that IBCLCs are more effective than other lactation professionals. The idea that IBCLCs are somehow the best lactation guidance available is simply not supported by any evidence I could find. There are many people who state this as a belief, and some who state this as a way of protecting the IBCLC profession, but no one stating this is stating fact.
Another issue I have with the way IBCLCs are presented is in presenting them as ‘medical professionals’ which is claimed to make them more authoritative than CLCs. Consider this statement from Amber McCann, IBCLC who wrote the above referenced Best for Babes article:
Mothers have long relied on mother-to-mother breastfeeding support groups like La LecheLeague, which are outstanding when we have questions and seek a community of other new and experienced moms, but sometimes, the eyes and knowledge of a medical professional are necessary[…] The training to become an IBCLC is rigorous. It’s a major commitment, just like the training and education any medical professional must acquire. (emphasis mine again.)
Since when is a physiologically normal function of the human body the realm of ‘medical professionals’? To someone who is a normal birth advocate, this kind of statement worries me. I wonder if the IBCLC ‘gold standard’ myth is a throw-back to the old anti-midwife propaganda of the early twentieth century. If the IBCLC ‘medical professionals’ can convince the public that they are the only bonafide professional who can assist them, they corner the market in lactation guidance and enjoy both the esteem of the maternity and breastfeeding community and the financial benefits of having stamped out any competition.
I do not mean to imply that this is the attitude of all IBCLCs- but it is the stance of some. I became a CLC in May of 2011. Realizing that I have less experience than many CLCs or IBCLCs, I desired to find a lactation mentor who would allow me to glean techniques and skills from her experience. I called the IBCLC to whom I had referred several clients and explained my passion for breastfeeding couples and my hopes of assisting women and babies in the future. Her response: “I only work with women who are planning to become real lactation consultants.”
How very sad that this Lactation Consultant who is so gifted in helping women breastfeed successfully is perpetuating the idea that there are gradations of lactation professionals. I wonder how many women she’s influenced by advising her to get a ‘real’ lactation guide if she had trouble breastfeeding. That a lactation professional would put such a stumbling block in a mother’s way when she is in a vulnerable position and needs help to feed her baby- especially when there is no evidence to suggest that IBCLCs have better client outcomes over CLCs– is irresponsible at best. At worst, it is ‘turf warring’ where women and their babies become territory specific professions feel they must defend or lose their livelihood. This is simply unacceptable.
In part IV of this series, we’ll explore how to find really excellent lactation guidance.