pregnancy, birth & lactation services… at home
So something’s happening currently that has my thinking juices stirring (if there is such a thing). The state of Georgia is considering H.B. 363 which provides for the licensing of IBCLCs. This would allow IBCLCs to be reimbursed by Medicaid and would ease the way for other insurers to accept IBCLCs as medical professionals able to offer ‘lactation services’ as described in the 2010 Affordable Care Act (ACA).
Sounds like a great win for breastfeeding moms and advocates, right? Well, no.
H.B. 363 *also* criminalizes anyone who is not an IBCLC and offers ‘lactation services’ including “Lactation assessment through the systematic collection of subjective and objective data; Analysis of data and creation of a plan of care; Implementation of a lactation care plan with demonstration and instruction to parents and communication to the primary health care provider; Evaluation of outcomes; Provision of lactation education to parents and health care providers; and The recommendation and use of assistive devices.”
That’s right- if this bill passes no one- not midwives, breastfeeding educators, childbirth educators, Certified Lactation Counselors,- no one who works privately and collects a fee for services will be able to practice. One would be *breaking the law* to hold a prenatal breastfeeding class for families in the community or for doing normal business within the scope of one’s training. Unless you are an IBCLC or working for a government agency like WIC. [Edited 4/25/13- see note at end of post].
How can this *possibly* increase awareness of breastfeeding? How can this *possibly* increase access to lactation information? Will childbirth educators who offer a unit about beginning breastfeeding in the hospital be hauled off to jail for daring to teach this subject? Or will only those who agitate the ‘powers that be’ be prosecuted for breaking the law?
Currently, the ACA requires (some) insurance providers to cover lactation services by professional lactation care specialists (many kinds of professionals can and have become credentialed by insurance companies to provide these services). Passage of H.B. 363 will mean that poor women will have their right to choose their own provider taken from them (only IBCLCs will be offered for lactation care services) , but even those women willing to pay out-of-pocket for the care they desire from the professional they desire will be unable to. I’d like to believe that most IBCLCs will look at this law and realize that it is not in women’s and babies’ best interest and would work against its passage. Criminalizing breastfeeding assistance is *not* the way to protect, promote and support women!
Several other issues come to mind with this: Firstly, what evidence exists that shows that IBCLCs provide better care than other kinds of lactation professionals? No one doubts that most IBCLCs do excellent work, but is there evidence that they should be the only professional able to operate? Where’s the data backing up this call to criminalize anyone not approved by the International Board of Lactation Examiners?
Secondly, who decides which professionals are best suited to meet women’s lactation care needs? Is it the group that certifies a specific kind of lactation care specialist or that group’s trade organization? Is it the mostly male Georgia legislature? Shouldn’t a woman be able to select the professional most appropriate to her needs? Many midwives will hear echos of another debate about access to perinatal providers in these questions. It’s so strange to feel that I could possibly be one of those women who would risk prosecution if I practice in the wrong state…
This past weekend, I had a client come to my home on her way home from church. She is a very conservative, religious woman and she was looking for someone within her own social group to offer her breastfeeding assistance. Generally, she uses a nursing cover even when in a private room if she is not at home. During our time together, we were able to speak about culturally connective things, things that we each understood and appreciated and this put my client at ease. When her son awoke from his nap, my client felt comfortable exposing her breast and allowing me to watch how she and her son were working together. We addressed the issue positively and she left- satisfied and grateful- with a care plan and advice to help her meet her personal breastfeeding goals.
In Georgia, I could have been arrested.
Women’s bodies belong to themselves. Ultimately, *women*, not the professionals who measure, parse, examine and assess, should be making the decisions about who they go to for care. Choosing to reimburse some and not others is one (misguided) thing, but criminalizing women’s wisdom about their own bodies is another thing altogether. Wisdom about breastfeeding belongs to women. It is part of who we are, part of our history, our biology, our story. It isn’t right that *any* legislative body should decide that certain women can’t share this wisdom, can’t ply their chosen profession and passion, especially when that means that women who *want* services will be denied them. Or that women will face prosecution if they dare share their knowledge and skills.
See also: Unintentionally Disenfranchised by Shahira Long and Kim Bugg for more about this issue and here’s a petition for the Georgia Legislature.
[Edited 4/25/13- Upon further reading of the law, doulas and childbirth educators are, indeed, allowed to provide “non-clinical lactation education”. The law still criminalized anyone except IBCLCs offering clinical assessment, lactation management or counsel in the use of lactation aids except as noted above (working for a government agency like WIC, volunteering, etc.)].
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