Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

Discrepancies between IBCLC claims and reality

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Lactation consultants claim that their services are required in very few cases when breastfeeding presents a complex problem – premature infants, infants born with abnormalities, or when mothers suffer from diseases that interfere with breastfeeding. The reality of IBCLC education requirements does not fulfill the promise to prepare an IBCLC to deal with most of these complex issues. The basic general education requirements historically did not lay the foundation to deal with complicated pathology in either infant, or the mother.  The new 2012 general education requirements mimic requisites for a nursing degree, but severely lack in pathology physiology theory and hands-on training. Lactation education (theory) hours was bloated to 90 hours instead of 45. Clinical hours requirement varies from 300 to 1000 hours depending on the pathway to certification. Suggested venues to acquire clinical experience are hospitals, clinics, birthing centers, medical practices, public health departments, and mother support counselor organizations.

Taking into consideration that breastfeeding is a very practical skill, clinical skills should be very important, especially when helping women and infants whose experiences lie outside the norm. The requirement of clinical hours  looks good on paper. In reality, in every single setting except the hospital one would be hard pressed to encounter enough abnormalities and pathologies to develop any clinically significant level of expertise lactation consultants claim they should be able to handle. Even at an average hospital an average postpartum floor a chance at dealing with pathology and abnormality is infrequent. The most common pathology clinicians at hospitals encounter is prematurity. To have access to a wide variety of pathology in both mothers and infants a lactation consultant would have to be trained at a teaching hospital affiliated with a medical school.  To my knowledge, few, if any, lactation education programs offer this type of experience to develop entry level-expertise at the level declared by IBCLC certification.

Then lies the issue of developing the expertise further and continuously sustaining it. Again, this is only possible for selected few lactation consultants who have access to a relatively large number of pathological cases on a regular basis.  An average lactation consultant in a hospital setting encounters an estimate of 85-95% of cases that require no technical or medical expertise of any kind. Psychological or counseling skills are all that is needed in the vast majority of cases with breastfeeding. One would think that advanced counseling, not medicalized technical skills would be placed higher in the context of this fact.

As of 2012 it is entirely possible to have virtually no clinical hands-on experience in helping mothers and infants with pathologies, pass the exam, and claim that you are qualified to handle complex cases that lie outside the norm. From an informal survey of IBCLC candidates in 2011 it was clear that even 10 years of experience in the capacity of lactation consultant does not guarantee any kind of broad expertise in breastfeeding help, even in routine normal cases. Majority of hospital based IBCLCs deal with a very small number of problems that women usually encounter in the first two days at the hospital. Often, there is no breastfeeding at the breast, but breastpump expression. Most hospitals do not report whether the infant was put to the breast or was receiving a bottle with expressed milk in their official statistics, although hospital records at times do contain this information.

The number one pathology some hospital IBCLCs are somewhat prepared to deal with is prematurity. This expertise is acquired on the job, it does not come from any training that most IBCLCs receive prior to sitting for the exam. Non-hospital based IBCLCs usually have no access to premature infants to gain the experience. IBCLCs who have not been trained through mother support groups typically have very limited knowledge of breastfeeding past 6 weeks, the time frame when most mothers seek IBCLC help.


Written by Medical Nemesis

August 12, 2012 at 21:21

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To nurse, or not to nurse: that is not a question!

Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

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