Breast. No Bottle.

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

Licensure of IBCLCs on the march

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Last week Georgia was the second state in the Unites States to pass a law that will require a license to practice breastfeeding help. The licensure legislation is being pushed by the IBCLCs in many states. Here is what the United States Lactation Consultant Association has to say about the purpose of licensure legislation:

USLCA Licensure for IBCLCs

The US Lactation Consultant Association has received numerous inquiries regarding the necessity and value of licensure for the IBCLC©. Since there is no process for national licensure, the licensing of health professionals is done by each state. The goal of licensure is to provide public safety. USLCA’s Licensure and Reimbursement Committee is currently working to secure licensure for the IBCLC© in most states. [emphasis mine]

And further:

Licensure protects consumers, encourages quality, assigns responsibility, raises professional standards of practice, and prevents unqualified individuals from practicing. It provides consumers with the tools needed to evaluate the practitioners. Licensure is permission granted by a competent authority to engage in an occupation. It is the most restrictive form of professional and occupational regulation. Licensure therefore could be used to protect the title of lactation consultant, provide a single set of standards for the profession enable, autonomy of practice and increase access to care, culminating in support for billing and reimbursement.

Historically, in the United Stated licensure was used to

  1. Eliminate competition thus limiting the choices of providers for consumers
  2. Create a monopoly thus controlling the market of available services to consumers
  3. Increase the cost of services to consumers due to the points #1 and 2 as well as the costs associated with maintaining a license. The cost is usually passed down to the consumer.

This would be great if the public got a benefit of safety and increase in quality of the serviced provided to them. The question begs to be asked – does licenusure law encourage quality or protect consumers from harm?

As a consumer I know that I increasingly have a hard time finding intelligent and competent people in just about any area of my life. I would love to pay money to just about anybody to even talk to me for one hour on a subject of my interest – be it a malady or food, purchasing a product or planting a garden. I know that licensed providers available to me are not a guarantee of quality. In fact, they are guaranteed to deliver me government regulated service sponsored by big business that is often not beneficial to me but to the big business that sponsored it. Consumers increasingly turn to lay bloggers and group review sites to get their information about providers of any services. A passionate amateur of today will offer you the quality of information and research that supersede an average licenced expert. More so, many passionate people today refuse to do anything that is controlled by the State, governing professional boards, or even client whims – instead choosing to hone their skills and crafts in an environments ruled by their ethics, consciousnesses, and their understanding of what is right.

Research on the issue seconds my lived experiences.

When government sets the standards for quality, the standards are more likely to be dictated by political pressures. (John Hood) In the United States, at least, these regulations typically raise the price of services without significantly raising service quality—and indeed, in many instances regulation appears to lower the quality of services consumers buy. 

Several studies have shown that regulations reduce the quality of services and consumer safety. Quality declines because the quantity of professionals falls.

And from Sen.Mike Lee in The Rise of Licencing Cartel

According to a study by University of Minnesota Professor Morris Kleiner, “Occupational licensing has either no impact or even a negative impact on the quality of services provided to customers by members of the regulated occupation.”

Occupational licensing has grown not because consumers demanded it, but because lobbyists recognized a business opportunity where they could use government power to get rich at the public’s expense.

Established professionals (who are almost always exempt from new licensing requirements) get state-sanctioned monopoly profits, lawmakers get campaign contributions from those licensed professionals, and lobbyists get a little taste from everyone involved.

Everyone wins but the American public. 

Consumers end up paying $200 billion in higher costs annually, prospective professionals lose an estimated three million jobs, and millions more Americans find it harder to live where they want due to licensing requirements that vary by state.

Stanley L.Gross in his article Professional Licensure and Quality: The Evidence fails to find evidence that licensure increased quality of services available to the public. He did find that minorities have increasingly harder time of accessing both the profession and the serviced offered to them thus marginalizing the underserved populations even more.

Paul B.Ginsburg and Ernest Moy in Physician Licensure and the Quality of Care conclude that it is the private not professional effort that drives the quality of services offered to the public.

As somebody who personally witnessed peer support and IBCLC education, I can attest that the level of education required to IBCLCs today as evidenced by the exam they have to pass is much lower than lay sector has to offer to a consumer. IBCLC exam is geared at an existing licensed healthcare provider with no knowledge or most importantly experience of breastfeeding to enlighten them of the basics of “lactation management”. As a result an average IBCLC has very little knowledge of nursing at the breast, is very familiar with milk extraction by a pump, and can be of little help with either basic breastfeeding support or advanced clinical cases. As a mother, I would reach out to lay sector for breastfeeding information needs or to specific people who are known to have developed expertise on certain subject. From what I see around me, hospital IBCLC help reduces chances to nurse at the breast due to factors described earlier in the blog (medicinal nature of the profession, indoctrination with medical attitudes towards women, birth practices, nature of modern medicine).

Finally, a quote from a blog Morning Thoughts by Nikki Lee that attests to the fact that having a flashy title does not render quality, safety, or help.

All the local birthing hospitals are working to implement best practices for new mothers who are breastfeeding. This is now the fulfillment of a career-long dream that I have had for as long as I have worked as a nurse, childbirth educator, and lactation consultant in my region. Hospital culture is changing in favor of breastfeeding; this is a long, slow and important process. YAY!!

I expected my private practice to disappear once the hospitals supported breastfeeding with encouragement and accurate advice. To the contrary, it is expanding. I am surprised. I’ve seen dyads in my private practice who have delivered at all of the local hospitals; this gives me a window into what is going on everywhere in my region. Hospital breastfeeding help has the best of intentions, yet it is not always effective.

[…] a dyad came for both breastfeeding help and craniosacral therapy. The mother had a lovely spontaneous, undisturbed labor in a hospital that is working to meet a deadline for implementing best practice.  The first few hours after birth were wonderful; her baby was skin to skin and crawled to breast and self attached. She kept using this baby-led self-attachment technique until hospital staff and lactation specialists told her to be “more aggressive” when breastfeeding, and not to let the baby control the attachment. She was counseled to sit and to hold her breast in a particular way, to wait for the baby to open wide and then push her baby and breast together.  She was told to feed every 2 to 2 1/2 hours. Breastfeeding then became painful and damaging, leading her to seek help from 3 IBCLCs in community for relief. 2 of the community IBCLCs said the same things that the 2 hospital IBCLCs said; 4 of 5 reinforced that her latch was “shallow” and “wrong”, and gave her lists of corrections. The only useful help they gave was to prescribe a compound that relieved the nipple soreness.

As a result of all the expert advice, she stopped doing the things that she and her baby had figured out in the first few hours after birth.  Breastfeeding then became something dreaded; she would think, “I can’t believe I have to do this again”, before every 2-hour routine of breastfeed, pump, and bottle-feed. She and her partner wondered, “Why are lactation consultants so mean?”





Written by Medical Nemesis

May 2, 2016 at 20:48

Posted in Other

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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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