Economic consequences of IBCLC profession. Ethical considerations of IBCLC marketing in La Leche League
NB. This is a re-write of the original post from July 4, 2014.
A little-known reality about private practice lactation consultants, especially those who are authors and speakers, is that most of us are able to do this work only because we have supportive partners with good jobs that pay the household bills and provide health insurance. Diana West, IBCLC (from Facebook )
One of the least spoken and most cruel aspect of the medicalization of breastfeeding – the economic punishment of women who invested a lot of time and money into obtaining a certificate that asserts that they know something about breastfeeding to warrant a casual consideration from doctors.
From the birth of the profession from the ranks of White Christian and Jewish middle to upper-middle class women in La Leche League and with the seed money from La Leche League International (LLLI), there was no goal to affirm the knowledge and experience of La Leche League leaders and give them an opportunity to make a living. The plans for the profession were two-fold: give an opportunity to some older leaders to make some pin money once their children were grown and educate existing healthcare workers about breastfeeding. From the very beginning LLLI advertised the IBCLC certificate within LLL and pushed leaders to get certified before the profession eventually closed to experienced breastfeeding volunteer-mothers in La Leche League. Long before profession closure to the experienced women existing licensed medical providers overtook La Leche League leaders sitting for the exam.
Over the course of the last three decades requirements of IBCLC certificate gradually increased, requiring more and more courses thus more time and most importantly money to get the piece of paper. At the same time, nurses and especially medical doctors already satisfy most of the requirements to sit for the exam. They are also primed for quick memorization of large volumes of information and have experience taking tests that are fashioned on the RN licensure exam. All of this in combination makes IBCLC certification exceptionally easy for existing medical providers and exceptionally difficult for La Leche League Leaders.
Even when you have your certificate, it does not guarantee you a job within the field. Most hospitals and doctor’s offices hire people with established medical or allied health profession credentials. Hospitals do not pay for your certificate title job but for the existing doctor, nurse, dietitian, or speech therapist license job. Further, lactation consulting is non-acute optional care. In any economic crisis, your job will be the first to go. In the times of stable economy, it is not the highest paid occupation either. If you are a healthcare provider with a degree and a license AND you have to feed a family, it makes no financial or economic sense to go to the lowest paid occupation within your field. You may have to get two jobs and work seven days a week to make ends meet if you are determined to work with breastfeeding mothers.
Why does this all matter when we talk about IBCLC marketing for LLL Leaders? La Leche League leaders historically stayed at home out of paid workforce. This means no wages, no retirements savings, no health insurance of your own as well as loss of accumulated future income and loss of paid work experience that can be sold on the market. Luring women who are already at a financial disadvantage into a knowingly low prospect low wage occupation raises questions about the ethics of the whole enterprise. Being a mother is a risk factor for poverty in old age. Being a mother who is lured into the low paying occupation is a financial suicide.
I participated in a round table problem solving discussion at the Breastfeeding and Feminism Conference with Mary Rose Tully right before her death. We were supposed to pick any issue within breastfeeding and come up with solutions. The only issue on Ms.Tully’s mind was financial compensation for IBCLCs. It struck me as odd for a person of such prominence to not be appropriately compensated for her work. Yet looking around every IBCLC I knew relied on their husbands to provide and IBCLC work was a supplementary (if at all) hobby income that may cover the expenses of being an IBCLC.
Heavy marketing of IBCLC in La Leche League continued as long as I knew it for one and only reason – money to sustain the IBLCE (the board of lactation examiners) and provide income in a pyramid scheme where people at the top relied on the income brought in by training seminars. When the profession is so new, any and every dollar they can get from any woman participating in the scheme helps propel the profession forward. Nobody cares that the road to IBCLC days of glory is littered by destitute women who unknowingly sacrificed their well-being for the “greater cause” of medicalized breastfeeding. How ethical and moral is it to establish an occupation that poached freely shared women’s knowledge and experience, turned it medical, and monetized it all while throwing experienced breastfeeding women under the bus?