Re: lactation professionals - licensure?

[Guest guest]

Not too long ago, I would have agreed with the statement that there needs to be

licensure for Lactation Consultants. I no longer feel that way.

While I agree that it is unfortunate that there are varying degrees of

experience, and that the public doesn't usually have a clue, I also feel that it

restricts the rights of parents to ask whoever they want Breastfeeding advise.

I don't think that forming an elitest group of the " in " LC's is either ethical

or an effective solution to the problem.

Anytime we remove the rights of parents to make a decision, we are

disempowering.

Parents who care, will educate themselves. That goes for anything - Lactation,

Midwifery - I'd even go so far as to say it goes for the practice of Medicine. I

know more doctors who 'practice malpractice' and get away with it than ethical,

attentive, evidence based practicing physicians.

Let the education, certifications and recommendations speak for themselves I say

>

> This is why we need licensure which ties the legal practice of lactation

> consulting to the IBCLC requirements. No one outside of our own community of

> professionals knows the difference between all of the many lactation

> certifications out there, including sometimes those that actually hold them.

> The well intentioned person who wants to help mothers and takes a course

> advertised to certify them as a lactation consultant may have no clue what

> they do not know or know about the IBCLC. More importantly, the public

> cannot assess whether any given individual is more qualified to provide

> lactation services because they don't know the backgrounds of varied

> certifications. Also, when the family gets poor care and reports it to their

> health professional or their family and friends, it makes anyone who calls

> themselves a lactation consultant look bad - and that is us. Licensure as

> proposed and advocated for, by the USLCA includes legislative language

> specifying the minimum requirements of the IBLCE to sit for the exam and the

> requirement of passing a criterion referenced exam as well.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

Licensing

IBCLCs will not preclude others from practicing. It will require they call

themselves what they are “certified lactation counselors” NOT “lactation

consultants”. This is an issue of defining the lactation consultant and

over time, the understanding to the public, health professionals, public health

administrators and insurers comes that the “lactation consultant”

has a specific set of qualifications and the other folks don’t have the

same training. Also, licensure is an avenue needed to allow for reimbursement

from third parties. And I realize some of you will not choose to be reimbursed

by insurance, that is fine and you don’t have to.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

I have a question about insurance reimbursement? Do we know how much each insurance company will reimburse or are we guessing? Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and

baby To: Sent: Tuesday, November 29, 2011 7:56 AM Subject: Re: lactation "professionals" - licensure?

Licensing

IBCLCs will not preclude others from practicing. It will require they call

themselves what they are “certified lactation counselors†NOT “lactation

consultantsâ€. This is an issue of defining the lactation consultant and

over time, the understanding to the public, health professionals, public health

administrators and insurers comes that the “lactation consultantâ€

has a specific set of qualifications and the other folks don’t have the

same training. Also, licensure is an avenue needed to allow for reimbursement

from third parties. And I realize some of you will not choose to be reimbursed

by insurance, that is fine and you don’t have to. Judy Judith

L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell

Phone Fax

[Guest guest]

I don't think it's a question of being elitist. It's a question of knowledge. There should be no argument here. IBCLC is to CLC like MD is to Nurse like Nurse is to Nurses Aide. I have been a CLC and a CLE. Each is stepping stone of knowledge but it certainly doesn't end there. It is wonderful for moms to have additional support for breastfeeding but if we are going to stop there, is there a need to become IBCLC at all? Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby To: Sent: Tuesday, November 29, 2011 1:15 AM Subject: Re: lactation "professionals" - licensure?

Not too long ago, I would have agreed with the statement that there needs to be licensure for Lactation Consultants. I no longer feel that way.

While I agree that it is unfortunate that there are varying degrees of experience, and that the public doesn't usually have a clue, I also feel that it restricts the rights of parents to ask whoever they want Breastfeeding advise.

I don't think that forming an elitest group of the "in" LC's is either ethical or an effective solution to the problem.

Anytime we remove the rights of parents to make a decision, we are disempowering.

Parents who care, will educate themselves. That goes for anything - Lactation, Midwifery - I'd even go so far as to say it goes for the practice of Medicine. I know more doctors who 'practice malpractice' and get away with it than ethical, attentive, evidence based practicing physicians.

Let the education, certifications and recommendations speak for themselves I say

>

> This is why we need licensure which ties the legal practice of lactation

> consulting to the IBCLC requirements. No one outside of our own community of

> professionals knows the difference between all of the many lactation

> certifications out there, including sometimes those that actually hold them.

> The well intentioned person who wants to help mothers and takes a course

> advertised to certify them as a lactation consultant may have no clue what

> they do not know or know about the IBCLC. More importantly, the public

> cannot assess whether any given individual is more qualified to provide

> lactation services because they don't know the backgrounds of varied

> certifications. Also, when the family gets poor care and reports it to their

> health professional or their family and friends, it makes anyone who calls

> themselves a lactation consultant look bad - and that is us. Licensure as

> proposed and advocated for, by the USLCA includes legislative language

> specifying the minimum requirements of the IBLCE to sit for the exam and the

> requirement of passing a criterion referenced exam as well.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

Why is the word elitist used at all? It is simply a matter of level of practice. I do not think my Doctor is elitist because he practices at a different level... I EXPECT him or her to. Trust me, moms will still reach out to whomever they wish for breastfeeding advice, heck, sometimes it's their sisters' friends cousin's sister! Licensure will actually help guide families to the level of expertise and education they desire, it will in no way infringe on their rights.Insurance coverage will be a tricky thing going forward, fraught with growing pains along the way I am sure. But it legitimizes all we do, and remember: It will help open the door to many, many families who cannot afford out of pocket lactation support!! Medicaid moms, families that have no extra cash after a baby,

need I go on?

Below is a partial email I received from a friend working in the upper reaches of Big Insurance.. This info may have been posted previously, my apologies if it is redundant..

" As promised, I checked my reference documents and found that under the PPACA, the definition of women's preventive services was expanded to include "breastfeeding support, supplies and counseling, including costs for renting breastfeeding equipment". These must be covered with no cost-share. It went into place effective 8/1/2011 but will not have an impact until 8/1/2012. New health plans and non-grandfathered plans will need to provide this coverage with no cost share effective 8/1/2012. This is for plan years beginning on or after 8/1/2012 which means 1/1/12 will be the time when there is a larger impact since most plans are on a calendar year.As with any law, there are exceptions to having to provide for this coverage. However it is fairly wide reaching. Grandfathered plans are excluded as are plans sponsored

by certain religious employers. It does apply however to both fully insured and self-funded groups as well as group and individual health insurance coverage."

Lori Atkins, RN, IBCLC

To: " " < > Sent: Tuesday, November 29, 2011 8:10 AMSubject: Re: Re: lactation "professionals" - licensure?

I don't think it's a question of being elitist. It's a question of knowledge. There should be no argument here. IBCLC is to CLC like MD is to Nurse like Nurse is to Nurses Aide. I have been a CLC and a CLE. Each is stepping stone of knowledge but it certainly doesn't end there. It is wonderful for moms to have additional support for breastfeeding but if we are going to stop there, is there a need to become IBCLC at all?

Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

To: Sent: Tuesday, November 29, 2011 1:15 AMSubject: Re: lactation "professionals" - licensure?

Not too long ago, I would have agreed with the statement that there needs to be licensure for Lactation Consultants. I no longer feel that way. While I agree that it is unfortunate that there are varying degrees of experience, and that the public doesn't usually have a clue, I also feel that it restricts the rights of parents to ask whoever they want Breastfeeding advise. I don't think that forming an elitest group of the "in" LC's is either ethical or an effective solution to the problem. Anytime we remove the rights of parents to make a decision, we are disempowering. Parents who care, will educate themselves. That goes for anything - Lactation, Midwifery - I'd even go so far as to say it goes for the practice of Medicine. I know more doctors who 'practice malpractice' and get away with it than ethical, attentive, evidence based practicing physicians. Let the education, certifications and recommendations speak

for themselves I say>> This is why we need licensure which ties the legal practice of lactation> consulting to the IBCLC requirements. No one outside of our own community of> professionals knows the difference between all of the many lactation> certifications out there, including sometimes those that actually hold them.> The well intentioned person who wants to help mothers and takes a course> advertised to certify them as a lactation consultant may have no clue what> they do not know or know about the IBCLC. More importantly, the public> cannot assess whether any given individual is more qualified to provide> lactation services because they don't know the backgrounds of

varied> certifications. Also, when the family gets poor care and reports it to their> health professional or their family and friends, it makes anyone who calls> themselves a lactation consultant look bad - and that is us. Licensure as> proposed and advocated for, by the USLCA includes legislative language> specifying the minimum requirements of the IBLCE to sit for the exam and the> requirement of passing a criterion referenced exam as well. > > > > Judy> > Judith L. Gutowski, BA, IBCLC, RLC> > 135 McGrath Lane> > P Box 1> > Hannastown, PA 15635-0001> > Cell Phone > > Fax >

[Guest guest]

Why I use the word elitist, is that when Licensure goes into effect for IBCLCs,

that, by definition will most certainly mean that anyone without a License will

not be able to practice. I don't see any unlicensed Doctors, Midwives or Massage

therapists advertising their services to me - if they did it would be breaking

the law. Some midwives do actually, and they are often in trouble with the law.

Why I say that by doing this we are removing the rights of parents to choose any

breastfeeding professional they want is because we are. If it is illegal to

" practice lactation " unless you're licensed, then unlicensed providers would not

be able to legally practice, thus parents would not have the same ability to

choose one of them as they do currently. Parents would no longer have the right

to choose any breastfeeding professional as we will have eliminated all the

competition (albeit less educated competition).

Why I see this as totally wrong is because we as breastfeeding advocates should

never do anything that reduces choices for women. What if there is only one

Licensed IBCLC in that woman's immediate area and another former IBCLC or

extremely experienced Breastfeeding Professional/LLLL, but the licensed IBCLC is

no good? What then? What will happen to LLLI when licensure comes about?

I run a small Lactation Practice and don't have a lot of extra time to hold free

regular support groups. I send all of my clients to La Leche League meetings. I

am concerned that Licensure might eliminate this option for parents.

There are also several CLC's and CLE's practicing locally to me. Let me say that

I do have a problem with them 'biting off more than they can chew' and then

failing to send clients to an IBCLC later, or in the first place (sometimes the

clients come to us on their own, some of them quit altogether). So yes, I see

there is a huge problem. But although licensure promises to be the quick and

easy way out, I no longer believe that it will benefit either parents or the

IBCLC profession in the long run as much as Education of both parents and other

health care professionals about the level of care provided by IBCLCs.

I don't see why there is this idea that licensure is the magic ticket to

insurance reimbursement. Currently there is no licensure and most of my clients

are partially or fully reimbursed for the care I provide. I provide them with

comprehensive insurance forms and codes. I can't imagine it getting better than

that just because of licensure.

I know plenty of health care professions that are licensed (midwifery especially

as I am a licensed midwife) and even as a Licensed Midwife I do not get

reimbursed by most state programs. The best we have is one state program will

pay 1100(for complete prenatal, labor, birth and postnatal care) if you meet

stringent requirements and also agree not to accept any payment from the client.

Even as a licensed midwife, I don't meet their requirements, and I don't know

any midwife who is rich enough to accept 1100 for complete prenatal, labor,

birth and postpartum care. Accepting anything less than 2000 means that we are

paying clients to be their midwife. It's like a joke. Licensure if anything has

also limited our practice. Actually it's even illegal for licensed midwives to

practice in california since we have to have supervising physicians and no

physicians are allowed to supervise midwives.

California is not unique - overall licensure has not helped midwifery or

pregnant mothers. I think that goes for many other professions as well. I would

just be really disappointed when this happens to Lactation work. Who can

garuantee that licensure will be voluntary in all states? No one is arresting

Lactation Professionals for helping breastfeeding mothers, what if that becomes

a reality when licensure goes into effect?

> >

> > This is why we need licensure which ties the legal practice of lactation

> > consulting to the IBCLC requirements. No one outside of our own community of

> > professionals knows the difference between all of the many lactation

> > certifications out there, including sometimes those that actually hold them.

> > The well intentioned person who wants to help mothers and takes a course

> > advertised to certify them as a lactation consultant may have no clue what

> > they do not know or know about the IBCLC. More importantly, the public

> > cannot assess whether any given individual is more qualified to provide

> > lactation services because they don't know the backgrounds of varied

> > certifications. Also, when the family gets poor care and reports it to their

> > health professional or their family and friends, it makes anyone who calls

> > themselves a lactation consultant look bad - and that is us. Licensure as

> > proposed and advocated for, by the USLCA includes legislative language

> > specifying the minimum requirements of the IBLCE to sit for the exam and the

> > requirement of passing a criterion referenced exam as well.

> >

> >

> >

> > Judy

> >

> > Judith L. Gutowski, BA, IBCLC, RLC

> >

> > 135 McGrath Lane

> >

> > P Box 1

> >

> > Hannastown, PA 15635-0001

> >

> > Cell Phone

> >

> > Fax

> >

>

[Guest guest]

Dana Asks, “I have a question about insurance

reimbursement? Do we know how much each insurance company will reimburse or are

we guessing?”

If when licensure becomes possible the fee structure will

be set by CMS for Medicaid – USLCA is working with Medicaid attorneys and

has had meetings with Medicaid administrators at the federal level. We are

striving to educate them about what and IBCLC is and does and the time involved

in lactation consulting and seeking legitimate fees. Of course, we do not have

the ultimate say but we are providing input and making them aware that we are

not just giving a group class or providing education, but our visits have all

the comp0onents of a medical office visit. I am hoping for a fee structure

similar to other non-physician providers. We are also working with Medicaid

attorneys to write model Medicaid regulations regarding reimbursement for

IBCLCs. For all other private insurers, the individual IBCLC will negotiate her

own contract. They may have guidelines and you can choose to provider services

if they pay you what you want or not if you don’t want to accept their

reimbursement. Usually they pay slightly higher than the Medicaid providers.

The coding process is yet to be determined and will affect reimbursement. We

may be using existing E and M Code and Diagnosis codes or we may have new ones

specific to lactation like OTs have for their services

states, “What if there is only one Licensed

IBCLC in that woman's immediate area and another former IBCLC or extremely

experienced Breastfeeding Professional/LLLL, but the licensed IBCLC is no

good?” If you know an IBCLC is ‘no good’ then you have a duty

to mothers to communicate with this IBCLC or she should be reported to IBLCE

for disciplinary action as of right now. This will not change with licensure.

However, there could be a second disciplinary process from the state for IBCLCs

found practicing unethically or badly. Recently, the IBLCE Disciplinary

Procedures have been changed, you should be aware of this and letting them know

your opinion about it. There are some items of great concern in this new

document. I will be responding to IBLCE about this soon.

also states, “What will happen to LLLI when

licensure comes about?” LLL has nothing to do with the practice of lactation

consulting and will not be affected by licensure. The model legislation USLCA

proposes in many states has exemptions for a few types of lactation service

providers, including all those who work as “volunteers”, those

serving in military and working for federal government and WIOC peer

counselors.

Those of us in private practice have the most to gain or

lose by licensure. We need to be involved in the process of licensure, rather

than assuming only negative ideas about what it will do or won’t do. If

you are part of the solution to professional recognition and credibility of

IBCLCs you can make certain that it happens in a way that your concerns are

heard and care is taken to prevent problems.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

Well it all *sounds* great. I just hope that it does actually play out that way.

I would certainly like to believe that Licensure will work better for

home-visiting Lactation Consultants than it has for home-birth attending

Midwives.

I still just can't support Licensure for any health care providers any more, but

if it is going to happen, I certainly hope that it is done as fairly as possible

and that no other Lactation Professionals have their trade restricted, and that

parents continue to have the same ability to choose whatever Lactation

Professional help them.

As for the 'not-so-great' Lactation Consultants. I absolutely don't have the

time to police other Lactation Consultants or 'turn them in' because I disagree

with the way they practice. I feel that is the duty of parents and parents alone

who have been disatisfied with their experiences. It is parents who benefit or

lose, and they alone who should be filing complaints.

My job is to 1. breastfeed my own baby and 2. act as the best Lactation

Consultant to other moms as I can.

>

> Dana Asks, " I have a question about insurance reimbursement? Do we know how

> much each insurance company will reimburse or are we guessing? "

>

> If when licensure becomes possible the fee structure will be set by CMS for

> Medicaid - USLCA is working with Medicaid attorneys and has had meetings

> with Medicaid administrators at the federal level. We are striving to

> educate them about what and IBCLC is and does and the time involved in

> lactation consulting and seeking legitimate fees. Of course, we do not have

> the ultimate say but we are providing input and making them aware that we

> are not just giving a group class or providing education, but our visits

> have all the comp0onents of a medical office visit. I am hoping for a fee

> structure similar to other non-physician providers. We are also working with

> Medicaid attorneys to write model Medicaid regulations regarding

> reimbursement for IBCLCs. For all other private insurers, the individual

> IBCLC will negotiate her own contract. They may have guidelines and you can

> choose to provider services if they pay you what you want or not if you

> don't want to accept their reimbursement. Usually they pay slightly higher

> than the Medicaid providers. The coding process is yet to be determined and

> will affect reimbursement. We may be using existing E and M Code and

> Diagnosis codes or we may have new ones specific to lactation like OTs have

> for their services

>

>

>

>

>

> states, " What if there is only one Licensed IBCLC in that woman's

> immediate area and another former IBCLC or extremely experienced

> Breastfeeding Professional/LLLL, but the licensed IBCLC is no good? " If you

> know an IBCLC is 'no good' then you have a duty to mothers to communicate

> with this IBCLC or she should be reported to IBLCE for disciplinary action

> as of right now. This will not change with licensure. However, there could

> be a second disciplinary process from the state for IBCLCs found practicing

> unethically or badly. Recently, the IBLCE Disciplinary Procedures have been

> changed, you should be aware of this and letting them know your opinion

> about it. There are some items of great concern in this new document. I will

> be responding to IBLCE about this soon.

>

>

>

>

>

> also states, " What will happen to LLLI when licensure comes about? "

> LLL has nothing to do with the practice of lactation consulting and will not

> be affected by licensure. The model legislation USLCA proposes in many

> states has exemptions for a few types of lactation service providers,

> including all those who work as " volunteers " , those serving in military and

> working for federal government and WIOC peer counselors.

>

>

>

> Those of us in private practice have the most to gain or lose by licensure.

> We need to be involved in the process of licensure, rather than assuming

> only negative ideas about what it will do or won't do. If you are part of

> the solution to professional recognition and credibility of IBCLCs you can

> make certain that it happens in a way that your concerns are heard and care

> is taken to prevent problems.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

states, “

As for the 'not-so-great' Lactation Consultants. I

absolutely don't have the time to police other Lactation Consultants or 'turn

them in' because I disagree with the way they practice. I feel that is the duty

of parents and parents alone who have been dissatisfied with their experiences.

It is parents who benefit or lose, and they alone who should be filing

complaints.

My job is to 1. breastfeed my own baby and 2. act as the best Lactation

Consultant to other moms as I can.”

Sadly, most parents have no way of knowing when they

are getting poor advice. They just fail at breastfeeding and tell others that

they saw a lactation consultant and it didn’t help. This hurts the

reputation of every lactation consultant and hurts the chances for many parents

to succeed at breastfeeding. If we want “all mothers and babies” to

have the opportunity to breastfeed successfully, we have to step up and

intervene. By only focusing on our own little piece of the world, we hurt

ourselves and others. We have to take the TIME. Does any LC have time to do

this? Probably not, we all wear so many hats. I know I do. See my favorite clip

art graphic attached.

Sometimes what we hear from clients is not correct, their

new mommy brains don’t remember correctly or they misinterpreted, miscommunicated,

etc. The right thing to do is always assume the best of your

lactation consultant peers. However, if you are certain that another IBCLC is

making grave errors, not just using techniques different than what you choose,

then it behooves YOU to give them a call and discuss (not a particular client),

but the scenario and ask them what they might have been thinking or planning in

the management and discuss what you might do differently and why. If they turn

out to be unteachable AND

practicing poorly, then you should let them know that you will inform the

parents and/ or IBLCE.

It is also important to consider other factors in a

decision to do this. I have worked with quite a few other IBCLCs in clinical

situations and we all can choose different plans to manage the same situation,

this often depends on the mother’s skills and abilities and support

system and preferences. For example if a mother has a low supply my colleague

who is also an MD may go right to a prescription for Reglan because she can,

one mother might choose to pump after every feeding to increase the supply

because she has only 1 child and lots of help from dad, another mother who has

3 older kids and no help might choose only an at breast supplementer, another

mother might do any combination of the above which is not wrong, but applied to

different circumstances. If a mother comes to you reporting that the last LC

she saw used a different method you can say that is one way to do it, but I

have other options for you……. However, if the other LC said

to bottle feed the baby and only pump twice a day to increase a milk supply,

well that would be bad practice. You would call her and say gee, how is that

going to work? My evidence states you need a minimum of 8 -10 pumpings a day to

initiate a milk supply.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

1 of 1 Photo(s)

[Guest guest]

In an attempt to understand better the possible advantages of IBCLC Licensure, I

went to then USCLA website to learn more. I found this list of " Why do IBCLCs

need to be licensed? "

I have *starred* my questions/response following each checkpoint.

& #10004; Currently, anyone can call themselves a lactation consultant, even with

minimal training or without board certification. The public now has no means of

identifying a qualified lactation consultant and no protection from unqualified

practitioners. A family has no means of recourse in the event of a bad outcome

from an unqualified caregiver. Licensure would assure consumers, employers,

hospitals, and other health care providers and organizations that they are

engaging qualified professionals.

*Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

& #10004; Medicare and Medicaid reimburse only LICENSED health care providers.

*I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse my

services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

& #10004; Many other insurers also reimburse only licensed practitioners.

*As an IBCLC, I have about 80% of my fees reimbursed to clients, and of course I

am not licensed as there is no license. How is Licensure a guarantee that

services will be reimbursed or more highly reimbursed.*

& #10004; IBCLCs are healthcare professionals and need to be recognized as such

in states, hospitals, and health policy, just like all other healthcare

professionals.

*Yes! But why would a License change that? CPM Midwives are Licensed (or can be

if they choose), have been for 3 decades in and we are still the least respected

healthcare professional in the very states that license us. Certified Nurse

Midwives are not licensed - they are registered, certified but not licensed and

they are more respected in all states, hospitals and health policy than any

Licensed Midwife. The License just doesn't seem like the thing that causes

respect. *

& #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

*I feel like I am practicing to the full extent of my scope of practice. Please

let me know how Licensure will affect this, if I have something to learn, I

would love to humbly learn how my scope could be increased by being licensed. *

& #10004; Licensure places IBCLCs on a more even footing with other licensed

health professionals, allowing the voice of the IBCLC to be heard, respected,

and valued.

*Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we see

that actually this is not the case, in fact the opposite seems to be true.*

& #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

*Public citizens always have a form of recourse against any other member of the

public and can always report a health care professional to their appropriate

board (as happens with certified nurse midwives). What Licensing does is allow

anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an

IBCLC to lose her 'license to practice lactation' if the board (could be

connected to the local Medical or Nursing board) decides that the Lactation

Consultant is practicing outside of her standards of care. While again I do

agree that IBCLCs who are not helping clients, or practicing unethically should

be re-taught, have their registration put on probation or have their IBCLC

status removed -this is something that IBCLE can do on its own! Involving State

Licensing Boards that are so often attached to the Medical or Nursing boards

just seems like asking for the same trouble that midwives are now currently

suffering under. Of course there are a few, a select few states which have made

Midwifery Licensing work much better than other states - but who can guarantee

that each state will adhere to the same Licensing standards? There is no such

thing as National Licensure. *

& #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

*So, it sounds like Medicare and Medicaid don't reimburse non-licensed health

care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

I'm just feeling that Licensure could very well lead to unnecessary bureaucracy

and further issues for the IBCLC in PP, and feeling that this is a safe and open

forum to voice these concerns. Am I the only one with these concerns? If so,

perhaps I just need to be quiet : ) But I am a relatively new IBCLC, long-time

Midwife,. I've stopped seeing clients as a midwife because my local county and

hospitals within are not midwife/homebirth friendly and though I've personally

had no issues with any local Professionals and currently work well with them,

others have had legal proceedings from Physicians who are trying to restrict

trade. I've started just concentrating on Doula work and Lactation Consulting,

and my clients have been and are very happy with my Lactation Services.

I am concerned with the future of the IBCLC profession, as I'm an IBCLC and a

mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont go

into effect, perhaps it will. If so, at least I hope these issues are being

looked at VERY carefully and as I believe all things are possible, that perhaps

if the Licensing committee is diligent to these points, then perhaps it will not

become the mess that Midwifery Licensure has become. On the other hand, I just

still can't quite understand what incredibly important and essential thing that

Licensure is going to give us that we don't already have or are already in the

process of having?

Especially as an IBCLC in PP, writing in this PP forum - we are the ones that

Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

>

> states, "

>

> As for the 'not-so-great' Lactation Consultants. I absolutely don't have the

> time to police other Lactation Consultants or 'turn them in' because I

> disagree with the way they practice. I feel that is the duty of parents and

> parents alone who have been dissatisfied with their experiences. It is

> parents who benefit or lose, and they alone who should be filing complaints.

>

>

> My job is to 1. breastfeed my own baby and 2. act as the best Lactation

> Consultant to other moms as I can. "

>

>

>

> Sadly, most parents have no way of knowing when they are getting poor

> advice. They just fail at breastfeeding and tell others that they saw a

> lactation consultant and it didn't help. This hurts the reputation of every

> lactation consultant and hurts the chances for many parents to succeed at

> breastfeeding. If we want " all mothers and babies " to have the opportunity

> to breastfeed successfully, we have to step up and intervene. By only

> focusing on our own little piece of the world, we hurt ourselves and others.

> We have to take the TIME. Does any LC have time to do this? Probably not, we

> all wear so many hats. I know I do. See my favorite clip art graphic

> attached.

>

>

>

> Sometimes what we hear from clients is not correct, their new mommy brains

> don't remember correctly or they misinterpreted, miscommunicated, etc. The

> right thing to do is always assume the best of your lactation consultant

> peers. However, if you are certain that another IBCLC is making grave

> errors, not just using techniques different than what you choose, then it

> behooves YOU to give them a call and discuss (not a particular client), but

> the scenario and ask them what they might have been thinking or planning in

> the management and discuss what you might do differently and why. If they

> turn out to be unteachable AND practicing poorly, then you should let them

> know that you will inform the parents and/ or IBLCE.

>

>

>

> It is also important to consider other factors in a decision to do this. I

> have worked with quite a few other IBCLCs in clinical situations and we all

> can choose different plans to manage the same situation, this often depends

> on the mother's skills and abilities and support system and preferences. For

> example if a mother has a low supply my colleague who is also an MD may go

> right to a prescription for Reglan because she can, one mother might choose

> to pump after every feeding to increase the supply because she has only 1

> child and lots of help from dad, another mother who has 3 older kids and no

> help might choose only an at breast supplementer, another mother might do

> any combination of the above which is not wrong, but applied to different

> circumstances. If a mother comes to you reporting that the last LC she saw

> used a different method you can say that is one way to do it, but I have

> other options for you... However, if the other LC said to bottle feed the

> baby and only pump twice a day to increase a milk supply, well that would be

> bad practice. You would call her and say gee, how is that going to work? My

> evidence states you need a minimum of 8 -10 pumpings a day to initiate a

> milk supply.

>

>

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

CNMs are also 'Advanced Registered Nurse Practitioners', in other words they

have a nursing license. This ARNP status is what gives them prescriptive

authority and admission authority and so forth.

>

> In an attempt to understand better the possible advantages of IBCLC Licensure,

I went to then USCLA website to learn more. I found this list of " Why do IBCLCs

need to be licensed? "

> I have *starred* my questions/response following each checkpoint.

>

> & #10004; Currently, anyone can call themselves a lactation consultant, even

with minimal training or without board certification. The public now has no

means of identifying a qualified lactation consultant and no protection from

unqualified practitioners. A family has no means of recourse in the event of a

bad outcome from an unqualified caregiver. Licensure would assure consumers,

employers, hospitals, and other health care providers and organizations that

they are engaging qualified professionals.

>

> *Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

>

> & #10004; Medicare and Medicaid reimburse only LICENSED health care providers.

>

> *I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse my

services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

>

> & #10004; Many other insurers also reimburse only licensed practitioners.

>

> *As an IBCLC, I have about 80% of my fees reimbursed to clients, and of course

I am not licensed as there is no license. How is Licensure a guarantee that

services will be reimbursed or more highly reimbursed.*

>

> & #10004; IBCLCs are healthcare professionals and need to be recognized as such

in states, hospitals, and health policy, just like all other healthcare

professionals.

>

> *Yes! But why would a License change that? CPM Midwives are Licensed (or can

be if they choose), have been for 3 decades in and we are still the least

respected healthcare professional in the very states that license us. Certified

Nurse Midwives are not licensed - they are registered, certified but not

licensed and they are more respected in all states, hospitals and health policy

than any Licensed Midwife. The License just doesn't seem like the thing that

causes respect. *

>

> & #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

>

> *I feel like I am practicing to the full extent of my scope of practice.

Please let me know how Licensure will affect this, if I have something to learn,

I would love to humbly learn how my scope could be increased by being licensed.

*

>

> & #10004; Licensure places IBCLCs on a more even footing with other licensed

health professionals, allowing the voice of the IBCLC to be heard, respected,

and valued.

>

> *Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we see

that actually this is not the case, in fact the opposite seems to be true.*

>

> & #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

>

> *Public citizens always have a form of recourse against any other member of

the public and can always report a health care professional to their appropriate

board (as happens with certified nurse midwives). What Licensing does is allow

anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an

IBCLC to lose her 'license to practice lactation' if the board (could be

connected to the local Medical or Nursing board) decides that the Lactation

Consultant is practicing outside of her standards of care. While again I do

agree that IBCLCs who are not helping clients, or practicing unethically should

be re-taught, have their registration put on probation or have their IBCLC

status removed -this is something that IBCLE can do on its own! Involving State

Licensing Boards that are so often attached to the Medical or Nursing boards

just seems like asking for the same trouble that midwives are now currently

suffering under. Of course there are a few, a select few states which have made

Midwifery Licensing work much better than other states - but who can guarantee

that each state will adhere to the same Licensing standards? There is no such

thing as National Licensure. *

>

> & #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

>

> *So, it sounds like Medicare and Medicaid don't reimburse non-licensed health

care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

>

> I'm just feeling that Licensure could very well lead to unnecessary

bureaucracy and further issues for the IBCLC in PP, and feeling that this is a

safe and open forum to voice these concerns. Am I the only one with these

concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new

IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my

local county and hospitals within are not midwife/homebirth friendly and though

I've personally had no issues with any local Professionals and currently work

well with them, others have had legal proceedings from Physicians who are trying

to restrict trade. I've started just concentrating on Doula work and Lactation

Consulting, and my clients have been and are very happy with my Lactation

Services.

> I am concerned with the future of the IBCLC profession, as I'm an IBCLC and a

mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont go

into effect, perhaps it will. If so, at least I hope these issues are being

looked at VERY carefully and as I believe all things are possible, that perhaps

if the Licensing committee is diligent to these points, then perhaps it will not

become the mess that Midwifery Licensure has become. On the other hand, I just

still can't quite understand what incredibly important and essential thing that

Licensure is going to give us that we don't already have or are already in the

process of having?

> Especially as an IBCLC in PP, writing in this PP forum - we are the ones that

Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

> Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

>

[Guest guest]

Correct me here (with references) if I'm wrong, but they are " registered " , they

are " certified " but they are not " licensed. "

As IBCLCs we are " registered(RLC) " , we are " certified(IBCLC) " but we are also

not licensed...yet.

Do you have some references that goes against that statement?

> >

> > In an attempt to understand better the possible advantages of IBCLC

Licensure, I went to then USCLA website to learn more. I found this list of " Why

do IBCLCs need to be licensed? "

> > I have *starred* my questions/response following each checkpoint.

> >

> > & #10004; Currently, anyone can call themselves a lactation consultant, even

with minimal training or without board certification. The public now has no

means of identifying a qualified lactation consultant and no protection from

unqualified practitioners. A family has no means of recourse in the event of a

bad outcome from an unqualified caregiver. Licensure would assure consumers,

employers, hospitals, and other health care providers and organizations that

they are engaging qualified professionals.

> >

> > *Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

> >

> > & #10004; Medicare and Medicaid reimburse only LICENSED health care

providers.

> >

> > *I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse

my services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

> >

> > & #10004; Many other insurers also reimburse only licensed practitioners.

> >

> > *As an IBCLC, I have about 80% of my fees reimbursed to clients, and of

course I am not licensed as there is no license. How is Licensure a guarantee

that services will be reimbursed or more highly reimbursed.*

> >

> > & #10004; IBCLCs are healthcare professionals and need to be recognized as

such in states, hospitals, and health policy, just like all other healthcare

professionals.

> >

> > *Yes! But why would a License change that? CPM Midwives are Licensed (or can

be if they choose), have been for 3 decades in and we are still the least

respected healthcare professional in the very states that license us. Certified

Nurse Midwives are not licensed - they are registered, certified but not

licensed and they are more respected in all states, hospitals and health policy

than any Licensed Midwife. The License just doesn't seem like the thing that

causes respect. *

> >

> > & #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

> >

> > *I feel like I am practicing to the full extent of my scope of practice.

Please let me know how Licensure will affect this, if I have something to learn,

I would love to humbly learn how my scope could be increased by being licensed.

*

> >

> > & #10004; Licensure places IBCLCs on a more even footing with other licensed

health professionals, allowing the voice of the IBCLC to be heard, respected,

and valued.

> >

> > *Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we

see that actually this is not the case, in fact the opposite seems to be true.*

> >

> > & #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

> >

> > *Public citizens always have a form of recourse against any other member of

the public and can always report a health care professional to their appropriate

board (as happens with certified nurse midwives). What Licensing does is allow

anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an

IBCLC to lose her 'license to practice lactation' if the board (could be

connected to the local Medical or Nursing board) decides that the Lactation

Consultant is practicing outside of her standards of care. While again I do

agree that IBCLCs who are not helping clients, or practicing unethically should

be re-taught, have their registration put on probation or have their IBCLC

status removed -this is something that IBCLE can do on its own! Involving State

Licensing Boards that are so often attached to the Medical or Nursing boards

just seems like asking for the same trouble that midwives are now currently

suffering under. Of course there are a few, a select few states which have made

Midwifery Licensing work much better than other states - but who can guarantee

that each state will adhere to the same Licensing standards? There is no such

thing as National Licensure. *

> >

> > & #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

> >

> > *So, it sounds like Medicare and Medicaid don't reimburse non-licensed

health care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

> >

> > I'm just feeling that Licensure could very well lead to unnecessary

bureaucracy and further issues for the IBCLC in PP, and feeling that this is a

safe and open forum to voice these concerns. Am I the only one with these

concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new

IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my

local county and hospitals within are not midwife/homebirth friendly and though

I've personally had no issues with any local Professionals and currently work

well with them, others have had legal proceedings from Physicians who are trying

to restrict trade. I've started just concentrating on Doula work and Lactation

Consulting, and my clients have been and are very happy with my Lactation

Services.

> > I am concerned with the future of the IBCLC profession, as I'm an IBCLC and

a mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont

go into effect, perhaps it will. If so, at least I hope these issues are being

looked at VERY carefully and as I believe all things are possible, that perhaps

if the Licensing committee is diligent to these points, then perhaps it will not

become the mess that Midwifery Licensure has become. On the other hand, I just

still can't quite understand what incredibly important and essential thing that

Licensure is going to give us that we don't already have or are already in the

process of having?

> > Especially as an IBCLC in PP, writing in this PP forum - we are the ones

that Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

> > Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

> >

>

[Guest guest]

'Registered' Nurses are licensed to practice in the state they work in. CNMs are

also licensed nurses. That's what I'm referring to. In my state you need to be a

licensed nurse (an ARNP) to be a CNM. The CNM credential is considered a

specialty area for Advanced Registered Nurse Practitioners. Each state sets

criteria for the issuance of a nursing license for that state.

Just Google nursing licensure it's easy to find. You can't be a CNM without also

holding a nursing license.

> > >

> > > In an attempt to understand better the possible advantages of IBCLC

Licensure, I went to then USCLA website to learn more. I found this list of " Why

do IBCLCs need to be licensed? "

> > > I have *starred* my questions/response following each checkpoint.

> > >

> > > & #10004; Currently, anyone can call themselves a lactation consultant,

even with minimal training or without board certification. The public now has no

means of identifying a qualified lactation consultant and no protection from

unqualified practitioners. A family has no means of recourse in the event of a

bad outcome from an unqualified caregiver. Licensure would assure consumers,

employers, hospitals, and other health care providers and organizations that

they are engaging qualified professionals.

> > >

> > > *Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

> > >

> > > & #10004; Medicare and Medicaid reimburse only LICENSED health care

providers.

> > >

> > > *I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse

my services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

> > >

> > > & #10004; Many other insurers also reimburse only licensed practitioners.

> > >

> > > *As an IBCLC, I have about 80% of my fees reimbursed to clients, and of

course I am not licensed as there is no license. How is Licensure a guarantee

that services will be reimbursed or more highly reimbursed.*

> > >

> > > & #10004; IBCLCs are healthcare professionals and need to be recognized as

such in states, hospitals, and health policy, just like all other healthcare

professionals.

> > >

> > > *Yes! But why would a License change that? CPM Midwives are Licensed (or

can be if they choose), have been for 3 decades in and we are still the least

respected healthcare professional in the very states that license us. Certified

Nurse Midwives are not licensed - they are registered, certified but not

licensed and they are more respected in all states, hospitals and health policy

than any Licensed Midwife. The License just doesn't seem like the thing that

causes respect. *

> > >

> > > & #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

> > >

> > > *I feel like I am practicing to the full extent of my scope of practice.

Please let me know how Licensure will affect this, if I have something to learn,

I would love to humbly learn how my scope could be increased by being licensed.

*

> > >

> > > & #10004; Licensure places IBCLCs on a more even footing with other

licensed health professionals, allowing the voice of the IBCLC to be heard,

respected, and valued.

> > >

> > > *Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we

see that actually this is not the case, in fact the opposite seems to be true.*

> > >

> > > & #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

> > >

> > > *Public citizens always have a form of recourse against any other member

of the public and can always report a health care professional to their

appropriate board (as happens with certified nurse midwives). What Licensing

does is allow anyone (Doctors, Nurses, other IBCLCs, parents and anyone really)

to cause an IBCLC to lose her 'license to practice lactation' if the board

(could be connected to the local Medical or Nursing board) decides that the

Lactation Consultant is practicing outside of her standards of care. While again

I do agree that IBCLCs who are not helping clients, or practicing unethically

should be re-taught, have their registration put on probation or have their

IBCLC status removed -this is something that IBCLE can do on its own! Involving

State Licensing Boards that are so often attached to the Medical or Nursing

boards just seems like asking for the same trouble that midwives are now

currently suffering under. Of course there are a few, a select few states which

have made Midwifery Licensing work much better than other states - but who can

guarantee that each state will adhere to the same Licensing standards? There is

no such thing as National Licensure. *

> > >

> > > & #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

> > >

> > > *So, it sounds like Medicare and Medicaid don't reimburse non-licensed

health care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

> > >

> > > I'm just feeling that Licensure could very well lead to unnecessary

bureaucracy and further issues for the IBCLC in PP, and feeling that this is a

safe and open forum to voice these concerns. Am I the only one with these

concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new

IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my

local county and hospitals within are not midwife/homebirth friendly and though

I've personally had no issues with any local Professionals and currently work

well with them, others have had legal proceedings from Physicians who are trying

to restrict trade. I've started just concentrating on Doula work and Lactation

Consulting, and my clients have been and are very happy with my Lactation

Services.

> > > I am concerned with the future of the IBCLC profession, as I'm an IBCLC

and a mother who benefited from an IBCLC after I gave birth. Perhaps Licensure

wont go into effect, perhaps it will. If so, at least I hope these issues are

being looked at VERY carefully and as I believe all things are possible, that

perhaps if the Licensing committee is diligent to these points, then perhaps it

will not become the mess that Midwifery Licensure has become. On the other hand,

I just still can't quite understand what incredibly important and essential

thing that Licensure is going to give us that we don't already have or are

already in the process of having?

> > > Especially as an IBCLC in PP, writing in this PP forum - we are the ones

that Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

> > > Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

> > >

> >

>

[Guest guest]

I agree with your concerns . I'm not sure how licensure will help us. I

am hoping it will allow more access to care for mothers because insurance will

cover our services, but I'm not sure licensure will help us in that respect. But

I don't know as much about it as a lot of others do on this list.

I worry about LLL and WIC in all this. I have worked as a volunteer for 5 years

with LLL and I feel I have been an asset to my community. It would be horrible

if that went away.

And I know a lot of people will say that won't happen, but as I learned last

summer, licensure can make it tricky.

I had to file legal briefs to be appointed guardian of my mother. I couldn't

afford a lawyer so I was sent to the law library. The librarian told me " I'm not

sure if this book is what you will need and even if I did know I couldn't tell

you because that would be practicing law without a license. " If it weren't for a

few lawyers steering me in the right direction I never could have done it. I

would hope that wouldn't happen with lactation, but it does have me a bit

worried.

Sent via BlackBerry from T-Mobile

Re: lactation " professionals " - licensure?

In an attempt to understand better the possible advantages of IBCLC Licensure, I

went to then USCLA website to learn more. I found this list of " Why do IBCLCs

need to be licensed? "

I have *starred* my questions/response following each checkpoint.

& #10004; Currently, anyone can call themselves a lactation consultant, even with

minimal training or without board certification. The public now has no means of

identifying a qualified lactation consultant and no protection from unqualified

practitioners. A family has no means of recourse in the event of a bad outcome

from an unqualified caregiver. Licensure would assure consumers, employers,

hospitals, and other health care providers and organizations that they are

engaging qualified professionals.

*Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

& #10004; Medicare and Medicaid reimburse only LICENSED health care providers.

*I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse my

services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

& #10004; Many other insurers also reimburse only licensed practitioners.

*As an IBCLC, I have about 80% of my fees reimbursed to clients, and of course I

am not licensed as there is no license. How is Licensure a guarantee that

services will be reimbursed or more highly reimbursed.*

& #10004; IBCLCs are healthcare professionals and need to be recognized as such

in states, hospitals, and health policy, just like all other healthcare

professionals.

*Yes! But why would a License change that? CPM Midwives are Licensed (or can be

if they choose), have been for 3 decades in and we are still the least respected

healthcare professional in the very states that license us. Certified Nurse

Midwives are not licensed - they are registered, certified but not licensed and

they are more respected in all states, hospitals and health policy than any

Licensed Midwife. The License just doesn't seem like the thing that causes

respect. *

& #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

*I feel like I am practicing to the full extent of my scope of practice. Please

let me know how Licensure will affect this, if I have something to learn, I

would love to humbly learn how my scope could be increased by being licensed. *

& #10004; Licensure places IBCLCs on a more even footing with other licensed

health professionals, allowing the voice of the IBCLC to be heard, respected,

and valued.

*Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we see

that actually this is not the case, in fact the opposite seems to be true.*

& #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

*Public citizens always have a form of recourse against any other member of the

public and can always report a health care professional to their appropriate

board (as happens with certified nurse midwives). What Licensing does is allow

anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an

IBCLC to lose her 'license to practice lactation' if the board (could be

connected to the local Medical or Nursing board) decides that the Lactation

Consultant is practicing outside of her standards of care. While again I do

agree that IBCLCs who are not helping clients, or practicing unethically should

be re-taught, have their registration put on probation or have their IBCLC

status removed -this is something that IBCLE can do on its own! Involving State

Licensing Boards that are so often attached to the Medical or Nursing boards

just seems like asking for the same trouble that midwives are now currently

suffering under. Of course there are a few, a select few states which have made

Midwifery Licensing work much better than other states - but who can guarantee

that each state will adhere to the same Licensing standards? There is no such

thing as National Licensure. *

& #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

*So, it sounds like Medicare and Medicaid don't reimburse non-licensed health

care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

I'm just feeling that Licensure could very well lead to unnecessary bureaucracy

and further issues for the IBCLC in PP, and feeling that this is a safe and open

forum to voice these concerns. Am I the only one with these concerns? If so,

perhaps I just need to be quiet : ) But I am a relatively new IBCLC, long-time

Midwife,. I've stopped seeing clients as a midwife because my local county and

hospitals within are not midwife/homebirth friendly and though I've personally

had no issues with any local Professionals and currently work well with them,

others have had legal proceedings from Physicians who are trying to restrict

trade. I've started just concentrating on Doula work and Lactation Consulting,

and my clients have been and are very happy with my Lactation Services.

I am concerned with the future of the IBCLC profession, as I'm an IBCLC and a

mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont go

into effect, perhaps it will. If so, at least I hope these issues are being

looked at VERY carefully and as I believe all things are possible, that perhaps

if the Licensing committee is diligent to these points, then perhaps it will not

become the mess that Midwifery Licensure has become. On the other hand, I just

still can't quite understand what incredibly important and essential thing that

Licensure is going to give us that we don't already have or are already in the

process of having?

Especially as an IBCLC in PP, writing in this PP forum - we are the ones that

Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

>

> states, "

>

> As for the 'not-so-great' Lactation Consultants. I absolutely don't have the

> time to police other Lactation Consultants or 'turn them in' because I

> disagree with the way they practice. I feel that is the duty of parents and

> parents alone who have been dissatisfied with their experiences. It is

> parents who benefit or lose, and they alone who should be filing complaints.

>

>

> My job is to 1. breastfeed my own baby and 2. act as the best Lactation

> Consultant to other moms as I can. "

>

>

>

> Sadly, most parents have no way of knowing when they are getting poor

> advice. They just fail at breastfeeding and tell others that they saw a

> lactation consultant and it didn't help. This hurts the reputation of every

> lactation consultant and hurts the chances for many parents to succeed at

> breastfeeding. If we want " all mothers and babies " to have the opportunity

> to breastfeed successfully, we have to step up and intervene. By only

> focusing on our own little piece of the world, we hurt ourselves and others.

> We have to take the TIME. Does any LC have time to do this? Probably not, we

> all wear so many hats. I know I do. See my favorite clip art graphic

> attached.

>

>

>

> Sometimes what we hear from clients is not correct, their new mommy brains

> don't remember correctly or they misinterpreted, miscommunicated, etc. The

> right thing to do is always assume the best of your lactation consultant

> peers. However, if you are certain that another IBCLC is making grave

> errors, not just using techniques different than what you choose, then it

> behooves YOU to give them a call and discuss (not a particular client), but

> the scenario and ask them what they might have been thinking or planning in

> the management and discuss what you might do differently and why. If they

> turn out to be unteachable AND practicing poorly, then you should let them

> know that you will inform the parents and/ or IBLCE.

>

>

>

> It is also important to consider other factors in a decision to do this. I

> have worked with quite a few other IBCLCs in clinical situations and we all

> can choose different plans to manage the same situation, this often depends

> on the mother's skills and abilities and support system and preferences. For

> example if a mother has a low supply my colleague who is also an MD may go

> right to a prescription for Reglan because she can, one mother might choose

> to pump after every feeding to increase the supply because she has only 1

> child and lots of help from dad, another mother who has 3 older kids and no

> help might choose only an at breast supplementer, another mother might do

> any combination of the above which is not wrong, but applied to different

> circumstances. If a mother comes to you reporting that the last LC she saw

> used a different method you can say that is one way to do it, but I have

> other options for you... However, if the other LC said to bottle feed the

> baby and only pump twice a day to increase a milk supply, well that would be

> bad practice. You would call her and say gee, how is that going to work? My

> evidence states you need a minimum of 8 -10 pumpings a day to initiate a

> milk supply.

>

>

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

------------------------------------

[Guest guest]

WARNING---This is going to be VERY PISSY!!!

wrote:

" Parents who care, will educate themselves. That goes for anything - Lactation,

Midwifery - I'd even go so far as to say it goes for the practice of Medicine. I

know more doctors who 'practice malpractice' and get away with it than ethical,

attentive, evidence based practicing physicians. "

I am NOT in support of licensure. NOT even a tiny little bit. It is a

medicalized approach to infant feeding that I think will not improve outcomes

for anyone. And, frankly, until we have better assessment among our own

profession, I don't think we can say with any integrity that there is a common

standard of skill among IBCLCs.

And I do think people should be able to pay anyone they want to provide

services--provided it is possible for those people to actually understand what

the quality of the services are they are paying for. I have no interest in

insurance reimbursement and no interest in being constrained by licensure--which

always limits everyone who is not a doctor beyond any reason. Every licensure

process has as its priority protecting the practice of medicine (so that

everything is the practice of medicine and not allowed by anyone else) and not

protecting consumers who end up with sub-optimal care bc of it.

But, I also think the above comment is unfair--how can parents educate

themselves when I don't even know who all these people are?

IMO, this is a nightmare and it's only getting worse. I see the most awful

information given out by many of these supposed breastfeeding professionals and

they themselves have so little respect for the IBCLC credential that they are

frequently not open to learning. Everyone who gets near a pregnant or birthing

woman thinks she is a bfing expert and I find as much myth as fact from the

majority of doulas, midwives, CBEs, etc as I do from doctors and nurses.

I have been told that non-IBCLCs are legitimately " LCs " and IMO, most have no

idea what their limitations are. If I am a mom and I pay someone to see me and

that person is beyond their scope or knowledge base, why would I want to now pay

someone else? There is someone in my area charging $25 for a home visit. Are you

kidding me? She certainly makes claims that might make any mom think she is an

LC.

The IBLCE has contributed immensely to this problem by making it so difficult

for non-HCPs to become IBCLCs that many who are passionate about bfing will just

become CLCs and hang out their shingles. And that description of the CLC? That

sure doesn't sound like a stepping-stone credential (which makes no sense to me

anyway). It sounds like THE credential to help moms breastfeed. If I were a mom

trying to educate myself and found this, I would think this was an LC and I had

found the person to hire.

How we can continue to make all these little niches and think they serve women

blows my mind. I think it's fine to have an educator or counselor or whatever

credential for people who work with moms already such as WIC personnel or

hospital staff or doulas or whatever. But for any of them to qualify a person to

work in a primary role in breastfeeding? That makes no sense to me. For that,

one should become an IBCLC. OTOH, I also think IBCLCs need to begin with much

more knowledge than we currently do.

Bc, for example, the fact that more mothers are now diagnosing their own kids'

TTs AFTER seeing IBCLCs than seem to be diagnosed with the IBCLC should be

embarrassing to all of us.

I am beyond fed up. It is not in my nature to support gate-keeping. But, I know

I am not the only LC who helps moms who contact me every single day by email or

PM, after reading something I have written somewhere, desperate to rescue

breastfeeding after having had terrible advice from folks whose credentials I

cannot even sort out myself.

But, I do agree with you that we will not protect anyone by creating an

elite group of licensed providers--what that tends to do is create a fall sense

of security for consumers. As you said, " I know more doctors who 'practice

malpractice' and get away with it than ethical, attentive, evidence based

practicing physicians. " That happens bc of the lie that licensure ensures a

level of care that it does not. I have no desire to participate in such a

system.

But, I am at a loss.

Tow, IBCLC

> >

> > This is why we need licensure which ties the legal practice of lactation

> > consulting to the IBCLC requirements. No one outside of our own community of

> > professionals knows the difference between all of the many lactation

> > certifications out there, including sometimes those that actually hold them.

> > The well intentioned person who wants to help mothers and takes a course

> > advertised to certify them as a lactation consultant may have no clue what

> > they do not know or know about the IBCLC. More importantly, the public

> > cannot assess whether any given individual is more qualified to provide

> > lactation services because they don't know the backgrounds of varied

> > certifications. Also, when the family gets poor care and reports it to their

> > health professional or their family and friends, it makes anyone who calls

> > themselves a lactation consultant look bad - and that is us. Licensure as

> > proposed and advocated for, by the USLCA includes legislative language

> > specifying the minimum requirements of the IBLCE to sit for the exam and the

> > requirement of passing a criterion referenced exam as well.

> >

> >

> >

> > Judy

> >

> > Judith L. Gutowski, BA, IBCLC, RLC

> >

> > 135 McGrath Lane

> >

> > P Box 1

> >

> > Hannastown, PA 15635-0001

> >

> > Cell Phone

> >

> > Fax

> >

>

[Guest guest]

For background, I have been an IBCLC since 1986. Was a LLLL for thirty years before resigning and am now a volunteer breastfeeding counselor for Breastfeeding USA. I am also a registered medical technologist - we are the ones that do all the lab work. Presently I am working in that capacity as a Technical Team Leader in the chemistry department of a local hospital.

Medical technologists are also the " unseen " but very important workers in health care. Doctors base much of their diagnosis and treatment on their patients' lab results. To become a medical technologist you must earn a BS in medical technology and do an internship - it is quite an intense program including three to four years of chemistry and biological sciences plus math and statistics and the usual basic stuff. Then you have to pass a very rigorous registry exam. But we don't get much respect or recognition from the public or other health care professionals, for that matter. Nurses can go to school for 2 years and make more and get more recognition as new hires than med techs with years of experience. But that is another matter. Actually, nurses are getting laid off in some places now, but it is rare for a med tech not to be able to find a job.

Anyways, most med techs are not licensed except for a few states. I spent most of my career in New York where the med tech association worked for years and years to get licensure for med techs, on the premise that it would elevate our stature in the health world and lead to better pay. What actually happened is that the state got several hundred dollars out of each of us the first year and will continue to get money from us for ever more. Even though I have been a med tech since 1974, now that I have moved to Colorado, if I let my license lapse in NY and at some time in the future decide to go back, I will have to take another really tough exam or will no be able to work in that state. So now I have the option of continuing to pay NY forever on the off chance I might return and want a job as a med tech, or just stop giving them money and take my chances. It's ridiculous. And the licensing law does not even include a requirement for continuing education to keep your license, which to me would be one of the only good things about it.  I did not see any change in how we were treated before or after licensure and it certainly did not affect our pay.

I am one who does not think that I will be making more money as a PPLC if I am licensed and reimbursable. There may be other reasons, to pursue it, but that is not one of them. I also don't think that the respect factor will go up - in many cases it will still be a matter of whether or not you are also a nurse.  Will it stop CLCs or completely untrained people from promoting themselves as LCs?  I don't know - it depends on how the law is written.  Will it require a certain amount of training/college degree/etc.?  Again, don't know.  Will it limits mothers' choices in who they can turn to for lactation help?  Again, don't know.

I do not foresee any impact on volunteer counselors, such as those working for BfUSA, LLL, NMC, WIC, etc. But you never know what will happen once bureaucrats get hold of something - again, it depends on the language of the law. I think that we all need to become more knowledgeable about what is being done on our behalf for those working towards licensure. But I don't think it will be a panacea for most of the problems that are facing the profession.

Sharon KnorrColorado

I agree with your concerns . I'm not sure how licensure will help us. I am hoping it will allow more access to care for mothers because insurance will cover our services, but I'm not sure licensure will help us in that respect. But I don't know as much about it as a lot of others do on this list.

I worry about LLL and WIC in all this. I have worked as a volunteer for 5 years with LLL and I feel I have been an asset to my community. It would be horrible if that went away.

And I know a lot of people will say that won't happen, but as I learned last summer, licensure can make it tricky.

I had to file legal briefs to be appointed guardian of my mother. I couldn't afford a lawyer so I was sent to the law library. The librarian told me " I'm not sure if this book is what you will need and even if I did know I couldn't tell you because that would be practicing law without a license. " If it weren't for a few lawyers steering me in the right direction I never could have done it. I would hope that wouldn't happen with lactation, but it does have me a bit worried.

Sent via BlackBerry from T-Mobile

Re: lactation " professionals " - licensure?

In an attempt to understand better the possible advantages of IBCLC Licensure, I went to then USCLA website to learn more. I found this list of " Why do IBCLCs need to be licensed? "

I have *starred* my questions/response following each checkpoint.

& #10004; Currently, anyone can call themselves a lactation consultant, even with minimal training or without board certification. The public now has no means of identifying a qualified lactation consultant and no protection from unqualified practitioners. A family has no means of recourse in the event of a bad outcome from an unqualified caregiver. Licensure would assure consumers, employers, hospitals, and other health care providers and organizations that they are engaging qualified professionals.

*Now that licensure is not in effect, families can go through civil and sometimes criminal proceedings as a means of recourse (thats why we have liability insurance as IBCLCs which USCLA has worked hard to make available for us all). If licensure goes into effect, it would become criminal means of recourse if 'practicing lactation without a license' will be illegal. Then the state would prosecute the professional for 'practicing lactation' without a license - something that would prevent that professional from ever getting a license. Can anyone guarantee that as long as the professional is not charging for his/her services, he/she will not have legal recourse… in all 50 states? There is no law in any of 50 states saying that if a midwife is not charging for her services, then she is not violating the law. In fact some traditional midwives do not charge for their services and have still been criminally prosecuted -even jailed for practicing medicine/midwifery without a license -though they were not charging.*

& #10004; Medicare and Medicaid reimburse only LICENSED health care providers.

*I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse my services. A few other Licensed Midwives who meet additional requirements are reimbursed - at less than 20% of their already discounted service fees. I don't know any (not to say that there are non) licensed midwives who have chosen to be a provider for such a low rate. *

& #10004; Many other insurers also reimburse only licensed practitioners.

*As an IBCLC, I have about 80% of my fees reimbursed to clients, and of course I am not licensed as there is no license. How is Licensure a guarantee that services will be reimbursed or more highly reimbursed.*

& #10004; IBCLCs are healthcare professionals and need to be recognized as such in states, hospitals, and health policy, just like all other healthcare professionals.

*Yes! But why would a License change that? CPM Midwives are Licensed (or can be if they choose), have been for 3 decades in and we are still the least respected healthcare professional in the very states that license us. Certified Nurse Midwives are not licensed - they are registered, certified but not licensed and they are more respected in all states, hospitals and health policy than any Licensed Midwife. The License just doesn't seem like the thing that causes respect. *

& #10004; Licensure allows the IBCLC to practice to full extent of the profession's scope of practice.

*I feel like I am practicing to the full extent of my scope of practice. Please let me know how Licensure will affect this, if I have something to learn, I would love to humbly learn how my scope could be increased by being licensed. *

& #10004; Licensure places IBCLCs on a more even footing with other licensed health professionals, allowing the voice of the IBCLC to be heard, respected, and valued.

*Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we see that actually this is not the case, in fact the opposite seems to be true.*

& #10004; Licensure of IBCLCs provides protection for the public, just as licensing does for other health professions.

*Public citizens always have a form of recourse against any other member of the public and can always report a health care professional to their appropriate board (as happens with certified nurse midwives). What Licensing does is allow anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an IBCLC to lose her 'license to practice lactation' if the board (could be connected to the local Medical or Nursing board) decides that the Lactation Consultant is practicing outside of her standards of care. While again I do agree that IBCLCs who are not helping clients, or practicing unethically should be re-taught, have their registration put on probation or have their IBCLC status removed -this is something that IBCLE can do on its own! Involving State Licensing Boards that are so often attached to the Medical or Nursing boards just seems like asking for the same trouble that midwives are now currently suffering under. Of course there are a few, a select few states which have made Midwifery Licensing work much better than other states - but who can guarantee that each state will adhere to the same Licensing standards? There is no such thing as National Licensure. *

& #10004; Licensure will improve access to lactation care and services, especially for families who cannot afford to pay out of pocket for health care services.

*So, it sounds like Medicare and Medicaid don't reimburse non-licensed health care professionals - but that would be saying that they don't reimburse Certified Nurse Midwives, which isn't true as far as I know. Very few midwives are rich enough to be able to basically donate their time and resources to women for the pennies that Medicare and Medicaid sometimes throw at us. And if those Midwives are so rich - they don't mind giving their services to women who can't afford care. This just doesn't seem like a big enough point for Licensure. If an IBCLC can accept what little Medicare and Medicaid pays (though I can't see why licensure would affect them paying), then she can also afford to see those clients for free anyway rather than deal with the additional fees and hassle of Licensure. *

I'm just feeling that Licensure could very well lead to unnecessary bureaucracy and further issues for the IBCLC in PP, and feeling that this is a safe and open forum to voice these concerns. Am I the only one with these concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my local county and hospitals within are not midwife/homebirth friendly and though I've personally had no issues with any local Professionals and currently work well with them, others have had legal proceedings from Physicians who are trying to restrict trade. I've started just concentrating on Doula work and Lactation Consulting, and my clients have been and are very happy with my Lactation Services.

I am concerned with the future of the IBCLC profession, as I'm an IBCLC and a mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont go into effect, perhaps it will. If so, at least I hope these issues are being looked at VERY carefully and as I believe all things are possible, that perhaps if the Licensing committee is diligent to these points, then perhaps it will not become the mess that Midwifery Licensure has become. On the other hand, I just still can't quite understand what incredibly important and essential thing that Licensure is going to give us that we don't already have or are already in the process of having?

Especially as an IBCLC in PP, writing in this PP forum - we are the ones that Licensure will affect the most. Hospital based IBCLCs may not see much of a change, or a slight change in the way things are done. PP IBCLCs will be greatly affected by IBCLC Licensure -of that I'm sure.

Again, don't mean to step on anyone's toes here - but I have some serious concerns. Am I alone?

>

> states, "

>

> As for the 'not-so-great' Lactation Consultants. I absolutely don't have the

> time to police other Lactation Consultants or 'turn them in' because I

> disagree with the way they practice. I feel that is the duty of parents and

> parents alone who have been dissatisfied with their experiences. It is

> parents who benefit or lose, and they alone who should be filing complaints.

>

>

> My job is to 1. breastfeed my own baby and 2. act as the best Lactation

> Consultant to other moms as I can. "

>

>

>

> Sadly, most  parents have no way of knowing when they are getting poor

> advice. They just fail at breastfeeding and tell others that they saw a

> lactation consultant and it didn't help. This hurts the reputation of every

> lactation consultant and hurts the chances for many parents to succeed at

> breastfeeding. If we want " all mothers and babies " to have the opportunity

> to breastfeed successfully, we have to step up and intervene. By only

> focusing on our own little piece of the world, we hurt ourselves and others.

> We have to take the TIME. Does any LC have time to do this? Probably not, we

> all wear so many hats. I know I do. See my favorite clip art graphic

> attached.

>

>

>

> Sometimes what we hear from clients is not correct, their new mommy brains

> don't remember correctly or they misinterpreted, miscommunicated, etc.   The

> right thing to do is always assume the best of your lactation consultant

> peers. However, if you are certain that another IBCLC is making grave

> errors, not just using techniques different than what you choose, then it

> behooves YOU to give them a call and discuss (not a particular client), but

> the scenario and ask them what they might have been thinking or planning in

> the management and discuss what you might do differently and why. If they

> turn out to be unteachable AND practicing poorly, then you should let them

> know that you will inform the parents and/ or IBLCE.

>

>

>

> It is also important to consider other factors in a decision to do this. I

> have worked with quite a few other IBCLCs in clinical situations and we all

> can choose different plans to manage the same situation, this often depends

> on the mother's skills and abilities and support system and preferences. For

> example if a mother has a low supply my colleague who is also an MD may go

> right to a prescription for Reglan because she can, one mother might choose

> to pump after every feeding to increase the supply because she has only 1

> child and lots of help from dad, another mother who has 3 older kids and no

> help might choose only an at breast supplementer, another mother might do

> any combination of the above which is not wrong, but applied to different

> circumstances. If a mother comes to you reporting that the last LC she saw

> used a different method you can say that is one way to do it, but I have

> other options for you...  However, if the other LC said to bottle feed the

> baby and only pump twice a day to increase a milk supply, well that would be

> bad practice. You would call her and say gee, how is that going to work? My

> evidence states you need a minimum of 8 -10 pumpings a day to initiate a

> milk supply.

>

>

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

------------------------------------

[Guest guest]

You are not alone, . I have said for some time that I don't see how licensure will help us. And the added expense of possibly several hundred dollars per year to maintain that license may just keep a lot of would-be private practice IBCLCs from ever trying private practice. To my way of thinking, licensure has the risk of causing all IBCLCs to become hospital- or WIC-based, and then mothers won't have the option of seeing an IBCLC in private practice who is free to tell the mother about symptoms that may be helped by craniosacral therapy or about symptoms of tongue tie. Many hospital-based IBCLCs would lose their job if they pointed out either of these to a mother, so they don't point them out and mothers are left to wonder why nothing is getting better.

Dee Kassing

Subject: Re: lactation "professionals" - licensure?To: Date: Wednesday, November 30, 2011, 6:33 PM

In an attempt to understand better the possible advantages of IBCLC Licensure, I went to then USCLA website to learn more. I found this list of "Why do IBCLCs need to be licensed?"I have *starred* my questions/response following each checkpoint. & #10004; Currently, anyone can call themselves a lactation consultant, even with minimal training or without board certification. The public now has no means of identifying a qualified lactation consultant and no protection from unqualified practitioners. A family has no means of recourse in the event of a bad outcome from an unqualified caregiver. Licensure would assure consumers, employers, hospitals, and other health care providers and organizations that they are engaging qualified professionals.*Now that licensure is not in effect, families can go through civil and sometimes criminal proceedings as a means of recourse (thats why we have liability insurance as IBCLCs which USCLA

has worked hard to make available for us all). If licensure goes into effect, it would become criminal means of recourse if 'practicing lactation without a license' will be illegal. Then the state would prosecute the professional for 'practicing lactation' without a license - something that would prevent that professional from ever getting a license. Can anyone guarantee that as long as the professional is not charging for his/her services, he/she will not have legal recourse… in all 50 states? There is no law in any of 50 states saying that if a midwife is not charging for her services, then she is not violating the law. In fact some traditional midwives do not charge for their services and have still been criminally prosecuted -even jailed for practicing medicine/midwifery without a license -though they were not charging.* & #10004; Medicare and Medicaid reimburse only LICENSED health care providers.*I am a Licensed Midwife.

Medicare and Medicaid do not currently reimburse my services. A few other Licensed Midwives who meet additional requirements are reimbursed - at less than 20% of their already discounted service fees. I don't know any (not to say that there are non) licensed midwives who have chosen to be a provider for such a low rate. * & #10004; Many other insurers also reimburse only licensed practitioners.*As an IBCLC, I have about 80% of my fees reimbursed to clients, and of course I am not licensed as there is no license. How is Licensure a guarantee that services will be reimbursed or more highly reimbursed.* & #10004; IBCLCs are healthcare professionals and need to be recognized as such in states, hospitals, and health policy, just like all other healthcare professionals.*Yes! But why would a License change that? CPM Midwives are Licensed (or can be if they choose), have been for 3 decades in and we are still the least

respected healthcare professional in the very states that license us. Certified Nurse Midwives are not licensed - they are registered, certified but not licensed and they are more respected in all states, hospitals and health policy than any Licensed Midwife. The License just doesn't seem like the thing that causes respect. * & #10004; Licensure allows the IBCLC to practice to full extent of the profession's scope of practice.*I feel like I am practicing to the full extent of my scope of practice. Please let me know how Licensure will affect this, if I have something to learn, I would love to humbly learn how my scope could be increased by being licensed. * & #10004; Licensure places IBCLCs on a more even footing with other licensed health professionals, allowing the voice of the IBCLC to be heard, respected, and valued.*Again, if we look at Licensed Midwives and "Certified" Nurse Midwives, we see that actually this

is not the case, in fact the opposite seems to be true.* & #10004; Licensure of IBCLCs provides protection for the public, just as licensing does for other health professions.*Public citizens always have a form of recourse against any other member of the public and can always report a health care professional to their appropriate board (as happens with certified nurse midwives). What Licensing does is allow anyone (Doctors, Nurses, other IBCLCs, parents and anyone really) to cause an IBCLC to lose her 'license to practice lactation' if the board (could be connected to the local Medical or Nursing board) decides that the Lactation Consultant is practicing outside of her standards of care. While again I do agree that IBCLCs who are not helping clients, or practicing unethically should be re-taught, have their registration put on probation or have their IBCLC status removed -this is something that IBCLE can do on its own! Involving State

Licensing Boards that are so often attached to the Medical or Nursing boards just seems like asking for the same trouble that midwives are now currently suffering under. Of course there are a few, a select few states which have made Midwifery Licensing work much better than other states - but who can guarantee that each state will adhere to the same Licensing standards? There is no such thing as National Licensure. * & #10004; Licensure will improve access to lactation care and services, especially for families who cannot afford to pay out of pocket for health care services.*So, it sounds like Medicare and Medicaid don't reimburse non-licensed health care professionals - but that would be saying that they don't reimburse Certified Nurse Midwives, which isn't true as far as I know. Very few midwives are rich enough to be able to basically donate their time and resources to women for the pennies that Medicare and Medicaid sometimes throw

at us. And if those Midwives are so rich - they don't mind giving their services to women who can't afford care. This just doesn't seem like a big enough point for Licensure. If an IBCLC can accept what little Medicare and Medicaid pays (though I can't see why licensure would affect them paying), then she can also afford to see those clients for free anyway rather than deal with the additional fees and hassle of Licensure. *I'm just feeling that Licensure could very well lead to unnecessary bureaucracy and further issues for the IBCLC in PP, and feeling that this is a safe and open forum to voice these concerns. Am I the only one with these concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my local county and hospitals within are not midwife/homebirth friendly and though I've personally had no issues with any local Professionals and currently

work well with them, others have had legal proceedings from Physicians who are trying to restrict trade. I've started just concentrating on Doula work and Lactation Consulting, and my clients have been and are very happy with my Lactation Services. I am concerned with the future of the IBCLC profession, as I'm an IBCLC and a mother who benefited from an IBCLC after I gave birth. Perhaps Licensure wont go into effect, perhaps it will. If so, at least I hope these issues are being looked at VERY carefully and as I believe all things are possible, that perhaps if the Licensing committee is diligent to these points, then perhaps it will not become the mess that Midwifery Licensure has become. On the other hand, I just still can't quite understand what incredibly important and essential thing that Licensure is going to give us that we don't already have or are already in the process of having?Especially as an IBCLC in PP, writing in this PP forum -

we are the ones that Licensure will affect the most. Hospital based IBCLCs may not see much of a change, or a slight change in the way things are done. PP IBCLCs will be greatly affected by IBCLC Licensure -of that I'm sure. Again, don't mean to step on anyone's toes here - but I have some serious concerns. Am I alone?>> states, "> > As for the 'not-so-great' Lactation Consultants. I absolutely don't have the> time to police other Lactation Consultants or 'turn them in' because I> disagree with the way they practice. I feel that is the duty of parents and> parents alone who have been dissatisfied with their experiences. It is> parents who

benefit or lose, and they alone who should be filing complaints.> > > My job is to 1. breastfeed my own baby and 2. act as the best Lactation> Consultant to other moms as I can."> > > > Sadly, most parents have no way of knowing when they are getting poor> advice. They just fail at breastfeeding and tell others that they saw a> lactation consultant and it didn't help. This hurts the reputation of every> lactation consultant and hurts the chances for many parents to succeed at> breastfeeding. If we want "all mothers and babies" to have the opportunity> to breastfeed successfully, we have to step up and intervene. By only> focusing on our own little piece of the world, we hurt ourselves and others.> We have to take the TIME. Does any LC have time to do this? Probably not, we> all wear so many hats. I know I do. See my favorite clip art

graphic> attached. > > > > Sometimes what we hear from clients is not correct, their new mommy brains> don't remember correctly or they misinterpreted, miscommunicated, etc. The> right thing to do is always assume the best of your lactation consultant> peers. However, if you are certain that another IBCLC is making grave> errors, not just using techniques different than what you choose, then it> behooves YOU to give them a call and discuss (not a particular client), but> the scenario and ask them what they might have been thinking or planning in> the management and discuss what you might do differently and why. If they> turn out to be unteachable AND practicing poorly, then you should let them> know that you will inform the parents and/ or IBLCE. > > > > It is also important to consider other factors in a decision to do this.

I> have worked with quite a few other IBCLCs in clinical situations and we all> can choose different plans to manage the same situation, this often depends> on the mother's skills and abilities and support system and preferences. For> example if a mother has a low supply my colleague who is also an MD may go> right to a prescription for Reglan because she can, one mother might choose> to pump after every feeding to increase the supply because she has only 1> child and lots of help from dad, another mother who has 3 older kids and no> help might choose only an at breast supplementer, another mother might do> any combination of the above which is not wrong, but applied to different> circumstances. If a mother comes to you reporting that the last LC she saw> used a different method you can say that is one way to do it, but I have> other options for you... However, if the

other LC said to bottle feed the> baby and only pump twice a day to increase a milk supply, well that would be> bad practice. You would call her and say gee, how is that going to work? My> evidence states you need a minimum of 8 -10 pumpings a day to initiate a> milk supply. > > > > > > Judy> > Judith L. Gutowski, BA, IBCLC, RLC> > 135 McGrath Lane> > P Box 1> > Hannastown, PA 15635-0001> > Cell Phone > > Fax >

[Guest guest]

Sharon wrote: "I do not foresee any impact on volunteer counselors, such as those working for BfUSA, LLL, NMC, WIC, etc. ..."

FYI: At least in Illinois, where I live, WIC Peer Counselors are not volunteers. They are paid. Some are considered employees of a particular health department or health district, but others are considered contractual employees (in other words, Peer Counselors in private practice). So that may place them in even more limbo than volunteer counselors, if licensure law would require that you be a licensed IBCLC to "practice lactation", since they do get paid.

Dee Kassing

[Guest guest]

You are correct, Dee. Most WIC counselors are paid. And you are also correct that they could be in an even more awkward position.Sharon

 

Sharon wrote:  " I do not foresee any impact on volunteer counselors, such as those working for BfUSA, LLL, NMC, WIC, etc. ... "

 

FYI:  At least in Illinois, where I live, WIC Peer Counselors are not volunteers.  They are paid.  Some are considered employees of a particular health department or health district, but others are considered contractual employees (in other words, Peer Counselors in private practice).  So that may place them in even more limbo than volunteer counselors, if licensure law would require that you be a licensed IBCLC to " practice lactation " , since they do get paid.

    Dee Kassing

[Guest guest]

Hi,

Just joining this conversation. I am a CNM in NYC and here you need a Midwife

license to practice Midwifery. I think it may vary from state to state. In NY I

am also able to prescribe medications although this is not the case in all

states.

I honestly do not know if licensure is a good thing or not. I am glad there is a

certifying board and that the requirements for certification are very rigorous.

Not sure that being licensed would add anything to the profession.

Meredith Barish

> > >

> > > In an attempt to understand better the possible advantages of IBCLC

Licensure, I went to then USCLA website to learn more. I found this list of " Why

do IBCLCs need to be licensed? "

> > > I have *starred* my questions/response following each checkpoint.

> > >

> > > & #10004; Currently, anyone can call themselves a lactation consultant,

even with minimal training or without board certification. The public now has no

means of identifying a qualified lactation consultant and no protection from

unqualified practitioners. A family has no means of recourse in the event of a

bad outcome from an unqualified caregiver. Licensure would assure consumers,

employers, hospitals, and other health care providers and organizations that

they are engaging qualified professionals.

> > >

> > > *Now that licensure is not in effect, families can go through civil and

sometimes criminal proceedings as a means of recourse (thats why we have

liability insurance as IBCLCs which USCLA has worked hard to make available for

us all). If licensure goes into effect, it would become criminal means of

recourse if 'practicing lactation without a license' will be illegal. Then the

state would prosecute the professional for 'practicing lactation' without a

license - something that would prevent that professional from ever getting a

license. Can anyone guarantee that as long as the professional is not charging

for his/her services, he/she will not have legal recourse… in all 50 states?

There is no law in any of 50 states saying that if a midwife is not charging for

her services, then she is not violating the law. In fact some traditional

midwives do not charge for their services and have still been criminally

prosecuted -even jailed for practicing medicine/midwifery without a license

-though they were not charging.*

> > >

> > > & #10004; Medicare and Medicaid reimburse only LICENSED health care

providers.

> > >

> > > *I am a Licensed Midwife. Medicare and Medicaid do not currently reimburse

my services. A few other Licensed Midwives who meet additional requirements are

reimbursed - at less than 20% of their already discounted service fees. I don't

know any (not to say that there are non) licensed midwives who have chosen to be

a provider for such a low rate. *

> > >

> > > & #10004; Many other insurers also reimburse only licensed practitioners.

> > >

> > > *As an IBCLC, I have about 80% of my fees reimbursed to clients, and of

course I am not licensed as there is no license. How is Licensure a guarantee

that services will be reimbursed or more highly reimbursed.*

> > >

> > > & #10004; IBCLCs are healthcare professionals and need to be recognized as

such in states, hospitals, and health policy, just like all other healthcare

professionals.

> > >

> > > *Yes! But why would a License change that? CPM Midwives are Licensed (or

can be if they choose), have been for 3 decades in and we are still the least

respected healthcare professional in the very states that license us. Certified

Nurse Midwives are not licensed - they are registered, certified but not

licensed and they are more respected in all states, hospitals and health policy

than any Licensed Midwife. The License just doesn't seem like the thing that

causes respect. *

> > >

> > > & #10004; Licensure allows the IBCLC to practice to full extent of the

profession's scope of practice.

> > >

> > > *I feel like I am practicing to the full extent of my scope of practice.

Please let me know how Licensure will affect this, if I have something to learn,

I would love to humbly learn how my scope could be increased by being licensed.

*

> > >

> > > & #10004; Licensure places IBCLCs on a more even footing with other

licensed health professionals, allowing the voice of the IBCLC to be heard,

respected, and valued.

> > >

> > > *Again, if we look at Licensed Midwives and " Certified " Nurse Midwives, we

see that actually this is not the case, in fact the opposite seems to be true.*

> > >

> > > & #10004; Licensure of IBCLCs provides protection for the public, just as

licensing does for other health professions.

> > >

> > > *Public citizens always have a form of recourse against any other member

of the public and can always report a health care professional to their

appropriate board (as happens with certified nurse midwives). What Licensing

does is allow anyone (Doctors, Nurses, other IBCLCs, parents and anyone really)

to cause an IBCLC to lose her 'license to practice lactation' if the board

(could be connected to the local Medical or Nursing board) decides that the

Lactation Consultant is practicing outside of her standards of care. While again

I do agree that IBCLCs who are not helping clients, or practicing unethically

should be re-taught, have their registration put on probation or have their

IBCLC status removed -this is something that IBCLE can do on its own! Involving

State Licensing Boards that are so often attached to the Medical or Nursing

boards just seems like asking for the same trouble that midwives are now

currently suffering under. Of course there are a few, a select few states which

have made Midwifery Licensing work much better than other states - but who can

guarantee that each state will adhere to the same Licensing standards? There is

no such thing as National Licensure. *

> > >

> > > & #10004; Licensure will improve access to lactation care and services,

especially for families who cannot afford to pay out of pocket for health care

services.

> > >

> > > *So, it sounds like Medicare and Medicaid don't reimburse non-licensed

health care professionals - but that would be saying that they don't reimburse

Certified Nurse Midwives, which isn't true as far as I know. Very few midwives

are rich enough to be able to basically donate their time and resources to women

for the pennies that Medicare and Medicaid sometimes throw at us. And if those

Midwives are so rich - they don't mind giving their services to women who can't

afford care. This just doesn't seem like a big enough point for Licensure. If an

IBCLC can accept what little Medicare and Medicaid pays (though I can't see why

licensure would affect them paying), then she can also afford to see those

clients for free anyway rather than deal with the additional fees and hassle of

Licensure. *

> > >

> > > I'm just feeling that Licensure could very well lead to unnecessary

bureaucracy and further issues for the IBCLC in PP, and feeling that this is a

safe and open forum to voice these concerns. Am I the only one with these

concerns? If so, perhaps I just need to be quiet : ) But I am a relatively new

IBCLC, long-time Midwife,. I've stopped seeing clients as a midwife because my

local county and hospitals within are not midwife/homebirth friendly and though

I've personally had no issues with any local Professionals and currently work

well with them, others have had legal proceedings from Physicians who are trying

to restrict trade. I've started just concentrating on Doula work and Lactation

Consulting, and my clients have been and are very happy with my Lactation

Services.

> > > I am concerned with the future of the IBCLC profession, as I'm an IBCLC

and a mother who benefited from an IBCLC after I gave birth. Perhaps Licensure

wont go into effect, perhaps it will. If so, at least I hope these issues are

being looked at VERY carefully and as I believe all things are possible, that

perhaps if the Licensing committee is diligent to these points, then perhaps it

will not become the mess that Midwifery Licensure has become. On the other hand,

I just still can't quite understand what incredibly important and essential

thing that Licensure is going to give us that we don't already have or are

already in the process of having?

> > > Especially as an IBCLC in PP, writing in this PP forum - we are the ones

that Licensure will affect the most. Hospital based IBCLCs may not see much of a

change, or a slight change in the way things are done. PP IBCLCs will be greatly

affected by IBCLC Licensure -of that I'm sure.

> > > Again, don't mean to step on anyone's toes here - but I have some serious

concerns. Am I alone?

> > >

> >

>

[Guest guest]

I am an RN. I have a license. I have to renew that license every two years. I'm registered with the board of nursing, licensed with the state of IL. I used to be licensed with the state of MI, but let it lapse when I realized I would never live there again.

A CNM, as was stated, is licensed as an RN, and certified as a nurse midwife. My daughter is an RN, she is licensed in the state of FL. She is also a CFNP -- Certified Family Nurse Practitioner which gives her advanced registered nurse practitioner status.

My hairdresser is licensed with the state of IL. So is the woman who does my nails.

Jan

Correct me here (with references) if I'm wrong, but they are "registered", they are "certified" but they are not "licensed."

[Guest guest]

And why does a hairdresser need to be licensed? Does it make her a better hairdresser? Are med techs in NY better as a group at what they do because they are now licensed? Not in my experience - some are very good, some are pretty bad, many are in the middle, as it is with most professions. IMHO, licensing has become a way for the state to make more money in the guise of somehow protecting all of us (from rogue nail stylists?). If I went back to NY and had to take that test to practice as a med tech again if my license lapses, would that make me a better tech? No, it would just make things much more difficult and expensive. That license doesn't even require continuing education, which to me is the basis for at least making an attempt to keep up in your chosen profession. Also, as part of the licensing of med techs we cannot anymore train someone on the job, say with a BS in biology or chemistry, to become a med tech - they have to graduate from a recognized med tech program. What that does is remove a potential pool of workers that hospitals had been able to tap into for many years. What if state boards begin to require that all IBCLCs must graduate from a specific college program or first be RNs in order to be licensed? Someone please correct me if I am wrong, but that could conceivably happen, especially if the health professionals in that state wanted to push things in a certain direction. That is part of my worry.

Sharon Knorr

 

I am an RN.  I have a license.  I have to renew that license every two years.  I'm registered with the board of nursing, licensed with the state of IL.  I used to be licensed with the state of MI, but let it lapse when I realized I would never live there again. 

 

A CNM, as was stated, is licensed as an RN, and certified as a nurse midwife.  My daughter is an RN, she is licensed in the state of FL.  She is also a CFNP -- Certified Family Nurse Practitioner which gives her advanced registered nurse practitioner status.

 

My hairdresser is licensed with the state of IL.  So is the woman who does my nails. 

 

Jan  

Correct me here (with references) if I'm wrong, but they are " registered " , they are " certified " but they are not " licensed. "

[Guest guest]

“To my way of thinking, licensure has the risk of causing all IBCLCs to become hospital- or WIC-based, and then mothers won't have the option of seeing an IBCLC in private practice who is free to tell the mother about symptoms that may be helped by craniosacral therapy or about symptoms of tongue tie. “ I totally agree with you, Dee. I don’t know as much about the details of licensure as many of you do, but I am sure it will not help me, personally, or the mothers in my area. I came from a volunteer background and have advanced degrees in English, of all things. I will never be a nurse. I could never qualify to take the exam with the new requirements. However, I have earned the respect of the physicians, hospitals, and mothers in my area because I help mothers. Very few people here have any idea of my qualifications and wouldn’t care two cents if I was licensed or not. Many of my clients receive insurance reimbursement, and if someone can’t pay then I see them for reduced rates. Licensure would cost me money and get me what exactly? If I could not practice according to my own standards (and say tongue-tie whenever I feel it is appropriate!) then I would not practice, and there would not be anyone here to see mothers after they leave the hospital. As Dee says, the future of IBCLCs looks to me like they will all be in hospitals or in WIC. The new requirements almost certainly guarantee that, and licensure is likely to seal the deal. Becky , IBCLCMilky WayLa Plata, MD

[Guest guest]

I am not understanding what being a nurse has to do with licensure? I read many saying "I will never become a nurse". It is my understanding that licensure will raise our level of respect and hopefully increase referrals in the community. I also thought that the purpose of this was that non-RN IBCLCs can get an NPI number? Judy, please correct me if I'm wrong. I am in favor of it and it has nothing to do with me being a nurse. I already have an NPI number. What I need is recognition in the medical community as a fellow medical professional. I

don't want to be a hospital lactation consultant - I want to see moms AFTER they become engorged or when they are returning to work, etc. My vision is having docs call me or send written referrals to me as they would with any other specialist. I want to be on a preferred provider list to be THE breastfeeding specialist in my local area. Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and

baby To: Sent: Thursday, December 1, 2011 9:57 AM Subject: RE: Re: lactation "professionals" - licensure?

“To my way of thinking, licensure has the risk of causing all IBCLCs to become hospital- or WIC-based, and then mothers won't have the option of seeing an IBCLC in private practice who is free to tell the mother about symptoms that may be helped by craniosacral therapy or about symptoms of tongue tie. “ I totally agree with you, Dee. I don’t know as much about the details of licensure as many of you do, but I am sure it will not help me, personally, or the mothers in my area. I came from a volunteer background and have advanced degrees in English, of all things. I will never be a nurse. I could never qualify to take the exam with the new requirements. However, I have earned the respect of the physicians, hospitals, and mothers in my area because I

help mothers. Very few people here have any idea of my qualifications and wouldn’t care two cents if I was licensed or not. Many of my clients receive insurance reimbursement, and if someone can’t pay then I see them for reduced rates. Licensure would cost me money and get me what exactly? If I could not practice according to my own standards (and say tongue-tie whenever I feel it is appropriate!) then I would not practice, and there would not be anyone here to see mothers after they leave the hospital. As Dee says, the future of IBCLCs looks to me like they will all be in hospitals or in WIC. The new requirements almost certainly guarantee that, and licensure is likely to seal the deal. Becky , IBCLCMilky WayLa Plata, MD

[Guest guest]

Deirdre, I agree that we all want to be respected healthcare professionals. The question is, how will licensure help with that? As I said, almost no one here seems to have any understanding of my credentials so licensure will just add more words. The doctors and hospitals here refer to me because of my reputation, not because of my credentials. I really don’t think anyone will care about “licensed” any more than they care about “board certified”. I seriously doubt that licensure by itself will increase my referrals enough to cover the cost of licensure. Do you think that being able to say you are licensed will really change attitudes where you work? Becky , IBCLCMilky WayLa Plata, MD