Re: online lactation consult ???

[Guest guest]

I agree with everything has posted here. Although I do not do online consults because I am a technological dinosaur, I too have mothers drive 2 hrs one-way (sometimes even 4 or 5 hours one way!) to see me because they could not find the help they need in their nearby area.

Yes, there are a lot of LCs who really don't do a lot to increase their skills beyond passing the board exam, and they aren't good at handling the "train wrecks". And I feel they do a terrible disservice to our profession. And I won't refer to them.

But beyond that, what I actually tell mothers is this: "Twenty years ago, there weren't a lot of conferences about breastfeeding, and you might actually be able to attend most of them. But now there are many, many conferences. While it's good that there is so much more information about breastfeeding now, no one IBCLC can afford to go to all the conferences. She can't afford the registation and travel fees, and she can't afford to be out of her office all those days. So every one of us gets to attend different conferences and gets to find out different information. You may need to see 3 or 4 or 5 people before you find the one who got to the conference where she learned the exact tidbit of information you need to help your baby nurse better." It avoids making any derogatory statements about others in the area, is truthful about *some* of the others in the area, and gives the mother an idea she can live with

as to why she had to work so hard to find appropriate help.

Dee Kassing

Subject: Re: online lactation consult ???To: Date: Saturday, May 14, 2011, 7:28 PM

I do not see that as informed consent--I see it as control. I cannot imagine any mother is looking for someone on skype first and foremost. I had two skype consults this week. One was referred by her OB with whom I spoke. I gave the OB the name of the LC I refer to when I am away. This was a mastitis issue and she wanted the mom to work with me bc I use holistic interventions. It would be absurd to insist I had to give the names of other LCs or be in violation of some rule! The second was with a mom who had already seen three LCs in her area. One of whom I happen to know is VERY god. But, her problems have not been resolved and a friend of hers referred her to me for another opinion. I am sorry, and this may not be a popular thing to say--but there are a lot of ineffective LCs out there--I am NOT going to give out names of people I do not know to any mother. If I know of no one in an area, I will refer her to the ILCA list as

a last resort, but will first ask for a recommendation on a list like this one. If a mom wants to fly to France to see me, she can do that, but she cannot skype with me? I had moms drive 2 hours from out of state to see me in CT when I lived there. Should I have had to insist they see the LCs near them? Most already had, BTW. Also, I am not on the ILCA database. I am not a fan of ILCAs lack of support for non-medical IBCLCs and their posh to license and for insurance reimbursement--none of which I think reflects the real needs of mothers and babies or our profession. My name would never be given to anyone? Sorry, but I just do not see this as something to be afraid of. I think folks calling themselves LCs who aren't, the issues I mentioned above, and the lack of education for LCs beyond the basics are much more important issues. Tow, IBCLC, France> >> > I don't think you would need a company like this to get you going; and like > > everyone else that I have read responses from I agree that face-to face consults > > would be so much better. However, I am the only LC in my county not affiliated > > with the hospital or public health and will even "see" any mom once they are > > discharged from the hospital. And as a consumer, I would have loved to Skype ac > > LC 8 years ago when I moved out here to the boonies and developed all sorts of > > bfg problems. > > >

> Besides the "ease" of fitting it into moms life with a new baby, I think it will > > be an excellent way to reach MANY more mothers. Even moms "in your own > > backyard" may like to Skype first and talk about some easy stuff as a get to you > > first, and then feel a lot more comfortable about hauling themselves and baby > > (and all the gear they carry around down here) to see in in person. > > > > I am not sure if it is due to my location to the Mexican border, but I am > > finding that a lot of people are not receptive to a home visit.> > > > Laurean, IBCLC> > sunny, really hot Southern Ca> >>

[Guest guest]

The other thing I think is worthy of consideration is experience. Not everyone

shares the same experience. It's evident by reading this list there are a broad

variety of experience amongst IBCLC's, and with that also comes a broad variety

of skill building.

I also know IBCLC's who have re-certified 2-3 times who have not performed a

consult in over 10+ years. Even though they have 'more years' of certification,

I would be more inclined to refer a client to a more newly certified IBCLC who

has busted their rear to specialize in a specific area as opposed to sending the

client to someone who has more years of 'recertification'who is not currently

practicing or remaining active in the discipline. As my husband puts it, he is a

fireman, sometimes you find peers who have 20+ years of doing the same thing

over and over again. They don't really have 20+ years of cutting edge training

necessarily (this is not targeted to those of you who have both, lots of years

of recertification AND whom have remained active in the field).

I also see this as a problem with the IBLCE preceptor pathway. They need to do a

better job of defining the scope of ability of the persons doing the precepting.

Recertifying 1x is not an adequate assessment of anyone's professional

experience or abilities.

>

> I agree with everything has posted here.  Although I do not do

online consults because I am a technological dinosaur, I too have mothers drive

2 hrs one-way (sometimes even 4 or 5 hours one way!) to see me because they

could not find the help they need in their nearby area. 

>  

> Yes, there are a lot of LCs who really don't do a lot to increase their skills

beyond passing the board exam, and they aren't good at handling the " train

wrecks " .  And I feel they do a terrible disservice to our profession.  And I

won't refer to them.

>  

> But beyond that, what I actually tell mothers is this:  " Twenty years ago,

there weren't a lot of conferences about breastfeeding, and you might actually

be able to attend most of them.  But now there are many, many conferences. 

While it's good that there is so much more information about breastfeeding now,

no one IBCLC can afford to go to all the conferences.  She can't afford the

registation and travel fees, and she can't afford to be out of her office all

those days.  So every one of us gets to attend different conferences and gets

to find out different information.  You may need to see 3 or 4 or 5 people

before you find the one who got to the conference where she learned the exact

tidbit of information you need to help your baby nurse better. "   It avoids

making any derogatory statements about others in the area, is truthful about

*some* of the others in the area, and gives the mother an idea she can live with

as to why she had to work so hard

> to find appropriate help.

>     Dee Kassing

>

[Guest guest]

Dee I like that! I say something similar but yours is much much better. I think I'll steal it if it's ok with you! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Re: Re: online lactation consult ???To: Date: Saturday, May 14, 2011, 7:28 PM

I agree with everything has posted here. Although I do not do online consults because I am a technological dinosaur, I too have mothers drive 2 hrs one-way (sometimes even 4 or 5 hours one way!) to see me because they could not find the help they need in their nearby area.

Yes, there are a lot of LCs who really don't do a lot to increase their skills beyond passing the board exam, and they aren't good at handling the "train wrecks". And I feel they do a terrible disservice to our profession. And I won't refer to them.

But beyond that, what I actually tell mothers is this: "Twenty years ago, there weren't a lot of conferences about breastfeeding, and you might actually be able to attend most of them. But now there are many, many conferences. While it's good that there is so much more information about breastfeeding now, no one IBCLC can afford to go to all the conferences. She can't afford the registation and travel fees, and she can't afford to be out of her office all those days. So every one of us gets to attend different conferences and gets to find out different information. You may need to see 3 or 4 or 5 people before you find the one who got to the conference where she learned the exact tidbit of information you need to help your baby nurse better." It avoids making any derogatory statements about others in the area, is truthful about *some* of the others in the area, and gives the mother an idea she can live with

as to why she had to work so hard to find appropriate help.

Dee Kassing

Subject: Re: online lactation consult ???To: Date: Saturday, May 14, 2011, 7:28 PM

I do not see that as informed consent--I see it as control. I cannot imagine any mother is looking for someone on skype first and foremost. I had two skype consults this week. One was referred by her OB with whom I spoke. I gave the OB the name of the LC I refer to when I am away. This was a mastitis issue and she wanted the mom to work with me bc I use holistic interventions. It would be absurd to insist I had to give the names of other LCs or be in violation of some rule! The second was with a mom who had already seen three LCs in her area. One of whom I happen to know is VERY god. But, her problems have not been resolved and a friend of hers referred her to me for another opinion. I am sorry, and this may not be a popular thing to say--but there are a lot of ineffective LCs out there--I am NOT going to give out names of people I do not know to any mother. If I know of no one in an area, I will refer her to the ILCA list as

a last resort, but will first ask for a recommendation on a list like this one. If a mom wants to fly to France to see me, she can do that, but she cannot skype with me? I had moms drive 2 hours from out of state to see me in CT when I lived there. Should I have had to insist they see the LCs near them? Most already had, BTW. Also, I am not on the ILCA database. I am not a fan of ILCAs lack of support for non-medical IBCLCs and their posh to license and for insurance reimbursement--none of which I think reflects the real needs of mothers and babies or our profession. My name would never be given to anyone? Sorry, but I just do not see this as something to be afraid of. I think folks calling themselves LCs who aren't, the issues I mentioned above, and the lack of education for LCs beyond the basics are much more important issues. Tow, IBCLC, France> >> > I don't think you would need a company like this to get you going; and like > > everyone else that I have read responses from I agree that face-to face consults > > would be so much better. However, I am the only LC in my county not affiliated > > with the hospital or public health and will even "see" any mom once they are > > discharged from the hospital. And as a consumer, I would have loved to Skype ac > > LC 8 years ago when I moved out here to the boonies and developed all sorts of > > bfg problems. > > >

> Besides the "ease" of fitting it into moms life with a new baby, I think it will > > be an excellent way to reach MANY more mothers. Even moms "in your own > > backyard" may like to Skype first and talk about some easy stuff as a get to you > > first, and then feel a lot more comfortable about hauling themselves and baby > > (and all the gear they carry around down here) to see in in person. > > > > I am not sure if it is due to my location to the Mexican border, but I am > > finding that a lot of people are not receptive to a home visit.> > > > Laurean, IBCLC> > sunny, really hot Southern Ca> >>

[Guest guest]

I agree about the pathway three requirement. not enough! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- From: popikins

Subject: Re: online lactation consult ???To: Date: Saturday, May 14, 2011, 7:40 PM

The other thing I think is worthy of consideration is experience. Not everyone shares the same experience. It's evident by reading this list there are a broad variety of experience amongst IBCLC's, and with that also comes a broad variety of skill building.

I also know IBCLC's who have re-certified 2-3 times who have not performed a consult in over 10+ years. Even though they have 'more years' of certification, I would be more inclined to refer a client to a more newly certified IBCLC who has busted their rear to specialize in a specific area as opposed to sending the client to someone who has more years of 'recertification'who is not currently practicing or remaining active in the discipline. As my husband puts it, he is a fireman, sometimes you find peers who have 20+ years of doing the same thing over and over again. They don't really have 20+ years of cutting edge training necessarily (this is not targeted to those of you who have both, lots of years of recertification AND whom have remained active in the field).

I also see this as a problem with the IBLCE preceptor pathway. They need to do a better job of defining the scope of ability of the persons doing the precepting. Recertifying 1x is not an adequate assessment of anyone's professional experience or abilities.

>

> I agree with everything has posted here. Although I do not do online consults because I am a technological dinosaur, I too have mothers drive 2 hrs one-way (sometimes even 4 or 5 hours one way!) to see me because they could not find the help they need in their nearby area.Â

> Â

> Yes, there are a lot of LCs who really don't do a lot to increase their skills beyond passing the board exam, and they aren't good at handling the "train wrecks". And I feel they do a terrible disservice to our profession. And I won't refer to them.

> Â

> But beyond that, what I actually tell mothers is this: "Twenty years ago, there weren't a lot of conferences about breastfeeding, and you might actually be able to attend most of them. But now there are many, many conferences. While it's good that there is so much more information about breastfeeding now, no one IBCLC can afford to go to all the conferences. She can't afford the registation and travel fees, and she can't afford to be out of her office all those days. So every one of us gets to attend different conferences and gets to find out different information. You may need to see 3 or 4 or 5 people before you find the one who got to the conference where she learned the exact tidbit of information you need to help your baby nurse better." It avoids making any derogatory statements about others in the area, is truthful about *some* of the others in the area, and gives the mother an idea she

can live with as to why she had to work so hard

> to find appropriate help.

> Â Â Â Dee Kassing

>

[Guest guest]

Absolutely fine to "steal" it! I posted it so others could use it if they found it useful.

Dee

Dee I like that! I say something similar but yours is much much better. I think I'll steal it if it's ok with you!

[Guest guest]

YES when you pass the exam you get the paperwork that says

you may now use IBCLC and RLC, both. I never really understood why both but

now maybe I do.

Lou Moramarco IBCLC

Birth,

Breastfeeding & Before

International

Board Certified Lactation Consultant

Bradley

Childbirth Educator

Certified

Birth Doula

(732)

239-7771 marylou22@...

www.lunadoula.com

Hidden

Booby Trap: Is Your Lactation “Specialist” an Imposter?

http://www.bestforbabes.org/2010/03/hidden-booby-trap-is-your-lactation-specialist-an-imposter/

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[Guest guest]

Dee,What a beautiful way to phrase that we all have different strengths in our backgrounds and expertise! I am definitely going to to try that out. LaureanTo: Sent: Sat, May 14, 2011 7:28:17 PMSubject:

Re: Re: online lactation consult ???

I agree with everything has posted here. Although I do not do online consults because I am a technological dinosaur, I too have mothers drive 2 hrs one-way (sometimes even 4 or 5 hours one way!) to see me because they could not find the help they need in their nearby area.

Yes, there are a lot of LCs who really don't do a lot to increase their skills beyond passing the board exam, and they aren't good at handling the "train wrecks". And I feel they do a terrible disservice to our profession. And I won't refer to them.

But beyond that, what I actually tell mothers is this: "Twenty years ago, there weren't a lot of conferences about breastfeeding, and you might actually be able to attend most of them. But now there are many, many conferences. While it's good that there is so much more information about breastfeeding now, no one IBCLC can afford to go to all the conferences. She can't afford the registation and travel fees, and she can't afford to be out of her office all those days. So every one of us gets to attend different conferences and gets to find out different information. You may need to see 3 or 4 or 5 people before you find the one who got to the conference where she learned the exact tidbit of information you need to help your baby nurse better." It avoids making any derogatory statements about others in the area, is truthful about *some* of the others in the area, and gives the mother an idea she can live with

as to why she had to work so hard to find appropriate help.

Dee Kassing

Subject: Re: online lactation consult ???To: Date: Saturday, May 14, 2011, 7:28 PM

I do not see that as informed consent--I see it as control. I cannot imagine any mother is looking for someone on skype first and foremost. I had two skype consults this week. One was referred by her OB with whom I spoke. I gave the OB the name of the LC I refer to when I am away. This was a mastitis issue and she wanted the mom to work with me bc I use holistic interventions. It would be absurd to insist I had to give the names of other LCs or be in violation of some rule! The second was with a mom who had already seen three LCs in her area. One of whom I happen to know is VERY god. But, her problems have not been resolved and a friend of hers referred her to me for another opinion. I am sorry, and this may not be a popular thing to say--but there are a lot of ineffective LCs out there--I am NOT going to give out names of people I do not know to any mother. If I know of no one in an area, I will refer her to the ILCA list as

a last resort, but will first ask for a recommendation on a list like this one. If a mom wants to fly to France to see me, she can do that, but she cannot skype with me? I had moms drive 2 hours from out of state to see me in CT when I lived there. Should I have had to insist they see the LCs near them? Most already had, BTW. Also, I am not on the ILCA database. I am not a fan of ILCAs lack of support for non-medical IBCLCs and their posh to license and for insurance reimbursement--none of which I think reflects the real needs of mothers and babies or our profession. My name would never be given to anyone? Sorry, but I just do not see this as something to be afraid of. I think folks calling themselves LCs who aren't, the issues I mentioned above, and the lack of education for LCs beyond the basics are much more important issues. Tow, IBCLC, France> >> > I don't think you would need a company like this to get you going; and like > > everyone else that I have read responses from I agree that face-to face consults > > would be so much better. However, I am the only LC in my county not affiliated > > with the hospital or public health and will even "see" any mom once they are > > discharged from the hospital. And as a consumer, I would have loved to Skype ac > > LC 8 years ago when I moved out here to the boonies and developed all sorts of > > bfg problems. > > >

> Besides the "ease" of fitting it into moms life with a new baby, I think it will > > be an excellent way to reach MANY more mothers. Even moms "in your own > > backyard" may like to Skype first and talk about some easy stuff as a get to you > > first, and then feel a lot more comfortable about hauling themselves and baby > > (and all the gear they carry around down here) to see in in person. > > > > I am not sure if it is due to my location to the Mexican border, but I am > > finding that a lot of people are not receptive to a home visit.> > > > Laurean, IBCLC> > sunny, really hot Southern Ca> >>

[Guest guest]

I'm sure those of you who do give awesome Skype consults to moms who really

haven't found anyone local to help them with specific issues or natural remedies

etc. What I was saying was that everyone who does Skype consults should at least

give names of IBCLC's(from any directory, but I only know of ILCA who has such a

comprehensive directory -do you know of another such directory?) to

breastfeeding women who approach them of local IBCLC's to that woman.

What I was not saying is that you should necessarily refer them to any of those

IBCLCs. But

I feel it's important that women at the very least know that local IBCLC's

exist, if they do. Perhaps that woman already tried the local IBCLC's or heard

about them and would rather consult with you, so she schedules the Skype

consult, but at least she has done so with more information.

A woman who specifically asks for a Skype consult may be doing so for many

reasons, and many of those women will not change their mind about a Skype

consult, but some of them will once they do find out that there may be a skilled

nearby provider who is willing to travel a few extra miles for that woman.

I also feel it's important to support the in-person consult by a local IBCLC

when possible and helpful.

> > >

> > > I don't think you would need a company like this to get you going; and

like

> > > everyone else that I have read responses from I agree that face-to face

consults

> > > would be so much better. However, I am the only LC in my county not

affiliated

> > > with the hospital or public health and will even " see " any mom once they

are

> > > discharged from the hospital. And as a consumer, I would have loved to

Skype ac

> > > LC 8 years ago when I moved out here to the boonies and developed all

sorts of

> > > bfg problems.

> > >

> > > Besides the " ease " of fitting it into moms life with a new baby, I think

it will

> > > be an excellent way to reach MANY more mothers. Even moms " in your own

> > > backyard " may like to Skype first and talk about some easy stuff as a get

to you

> > > first, and then feel a lot more comfortable about hauling themselves and

baby

> > > (and all the gear they carry around down here) to see in in person.

> > >

> > > I am not sure if it is due to my location to the Mexican border, but I am

> > > finding that a lot of people are not receptive to a home visit.

> > >

> > > Laurean, IBCLC

> > > sunny, really hot Southern Ca

> > >

> >

>

[Guest guest]

Hello

To and Everyone,

I am

replying to ’s statements:

“Also,

I am not on the ILCA database. I am not a fan of ILCAs lack of support for

non-medical IBCLCs and their posh to license and for insurance reimbursement--none

of which I think reflects the real needs of mothers and babies or our

profession. My name would never be given to anyone?”

I am

chair of the Licensure and Reimbursement committee. I became an IBCLC via

my background in La Leche League and I have a BA in Psychology. I can

tell you that I am working hard to protect the IBCLC credential as a

“stand alone” independent credential aside from any medical

credential. The IBCLC is a practitioner on the merit of the certification from

IBLCE and no other credential that he or she might hold.

Just

to clarify, it is USLCA, not ILCA, which is working toward licensure and

reimbursement because these are issues unique to the United States lactation

consultants. The purpose of licensure is to protect the

“non-=medical” IBCLCs as breastfeeding experts along with those who

have medical backgrounds.

" The

mission of the USLCA Licensure and Reimbursement Committee is to fully

integrate International Board Certified Lactation Consultants into the US healthcare

system in order to provide consumer protection and ensure skilled clinical

lactation services are available and provided equitably. "

Rationale:

1.

Licensure will provide consumers, health care providers, insurance personnel

and employers with the ability to identify qualified lactation consultants.

2.

Licensure will provide a means of standardizing practice and maintaining sound

oversight of lactation professionals.

3.

Reimbursement within the health care system will ensure access to timely,

skilled, competent and culturally relevant breastfeeding support for all

mothers and babies.

4.

Reimbursement for services will positively impact the growth of the profession

of lactation consulting creating adequate numbers of IBCLCs needed to meet

current and future needs.

I

don’t know about the area in which you live, , but in most of the

US

there are not enough IBCLCs to meet the needs of mothers and babies. In fact,

there are not enough people who work in the maternal- child health field, and

who advise mothers, that understand what an IBCLC is, as opposed to any other

lesser lactation specialty certification. They also do not understand what it

is that we can do to help mothers overcome breastfeeding barriers. When you

consider licensed health care occupations, people generally DO know what

services they provide and they can find the practitioner and access their

services. . A person can go to the website or provider directory of their

insurance provider and look up by specialty. This is not true for finding an

IBCLC, even if the mother knows to look for one. I want to see a mother who is

having a breastfeeding problem be able to find “lactation

consultant” in that list of specialties at her local hospital website or

her insurance provider website or the local public health website, when she

clicks it to come up with a list of IBCLCs that can help her in her area. Once

a family finds a lactation consultant in their area I want them to be able to

afford to receive care. Maybe you work in an affluent area, but the average

middle class family here where I live can’t pull $100 or more out of

their pocket for a lactation consultant. The evidence of the lack of IBCLC

support is in the statistics for breastfeeding duration. We know why mothers

wean and we know we can help them overcome those reasons. Yet mothers, and the

people they look to for help, don’t know that we have the skills to help

them, they don’t know how to find us and they can’t always afford

us if they do. Lactation support is the supreme “preventive health care”

in my opinion. It should be part of standard health care just like preventive

dental care and other preventive health measures that are widely accepted.

Should

we achieve licensing as a profession, which is must be done state by state, an

IBCLC would be required to hold a license to work, but would not be required to

participate in the third party reimbursement system if she chooses not to. You

could continue to practice with your self-pay clients as you do now. However,

for most IBCLCs it will be a benefit to be able to serve clients who have

insurance coverage for the care and support of lactation.

For a

detailed explanation of the problem and the solution see the USLCA paper at

this link: http://www.uslcaonline.org/documents/White%20Paper/Reimbursement_White_Paper.pdf

Additionally,

The ILCA directory serves the purpose of helping families find a lactation consultant

in their geographic area. It is a service to families – however, they

have to know to look for a lactation consultant under ILCA. That is a problem

because most don’t. It is a service to us because it is basically

“free advertising”. An IBCLC trying to make herself available to

clients will do some kind of advertising and being listed in an online

directory is desirable. It is a free benefit of being and ILCA member, though

not required. An ILCA member can opt out of the directory listing if she

chooses.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

btw there are 2 's. T. and R. -and I am R : )

Thanks

>

> Hello To and Everyone,

>

> I am replying to 's statements:

>

> " Also, I am not on the ILCA database. I am not a fan of ILCAs lack of

> support for non-medical IBCLCs and their posh to license and for insurance

> reimbursement--none of which I think reflects the real needs of mothers and

> babies or our profession. My name would never be given to anyone? "

>

>

>

> I am chair of the Licensure and Reimbursement committee. I became an IBCLC

> via my background in La Leche League and I have a BA in Psychology. I can

> tell you that I am working hard to protect the IBCLC credential as a " stand

> alone " independent credential aside from any medical credential. The IBCLC

> is a practitioner on the merit of the certification from IBLCE and no other

> credential that he or she might hold.

>

> Just to clarify, it is USLCA, not ILCA, which is working toward licensure

> and reimbursement because these are issues unique to the United States

> lactation consultants. The purpose of licensure is to protect the

> " non-=medical " IBCLCs as breastfeeding experts along with those who have

> medical backgrounds.

>

> " The mission of the USLCA Licensure and Reimbursement Committee is to fully

> integrate International Board Certified Lactation Consultants into the US

> healthcare system in order to provide consumer protection and ensure skilled

> clinical lactation services are available and provided equitably. "

>

> Rationale:

>

> 1. Licensure will provide consumers, health care providers, insurance

> personnel and employers with the ability to identify qualified lactation

> consultants.

>

> 2. Licensure will provide a means of standardizing practice and maintaining

> sound oversight of lactation professionals.

>

> 3. Reimbursement within the health care system will ensure access to timely,

> skilled, competent and culturally relevant breastfeeding support for all

> mothers and babies.

>

> 4. Reimbursement for services will positively impact the growth of the

> profession of lactation consulting creating adequate numbers of IBCLCs

> needed to meet current and future needs.

>

>

>

> I don't know about the area in which you live, , but in most of the

> US there are not enough IBCLCs to meet the needs of mothers and babies. In

> fact, there are not enough people who work in the maternal- child health

> field, and who advise mothers, that understand what an IBCLC is, as opposed

> to any other lesser lactation specialty certification. They also do not

> understand what it is that we can do to help mothers overcome breastfeeding

> barriers. When you consider licensed health care occupations, people

> generally DO know what services they provide and they can find the

> practitioner and access their services. . A person can go to the website or

> provider directory of their insurance provider and look up by specialty.

> This is not true for finding an IBCLC, even if the mother knows to look for

> one. I want to see a mother who is having a breastfeeding problem be able to

> find " lactation consultant " in that list of specialties at her local

> hospital website or her insurance provider website or the local public

> health website, when she clicks it to come up with a list of IBCLCs that can

> help her in her area. Once a family finds a lactation consultant in their

> area I want them to be able to afford to receive care. Maybe you work in an

> affluent area, but the average middle class family here where I live can't

> pull $100 or more out of their pocket for a lactation consultant. The

> evidence of the lack of IBCLC support is in the statistics for breastfeeding

> duration. We know why mothers wean and we know we can help them overcome

> those reasons. Yet mothers, and the people they look to for help, don't know

> that we have the skills to help them, they don't know how to find us and

> they can't always afford us if they do. Lactation support is the supreme

> " preventive health care " in my opinion. It should be part of standard health

> care just like preventive dental care and other preventive health measures

> that are widely accepted.

>

> Should we achieve licensing as a profession, which is must be done state by

> state, an IBCLC would be required to hold a license to work, but would not

> be required to participate in the third party reimbursement system if she

> chooses not to. You could continue to practice with your self-pay clients as

> you do now. However, for most IBCLCs it will be a benefit to be able to

> serve clients who have insurance coverage for the care and support of

> lactation.

>

> For a detailed explanation of the problem and the solution see the USLCA

> paper at this link:

> http://www.uslcaonline.org/documents/White%20Paper/Reimbursement_White_Paper

> .pdf

>

>

>

>

>

> Additionally, The ILCA directory serves the purpose of helping families find

> a lactation consultant in their geographic area. It is a service to families

> - however, they have to know to look for a lactation consultant under ILCA.

> That is a problem because most don't. It is a service to us because it is

> basically " free advertising " . An IBCLC trying to make herself available to

> clients will do some kind of advertising and being listed in an online

> directory is desirable. It is a free benefit of being and ILCA member,

> though not required. An ILCA member can opt out of the directory listing if

> she chooses.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

thank you for the thankless job you're doing for licensure of IBCLC's! I just have to respond to one point. That there are few people who can't afford 100 dollars for an LC. It may be true that you live in a very poor area, but I don't think that's the norm. Lots of moms tell me they can't afford my services--then I see their cars, their clothes, the nursery and I get a little ticked off. Maybe THAT's why they say they can't afford an LC visit! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Re: online lactation consult ???To: Date: Monday, May 16, 2011, 6:44 AM

Hello

To and Everyone, I am

replying to ’s statements: “Also,

I am not on the ILCA database. I am not a fan of ILCAs lack of support for

non-medical IBCLCs and their posh to license and for insurance reimbursement- -none

of which I think reflects the real needs of mothers and babies or our

profession. My name would never be given to anyone?†I am

chair of the Licensure and Reimbursement committee. I became an IBCLC via

my background in La Leche League and I have a BA in Psychology. I can

tell you that I am working hard to protect the IBCLC credential as a

“stand alone†independent credential aside from any medical

credential. The IBCLC is a practitioner on the merit of the certification from

IBLCE and no other credential that he or she might hold. Just

to clarify, it is USLCA, not ILCA, which is working toward licensure and

reimbursement because these are issues unique to the United States lactation

consultants. The purpose of licensure is to protect the

“non-=medical†IBCLCs as breastfeeding experts along with those who

have medical backgrounds. "The

mission of the USLCA Licensure and Reimbursement Committee is to fully

integrate International Board Certified Lactation Consultants into the US healthcare

system in order to provide consumer protection and ensure skilled clinical

lactation services are available and provided equitably." Rationale: 1.

Licensure will provide consumers, health care providers, insurance personnel

and employers with the ability to identify qualified lactation consultants. 2.

Licensure will provide a means of standardizing practice and maintaining sound

oversight of lactation professionals. 3.

Reimbursement within the health care system will ensure access to timely,

skilled, competent and culturally relevant breastfeeding support for all

mothers and babies. 4.

Reimbursement for services will positively impact the growth of the profession

of lactation consulting creating adequate numbers of IBCLCs needed to meet

current and future needs. I

don’t know about the area in which you live, , but in most of the

US there are not enough IBCLCs to meet the needs of mothers and babies. In fact,

there are not enough people who work in the maternal- child health field, and

who advise mothers, that understand what an IBCLC is, as opposed to any other

lesser lactation specialty certification. They also do not understand what it

is that we can do to help mothers overcome breastfeeding barriers. When you

consider licensed health care occupations, people generally DO know what

services they provide and they can find the practitioner and access their

services. . A person can go to the website or provider directory of their

insurance provider and look up by specialty. This is not true for finding an

IBCLC, even if the mother knows to look for one. I want to see a mother who is

having a breastfeeding problem be able to find “lactation

consultant†in that list of specialties at her local hospital website or

her insurance provider website or the local public health website, when she

clicks it to come up with a list of IBCLCs that can help her in her area. Once

a family finds a lactation consultant in their area I want them to be able to

afford to receive care. Maybe you work in an affluent area, but the average

middle class family here where I live can’t pull $100 or more out of

their pocket for a lactation consultant. The evidence of the lack of IBCLC

support is in the statistics for breastfeeding duration. We know why mothers

wean and we know we can help them overcome those reasons. Yet mothers, and the

people they look to for help, don’t know that we have the skills to help

them, they don’t know how to find us and they can’t always afford

us if they do. Lactation support is the supreme “preventive health careâ€

in my opinion. It should be part of standard health care just like preventive

dental care and other preventive health measures that are widely accepted. Should

we achieve licensing as a profession, which is must be done state by state, an

IBCLC would be required to hold a license to work, but would not be required to

participate in the third party reimbursement system if she chooses not to. You

could continue to practice with your self-pay clients as you do now. However,

for most IBCLCs it will be a benefit to be able to serve clients who have

insurance coverage for the care and support of lactation. For a

detailed explanation of the problem and the solution see the USLCA paper at

this link: http://www.uslcaonline.org/documents/White%20Paper/Reimbursement_White_Paper.pdf Additionally,

The ILCA directory serves the purpose of helping families find a lactation consultant

in their geographic area. It is a service to families – however, they

have to know to look for a lactation consultant under ILCA. That is a problem

because most don’t. It is a service to us because it is basically

“free advertisingâ€. An IBCLC trying to make herself available to

clients will do some kind of advertising and being listed in an online

directory is desirable. It is a free benefit of being and ILCA member, though

not required. An ILCA member can opt out of the directory listing if she

chooses. Judy Judith

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

Phone Fax

[Guest guest]

Amen Judith.  thanks fo ryour work in this area., I think American mothers are not used to paying out of pocket for health expenses- they don't have an understanding of what they are paying for with their insurance dollars, since they often come out of the paycheck before they 'see it.'  I can't think of a nice way to say that my in-home service costs about the same as two hair cuts or a few oil changes.  I saw on one of your websites a list of local costs of services like this.

- Edenwww.Atlanta Breastfeeding Consultants.com

 

thank you for the thankless job you're doing for licensure of IBCLC's!  I just have to respond to one point.  That there are few people who can't afford 100 dollars for an LC.  It may be true that you live in a very poor area, but I don't think that's the norm.  Lots of moms tell me they can't afford my services--then I see their cars, their clothes, the nursery and I get a little ticked off.  Maybe THAT's why they say they can't afford an LC visit!

Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula

www.second9months.comBreastfeeding Between the Lines:  http://second9months.wordpress.com/

Facebook:  www.facebook.com/thesecond9months---

Subject: Re: online lactation consult ???

To: Date: Monday, May 16, 2011, 6:44 AM

 

Hello

To and Everyone, I am

replying to ’s statements: “Also,

I am not on the ILCA database. I am not a fan of ILCAs lack of support for

non-medical IBCLCs and their posh to license and for insurance reimbursement- -none

of which I think reflects the real needs of mothers and babies or our

profession. My name would never be given to anyone?”   I am

chair of the Licensure and Reimbursement committee.  I became an IBCLC via

my background in La Leche League and I have a BA in Psychology.  I can

tell you that I am working hard to protect the IBCLC credential as a

“stand alone” independent credential aside from any medical

credential. The IBCLC is a practitioner on the merit of the certification from

IBLCE and no other credential that he or she might hold. Just

to clarify, it is USLCA, not ILCA, which is working toward licensure and

reimbursement because these are issues unique to the United States lactation

consultants. The purpose of licensure is to protect the

“non-=medical” IBCLCs as breastfeeding experts along with those who

have medical backgrounds. " The

mission of the USLCA Licensure and Reimbursement Committee is to fully

integrate International Board Certified Lactation Consultants into the US healthcare

system in order to provide consumer protection and ensure skilled clinical

lactation services are available and provided equitably. " Rationale: 1.

Licensure will provide consumers, health care providers, insurance personnel

and employers with the ability to identify qualified lactation consultants. 2.

Licensure will provide a means of standardizing practice and maintaining sound

oversight of lactation professionals. 3.

Reimbursement within the health care system will ensure access to timely,

skilled, competent and culturally relevant breastfeeding support for all

mothers and babies. 4.

Reimbursement for services will positively impact the growth of the profession

of lactation consulting creating adequate numbers of IBCLCs needed to meet

current and future needs.   I

don’t know about the area in which you live, , but in most of the

US there are not enough IBCLCs to meet the needs of mothers and babies. In fact,

there are not enough people who work in the maternal- child health field, and

who advise mothers, that understand what an IBCLC is, as opposed to any other

lesser lactation specialty certification. They also do not understand what it

is that we can do to help mothers overcome breastfeeding barriers. When you

consider licensed health care occupations, people generally DO know what

services they provide and they can find the practitioner and access their

services. . A person can go to the website or provider directory of their

insurance provider and look up by specialty. This is not true for finding an

IBCLC, even if the mother knows to look for one. I want to see a mother who is

having a breastfeeding problem be able to find “lactation

consultant” in that list of specialties at her local hospital website or

her insurance provider website or the local public health website, when she

clicks it to come up with a list of IBCLCs that can help her in her area. Once

a family finds a lactation consultant in their area I want them to be able to

afford to receive care. Maybe you work in an affluent area, but the average

middle class family here where I live can’t pull $100 or more out of

their pocket for a lactation consultant. The evidence of the lack of IBCLC

support is in the statistics for breastfeeding duration. We know why mothers

wean and we know we can help them overcome those reasons. Yet mothers, and the

people they look to for help, don’t know that we have the skills to help

them, they don’t know how to find us and they can’t always afford

us if they do. Lactation support is the supreme “preventive health care”

in my opinion. It should be part of standard health care just like preventive

dental care and other preventive health measures that are widely accepted.   Should

we achieve licensing as a profession, which is must be done state by state, an

IBCLC would be required to hold a license to work, but would not be required to

participate in the third party reimbursement system if she chooses not to. You

could continue to practice with your self-pay clients as you do now. However,

for most IBCLCs it will be a benefit to be able to serve clients who have

insurance coverage for the care and support of lactation. For a

detailed explanation of the problem and the solution see the USLCA paper at

this link: http://www.uslcaonline.org/documents/White%20Paper/Reimbursement_White_Paper.pdf

    Additionally,

The ILCA directory serves the purpose of helping families find a lactation consultant

in their geographic area. It is a service to families – however, they

have to know to look for a lactation consultant under ILCA. That is a problem

because most don’t. It is a service to us because it is basically

“free advertising”. An IBCLC trying to make herself available to

clients will do some kind of advertising and being listed in an online

directory is desirable. It is a free benefit of being and ILCA member, though

not required. An ILCA member can opt out of the directory listing if she

chooses.   Judy Judith

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

Phone Fax

 

[Guest guest]

Great point, . I saw lots of MediCal/Medicaid moms doing OB home health who claimed to not have money for diapers but had cars, home stereo, etc. worth a lot of money.

Gail Neuman RNC BSN CPHW

certified in high risk OB

childbirth/lactation educator & student nurse practitioner

AHA BLS for Healthcare & Heartsaver Family/Friends instructor

Perinatal Nurse Associates

Baby Your Way Midwifery Associates

801 N. Tustin Ave., Suite 305

Santa Ana, CA 92705

[Guest guest]

Judy,

If the purpose of licensure is to protect non-medical IBCLCs then why are so

many in opposition non-medical IBCLCs? I can assure you it is not lack of

education on the subject. I personally spent several years as the chair of the

legislative committee in CT, working closely with a lobbyist to explore

licensure of midwives in the state. The conclusion we came to? In the end, the

midwives we sought to protect--the NON-nurse-midwives would ultimately be at

greater risk. The history of licensure in the US is a a history of control. Once

you license a group, you have the ability to place further limits on them than

their certification does. With all due respect, I believe that anyone who

supports licensure is terribly naive. Not only do I believe we would ultimately

eliminate rather than protect non-medical IBCLCs, but that reimbursement would

be so low that no one would be able to accept it. One of the reasons that we

have such miserable services already in the US is bc doctors and other providers

have to see far too many clients to make ends meet.

As to issues of poverty, licensure has not made many services such as home

births, acupuncture, chiropractic, CST, homeopathy and naturopathy available to

poor people either. These are the services I refer many clients to and bc they

work the same way that I do and I have established relationships with them--we

charge people who can afford it and charge less for those who cannot--my clients

get care. Those among my holistic colleagues who accept state reimbursement are

paid abysmally. Nine dollars for a chiropractic visit! For other insurance, it

is still an issue of who takes what insurance and many providers get next to

nothing, given the time-intensive nature of their work. Forty dollars for 2

hours for an ND intake! No thank you.

Finally, as to poor people having cars and sterios. I worked with an inner city

hospital community for 4 years. Yep, when it is unsafe for children to be on the

streets, you have all the equipment to try to keep them occupied indoors. Please

consider why things might be as they are before making assumptions. Many

families right now do indeed have houses and cars--that they can no longer

afford and are about to lose--so they may well not have resources to pay. OTOH,

I do not believe we as a culture value breastfeeding or LCs and that people who

can indeed afford the care will claim they cannot. That is why I rarely work for

free anymore. I make arrangements instead.

As to where I live--I live in France where LCs are very poorly paid. I did,

however only move here 6 months ago and worked in PP for 15 years in CT. In CT

there are plenty of PPLCs who cannot get work. During the last year I lived

there more than half the women who called did not schedule bc they wanted free

care. I had never had that happen before. I realize there is a lack of LCs in

some areas--but not true in all.

In France, NO ONE will EVER again be ale to become an ICLC who is not a doctor

due to the new rules. There are no community colleges or on-line courses here.

Unless you speak English fluently and can take distance courses no one will be

able to meet the requirements. IMO, that is by design.

Tow, IBCLC, France

>

> Hello To and Everyone,

>

> I am replying to 's statements:

>

> " Also, I am not on the ILCA database. I am not a fan of ILCAs lack of

> support for non-medical IBCLCs and their posh to license and for insurance

> reimbursement--none of which I think reflects the real needs of mothers and

> babies or our profession. My name would never be given to anyone? "

>

>

>

> I am chair of the Licensure and Reimbursement committee. I became an IBCLC

> via my background in La Leche League and I have a BA in Psychology. I can

> tell you that I am working hard to protect the IBCLC credential as a " stand

> alone " independent credential aside from any medical credential. The IBCLC

> is a practitioner on the merit of the certification from IBLCE and no other

> credential that he or she might hold.

>

> Just to clarify, it is USLCA, not ILCA, which is working toward licensure

> and reimbursement because these are issues unique to the United States

> lactation consultants. The purpose of licensure is to protect the

> " non-=medical " IBCLCs as breastfeeding experts along with those who have

> medical backgrounds.

>

> " The mission of the USLCA Licensure and Reimbursement Committee is to fully

> integrate International Board Certified Lactation Consultants into the US

> healthcare system in order to provide consumer protection and ensure skilled

> clinical lactation services are available and provided equitably. "

>

> Rationale:

>

> 1. Licensure will provide consumers, health care providers, insurance

> personnel and employers with the ability to identify qualified lactation

> consultants.

>

> 2. Licensure will provide a means of standardizing practice and maintaining

> sound oversight of lactation professionals.

>

> 3. Reimbursement within the health care system will ensure access to timely,

> skilled, competent and culturally relevant breastfeeding support for all

> mothers and babies.

>

> 4. Reimbursement for services will positively impact the growth of the

> profession of lactation consulting creating adequate numbers of IBCLCs

> needed to meet current and future needs.

>

>

>

> I don't know about the area in which you live, , but in most of the

> US there are not enough IBCLCs to meet the needs of mothers and babies. In

> fact, there are not enough people who work in the maternal- child health

> field, and who advise mothers, that understand what an IBCLC is, as opposed

> to any other lesser lactation specialty certification. They also do not

> understand what it is that we can do to help mothers overcome breastfeeding

> barriers. When you consider licensed health care occupations, people

> generally DO know what services they provide and they can find the

> practitioner and access their services. . A person can go to the website or

> provider directory of their insurance provider and look up by specialty.

> This is not true for finding an IBCLC, even if the mother knows to look for

> one. I want to see a mother who is having a breastfeeding problem be able to

> find " lactation consultant " in that list of specialties at her local

> hospital website or her insurance provider website or the local public

> health website, when she clicks it to come up with a list of IBCLCs that can

> help her in her area. Once a family finds a lactation consultant in their

> area I want them to be able to afford to receive care. Maybe you work in an

> affluent area, but the average middle class family here where I live can't

> pull $100 or more out of their pocket for a lactation consultant. The

> evidence of the lack of IBCLC support is in the statistics for breastfeeding

> duration. We know why mothers wean and we know we can help them overcome

> those reasons. Yet mothers, and the people they look to for help, don't know

> that we have the skills to help them, they don't know how to find us and

> they can't always afford us if they do. Lactation support is the supreme

> " preventive health care " in my opinion. It should be part of standard health

> care just like preventive dental care and other preventive health measures

> that are widely accepted.

>

> Should we achieve licensing as a profession, which is must be done state by

> state, an IBCLC would be required to hold a license to work, but would not

> be required to participate in the third party reimbursement system if she

> chooses not to. You could continue to practice with your self-pay clients as

> you do now. However, for most IBCLCs it will be a benefit to be able to

> serve clients who have insurance coverage for the care and support of

> lactation.

>

> For a detailed explanation of the problem and the solution see the USLCA

> paper at this link:

> http://www.uslcaonline.org/documents/White%20Paper/Reimbursement_White_Paper

> .pdf

>

>

>

>

>

> Additionally, The ILCA directory serves the purpose of helping families find

> a lactation consultant in their geographic area. It is a service to families

> - however, they have to know to look for a lactation consultant under ILCA.

> That is a problem because most don't. It is a service to us because it is

> basically " free advertising " . An IBCLC trying to make herself available to

> clients will do some kind of advertising and being listed in an online

> directory is desirable. It is a free benefit of being and ILCA member,

> though not required. An ILCA member can opt out of the directory listing if

> she chooses.

>

>

>

> Judy

>

> Judith L. Gutowski, BA, IBCLC, RLC

>

> 135 McGrath Lane

>

> P Box 1

>

> Hannastown, PA 15635-0001

>

> Cell Phone

>

> Fax

>

[Guest guest]

I

understand that some people’s priorities get in the way of spending money

on breastfeeding. Some of this is a cultural barrier to breastfeeding. We don’t

have a culture that thinks breastfeeding is important. They don’t

understand the long term consequences of their decision for mom and baby. They

decide to “try” breastfeeding and if it doesn’t work, then

ok. Some of these mothers decide they will just take the free WIC formula

instead, yet they go to their WIC appointments with expensive fake fingernails

and cigarettes in their purse that cost way more than formula would for a month.

So, that is a different topic than breastfeeding altogether.

The

families I am thinking of are not receiving Medicaid or other government

services. They are families who work hard at low wage jobs and are just getting

by paying the bills. Families that live on one income so mom can be at home

with the children, which is a value I strongly support. I have been one of

those moms. The truck drivers, retail cashiers and medical assistants to name a

few, and others who work for $10 to $15 an hour and may have health benefits.

But if you took a $100 out of their monthly budget some necessities would not

be able to be paid like the electric bill.

When

I provide lactation services at the physician office and the cost is the co-pay

of $5 to $25 they can come back 3 times in 2 weeks until the problem is

resolved. Otherwise, they might be only able to afford one visit and of course one

visit doesn’t fix everything and then we are faced with me providing free

follow up by phone which, isn’t good care and impacts my family finances,

or the mother not succeeding at breastfeeding. Then the first $100 investment

becomes a waste. All these babies who are induced a week early have trouble figuring

out breastfeeding. These may only need peer support, but can’t wait until

the next monthly LLL meeting and are not WIC clients so can’t get WIC

peer counselors. With complex breastfeeding situations, like a preterm

or late preterm infant, I have found it takes 6-7 visits over as many weeks to

increase a milk supply and for the baby to learn to latch, sustain a suck and

feed 100% at breast. There is a gradual shift from bottle feeding formula to

getting breast milk from the bottle and then some time of mixed feedings as

baby gradually succeeds with breastfeeds and then all breast. Even some more

routine latching issues can optimally take more than one visit with the

postpartum mother who had a difficult birth and is in pain with engorgement and

an episiotomy, she just doesn’t get all the teaching in one visit or the

mother who is not “natural” at handling an infant and she is not

even holding her baby comfortably. You can’t fix all this in one hour and

the changes over the first week postpartum lend themselves to a need for more

than a singe visit. It is a supreme advantage of working in the peds office because

the family comes for a visit, sees the doc for the otherwise necessary weight

and bili checks and other newborn issues and they can come back until breastfeeding

is established, the baby is feeding well and gaining weight and mother is

confident in the process and pain free. If other problems arise later, and they

do, like oversupply or dairy allergies or whatever, we have a relationship and

they can call the office or come in. It is not a financial burden to do so.

All that

being said, in private practice, even if I charged $100 a visit for a home

visit this would end up being a low wage for me with the expenses of

maintaining my IBCLC certification and other appropriate certifications like

CPR, keeping legal clearances for child abuse, etc, professional liability insurance,

office liability insurance and the rest of the office operating expenses of

running a business. If you add travel to client homes that is way more money

than a $100 visit can cover with the cost of gas now. So lactation visits would

cost more and in some areas of the country are as high as $250. On the other

hand, health insurance covers the cost of vaccinations if families choose them

and well child checks and Early Intervention programs spend tons of money for

at-risk kids on OT, speech, PT, parent training, social work etc. I work for

Early Intervention also doing feeding evals and these families, most are

formula feeding, and are receiving every kind of service and government program

and most still are (I am sorry to say) terrible parents and these kids don’t

have a chance in heck of succeeding in life. So if we spend all this on

practically lost causes in hopes of helping even one, I think our insurance

should cover lactation visits for families who are working hard to raise their

kids and do what is best for them. Providing lactation services as

preventive care will decrease their likelihood of moms giving up on

breastfeeding.

So

that is my soap box speech for today. I hope it comes across as I intended.

This is somewhat of a delicate subject and political too.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

I've been working in maternal child health for nearly 20 years now. I don't

believe I am naive to the issues surrounding the disparities in the ability of

women to access quality breastfeeding support. Nearly half of the population I

work with is considered low income or poor. The lack of insurance reimbursement

for quality lactation services is one of the number one barriers that this

population faces in terms of accessing quality lactation support. Licensure, and

reimbursement, is put into place to protect the consumers. Licensing of

professionals aids in the assurance of a minimum standard of competency amongst

the selected professional population and helps aid in providing a standard of

care.

I happen to live in a state which does license direct entry (non-nurse)

midwives. And it works. For the most part. It has its flaws as well. It is

because of this licensure of CPM's in my state that Medicaid DOES cover their

services, and pay for the use of CPM's. Without it my CPM friends have told me

they would probably lose 1/3-1/2 of their business volume. I have little to no

interest in protecting the business component, I figure that's my problem to

work around. The purpose behind supporting licensure and reimbursement is to

protect consumers. Until we can achieve licensure we will be dealing with people

who haven't taken a half a days worth of lactation training calling themselves

lactation consultants. Once we achieve licensure, the public, and hiring

organizations, will see consistency amongst the professional qualifications of

those who have earned the right to refer to themselves as such.

>

> Judy,

> If the purpose of licensure is to protect non-medical IBCLCs then why are so

many in opposition non-medical IBCLCs? I can assure you it is not lack of

education on the subject. I personally spent several years as the chair of the

legislative committee in CT, working closely with a lobbyist to explore

licensure of midwives in the state. The conclusion we came to? In the end, the

midwives we sought to protect--the NON-nurse-midwives would ultimately be at

greater risk. The history of licensure in the US is a a history of control. Once

you license a group, you have the ability to place further limits on them than

their certification does. With all due respect, I believe that anyone who

supports licensure is terribly naive. Not only do I believe we would ultimately

eliminate rather than protect non-medical IBCLCs, but that reimbursement would

be so low that no one would be able to accept it. One of the reasons that we

have such miserable services already in the US is bc doctors and other providers

have to see far too many clients to make ends meet.

>

> As to issues of poverty, licensure has not made many services such as home

births, acupuncture, chiropractic, CST, homeopathy and naturopathy available to

poor people either. These are the services I refer many clients to and bc they

work the same way that I do and I have established relationships with them--we

charge people who can afford it and charge less for those who cannot--my clients

get care. Those among my holistic colleagues who accept state reimbursement are

paid abysmally. Nine dollars for a chiropractic visit! For other insurance, it

is still an issue of who takes what insurance and many providers get next to

nothing, given the time-intensive nature of their work. Forty dollars for 2

hours for an ND intake! No thank you.

>

> Finally, as to poor people having cars and sterios. I worked with an inner

city hospital community for 4 years. Yep, when it is unsafe for children to be

on the streets, you have all the equipment to try to keep them occupied indoors.

Please consider why things might be as they are before making assumptions. Many

families right now do indeed have houses and cars--that they can no longer

afford and are about to lose--so they may well not have resources to pay. OTOH,

I do not believe we as a culture value breastfeeding or LCs and that people who

can indeed afford the care will claim they cannot. That is why I rarely work for

free anymore. I make arrangements instead.

>

> As to where I live--I live in France where LCs are very poorly paid. I did,

however only move here 6 months ago and worked in PP for 15 years in CT. In CT

there are plenty of PPLCs who cannot get work. During the last year I lived

there more than half the women who called did not schedule bc they wanted free

care. I had never had that happen before. I realize there is a lack of LCs in

some areas--but not true in all.

>

> In France, NO ONE will EVER again be ale to become an ICLC who is not a doctor

due to the new rules. There are no community colleges or on-line courses here.

Unless you speak English fluently and can take distance courses no one will be

able to meet the requirements. IMO, that is by design.

>

> Tow, IBCLC, France

>

[Guest guest]

As a CPM Midwife myself I've got to say also that many midwives and CPM midwives

in unlicensed states live in at least a small amount and sometimes a large

amount of fear.

Most states I know of who have licensure got there by first arresting all the

midwives, then over a few months/years forming(top down) usually a very poorly

thought out law about midwives -licensing them yet placing sometimes catch 22

laws onto them. Like in the state I live in now -California, we are licensed if

a supervising physician is officially on-the-loop on the woman's care. Yet,

physicians are not allowed to officially supervise due to their liability

insurance companies rules. So, we're licensed but technically not really allowed

to attend births. Most Licensed midwives I know here do attend births anyway, as

the medical board has " verbally " told us " don't worry " , but many of us still are

fearful and some decide to stop practicing or at the very least don't take on

clients who we would in other states feel comfortable caring for due to " risk

factors " . It's all basically a mess.

Something that would have prevented it is if midwives had had lots of 1.money

for a lobbyist etc or 2.support from consumers with money to hire a lobbyist etc

and 3. the realization that licensure was simply the next step, whether we

initiated it or the governing bodies initiated it.

So, in that way, I really respect what ILCA is doing with our membership money.

I know Lactation Consulting is different from Midwifery, but quality of care is

very important, and licensure sets a standard. All IBCLC's are of course not

created equal (as all Midwives and Obstetricians are also not) but at least we

become the standard. I don't think it's naive of me to think so. I'm happy with

the way things are headed, with intention leading the way to licensure,

bottom-up.

> >

> > Judy,

> > If the purpose of licensure is to protect non-medical IBCLCs then why are so

many in opposition non-medical IBCLCs? I can assure you it is not lack of

education on the subject. I personally spent several years as the chair of the

legislative committee in CT, working closely with a lobbyist to explore

licensure of midwives in the state. The conclusion we came to? In the end, the

midwives we sought to protect--the NON-nurse-midwives would ultimately be at

greater risk. The history of licensure in the US is a a history of control. Once

you license a group, you have the ability to place further limits on them than

their certification does. With all due respect, I believe that anyone who

supports licensure is terribly naive. Not only do I believe we would ultimately

eliminate rather than protect non-medical IBCLCs, but that reimbursement would

be so low that no one would be able to accept it. One of the reasons that we

have such miserable services already in the US is bc doctors and other providers

have to see far too many clients to make ends meet.

> >

> > As to issues of poverty, licensure has not made many services such as home

births, acupuncture, chiropractic, CST, homeopathy and naturopathy available to

poor people either. These are the services I refer many clients to and bc they

work the same way that I do and I have established relationships with them--we

charge people who can afford it and charge less for those who cannot--my clients

get care. Those among my holistic colleagues who accept state reimbursement are

paid abysmally. Nine dollars for a chiropractic visit! For other insurance, it

is still an issue of who takes what insurance and many providers get next to

nothing, given the time-intensive nature of their work. Forty dollars for 2

hours for an ND intake! No thank you.

> >

> > Finally, as to poor people having cars and sterios. I worked with an inner

city hospital community for 4 years. Yep, when it is unsafe for children to be

on the streets, you have all the equipment to try to keep them occupied indoors.

Please consider why things might be as they are before making assumptions. Many

families right now do indeed have houses and cars--that they can no longer

afford and are about to lose--so they may well not have resources to pay. OTOH,

I do not believe we as a culture value breastfeeding or LCs and that people who

can indeed afford the care will claim they cannot. That is why I rarely work for

free anymore. I make arrangements instead.

> >

> > As to where I live--I live in France where LCs are very poorly paid. I did,

however only move here 6 months ago and worked in PP for 15 years in CT. In CT

there are plenty of PPLCs who cannot get work. During the last year I lived

there more than half the women who called did not schedule bc they wanted free

care. I had never had that happen before. I realize there is a lack of LCs in

some areas--but not true in all.

> >

> > In France, NO ONE will EVER again be ale to become an ICLC who is not a

doctor due to the new rules. There are no community colleges or on-line courses

here. Unless you speak English fluently and can take distance courses no one

will be able to meet the requirements. IMO, that is by design.

> >

> > Tow, IBCLC, France

> >

>

[Guest guest]

In CT we did hire a lobbyist--a very, very good one. She wrote the law that

legalized Nurse-midwives in CT. She was fabulous. And we saw exactly what you

experienced in CA coming down the line if we continued with licensure.

Unfortunately, the CPMs there are now moving again toward licensure bc of

numerous health dept attacks on midwives. But, I am absolutely certain that

licensure will only serve to diminish the stature of the CPM, who should

absolutely not be required to have medical back-up, which in effect means

medical control, in order to practice. When I had my babies at home, midwives

were doing twins, breech and VBAC, no problem. Not any more. I have watched them

become more and more medicalized in their approach out of fear. Licensure will

simply legalize the limitations that fear has imposed on them. Whenever the

medical profession acts to support licensure of any other HCP, they do it solely

for the purpose of control and to limit access. In CT, the medical board is

constantly attempting to exert more control and impose more limitations on

chiropractors, for example. The have to keep someone observant all the time,

just to prevent rules that effect their practice from being enacted behind their

backs. I personally saw it happen at a Health Dept inquiry. PTs have even more

control--they cannot even treat w/o a referral--from a doctor who has no

knowledge about structure!

I cannot say for sure that if licensure came long--I would choose to practice as

an IBCLC. This is a nightmare and I really suspect we will only regret it. Why

we are not learning from other HCPs who fallen into this trap, I do not know.

Tow, IBCLC, France

>

> As a CPM Midwife myself I've got to say also that many midwives and CPM

midwives in unlicensed states live in at least a small amount and sometimes a

large amount of fear.

>

> Most states I know of who have licensure got there by first arresting all the

midwives, then over a few months/years forming(top down) usually a very poorly

thought out law about midwives -licensing them yet placing sometimes catch 22

laws onto them. Like in the state I live in now -California, we are licensed if

a supervising physician is officially on-the-loop on the woman's care. Yet,

physicians are not allowed to officially supervise due to their liability

insurance companies rules. So, we're licensed but technically not really allowed

to attend births. Most Licensed midwives I know here do attend births anyway, as

the medical board has " verbally " told us " don't worry " , but many of us still are

fearful and some decide to stop practicing or at the very least don't take on

clients who we would in other states feel comfortable caring for due to " risk

factors " . It's all basically a mess.

>

> Something that would have prevented it is if midwives had had lots of 1.money

for a lobbyist etc or 2.support from consumers with money to hire a lobbyist etc

and 3. the realization that licensure was simply the next step, whether we

initiated it or the governing bodies initiated it.

>

> So, in that way, I really respect what ILCA is doing with our membership

money. I know Lactation Consulting is different from Midwifery, but quality of

care is very important, and licensure sets a standard. All IBCLC's are of course

not created equal (as all Midwives and Obstetricians are also not) but at least

we become the standard. I don't think it's naive of me to think so. I'm happy

with the way things are headed, with intention leading the way to licensure,

bottom-up.

>

>

[Guest guest]

Hi ,

Thank you for being willing to discuss these issues

surrounding licensure and reimbursement for IBCLCs. I do need to hear the

varied and experienced opinions of IBCLCs who are out there in the field trying

to help mothers. When we better understand the problems licensure and

reimbursement can bring, then we can write better bills and work hard to avoid

those problems. We certainly have tried to learn from the journeys of other

professions in this area such as dieticians, occupational therapists, massage

therapists and midwives. I can tell you that this is not easy. The licensure,

and much to do with reimbursement, will vary from state to state. That means it

can be done 50 different ways!!! This can also happen without even the

knowledge of USLCA, with that we have no control at all.

It is the goal of USLCA to be an active part of licensure

efforts in every state where there are initiatives. We collect and study the

attempted efforts and we have some very qualified legal, insurance and

financial professionals and physicians helping us to try to avoid making big

mistakes. You are right to say that some folks do want to weed out non-medical

IBCLCs. We are collaborating with IBLCE to prevent this. It is a defined mutual

goal. The model bills that have been introduced in the past, and any that

may be forthcoming tie licensure to the IBCLC credential - period. There

are no other credentialing qualifications. There is a requirement to have

liability insurance. I would be happy to email you a copy of the latest

drafted model bill if you are interested in reading it. Once a bill gets to the

legislative floor in the US

we do take the chance that it is modified in ways we don’t like. In that

case we can find a compromise or have our sponsor pull the bill, which has

already happened once in Texas.

You are also correct that Medicaid pays incredibly low

fees. Right now an IBCLC who is a nurse and bills for lactation as a nurse

visit would likely receive around $6. This is abysmal. This is why we don’t

want to be licensed under nurses. Other allied health professionals who bill

regular codes can bill between $76 and $340. Most non-Medicaid insurance payers

in my area where I have done a rough survey paid about 60% of the billed amount

to a physician. Allied health professionals in most states are reimbursed

75-80% o the physician reimbursement. The low Medicaid reimbursement comes for

every health profession. That is why those facilities who serve Medicaid

populations often are non-profits that have to run on shoestring budgets and

grant funds. It stinks. The facilities serving affluent communities with

private insurers make profits. An IBCLC who only saw Medicaid patients would be

broke.

That being said, most private insurers don’t cover health

care professionals until the Medicaid and Medicare plans do so. So, it is like

in law where a precedent must be set. This is why we have set Medicaid in our

sites. Additionally, Medicaid is government administered and it is the public

health authorities who are promoting breastfeeding, the Surgeon General, CDC,

DHHS, FDA, USDA, etc. We believe they should, (not guaranteed of course), back

up their advice with actions to support it. We will see if that works

out. An IBCLC in practice, just like any other health care provider, can choose

not to accept Medicaid insurance reimbursement or any reimbursement for that

matter.

You mention many PPLCs who can’t get work when

the Surgeon General’s report states that we need approximately 8.6 IBCLCs per 1,000

births. CT has 4.5 per 1000, yet even though the need is there, the IBCLC

cannot get work. Hospitals and out-patient health care entities won’t

provide LC services if they are not reimbursed for them. It is that simple and

we can’t get reimbursed if we are not licensed. That is a federal

regulation in Medicaid. So it is an unrelenting cycle.

Lastly, I did not make a comment about cars and stereos.

My beef is with public funds supporting folks who smoke cigarettes, at $5 a

pack and expensive manicures; you could add Red Bull to that list too. I have

family and people I love very much in this category so don’t count me as judgmental

for saying this. But I have seen their kids eat crappy food and have no health

care while about $300 a month goes for each parent to smoke a pack of

cigarettes a day. Add then the Red Bull at $3 a can times 3 or 4 cans a day and

beer after that. But that is all really off topic.

Judy

Judith

L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell

Phone

Fax

[Guest guest]

Thank you, Judy! What a mess our health care "system" is! Thank you for your tireless efforts and candor! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: online lactation consult ???To: Date: Friday, May 20, 2011, 6:52 PM

Hi , Thank you for being willing to discuss these issues

surrounding licensure and reimbursement for IBCLCs. I do need to hear the

varied and experienced opinions of IBCLCs who are out there in the field trying

to help mothers. When we better understand the problems licensure and

reimbursement can bring, then we can write better bills and work hard to avoid

those problems. We certainly have tried to learn from the journeys of other

professions in this area such as dieticians, occupational therapists, massage

therapists and midwives. I can tell you that this is not easy. The licensure,

and much to do with reimbursement, will vary from state to state. That means it

can be done 50 different ways!!! This can also happen without even the

knowledge of USLCA, with that we have no control at all. It is the goal of USLCA to be an active part of licensure

efforts in every state where there are initiatives. We collect and study the

attempted efforts and we have some very qualified legal, insurance and

financial professionals and physicians helping us to try to avoid making big

mistakes. You are right to say that some folks do want to weed out non-medical

IBCLCs. We are collaborating with IBLCE to prevent this. It is a defined mutual

goal. The model bills that have been introduced in the past, and any that

may be forthcoming tie licensure to the IBCLC credential - period. There

are no other credentialing qualifications. There is a requirement to have

liability insurance. I would be happy to email you a copy of the latest

drafted model bill if you are interested in reading it. Once a bill gets to the

legislative floor in the US we do take the chance that it is modified in ways we don’t like. In that

case we can find a compromise or have our sponsor pull the bill, which has

already happened once in Texas .

You are also correct that Medicaid pays incredibly low

fees. Right now an IBCLC who is a nurse and bills for lactation as a nurse

visit would likely receive around $6. This is abysmal. This is why we don’t

want to be licensed under nurses. Other allied health professionals who bill

regular codes can bill between $76 and $340. Most non-Medicaid insurance payers

in my area where I have done a rough survey paid about 60% of the billed amount

to a physician. Allied health professionals in most states are reimbursed

75-80% o the physician reimbursement. The low Medicaid reimbursement comes for

every health profession. That is why those facilities who serve Medicaid

populations often are non-profits that have to run on shoestring budgets and

grant funds. It stinks. The facilities serving affluent communities with

private insurers make profits. An IBCLC who only saw Medicaid patients would be

broke. That being said, most private insurers don’t cover health

care professionals until the Medicaid and Medicare plans do so. So, it is like

in law where a precedent must be set. This is why we have set Medicaid in our

sites. Additionally, Medicaid is government administered and it is the public

health authorities who are promoting breastfeeding, the Surgeon General, CDC,

DHHS, FDA, USDA, etc. We believe they should, (not guaranteed of course), back

up their advice with actions to support it. We will see if that works

out. An IBCLC in practice, just like any other health care provider, can choose

not to accept Medicaid insurance reimbursement or any reimbursement for that

matter. You mention many PPLCs who can’t get work when

the Surgeon General’s report states that we need approximately 8.6 IBCLCs per 1,000

births. CT has 4.5 per 1000, yet even though the need is there, the IBCLC

cannot get work. Hospitals and out-patient health care entities won’t

provide LC services if they are not reimbursed for them. It is that simple and

we can’t get reimbursed if we are not licensed. That is a federal

regulation in Medicaid. So it is an unrelenting cycle. Lastly, I did not make a comment about cars and stereos.

My beef is with public funds supporting folks who smoke cigarettes, at $5 a

pack and expensive manicures; you could add Red Bull to that list too. I have

family and people I love very much in this category so don’t count me as judgmental

for saying this. But I have seen their kids eat crappy food and have no health

care while about $300 a month goes for each parent to smoke a pack of

cigarettes a day. Add then the Red Bull at $3 a can times 3 or 4 cans a day and

beer after that. But that is all really off topic. Judy Judith

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

Phone Fax