Monday, September 5, 2016

The future of lactation credentials

I wrote a good portion of this back in July. Although the email survey from IBLCE has expired, the points still remain. I see people in person tell me this, I see this almost WEEKLY on Facebook how people believe that every lactation designation is equal. They are debating in the comments section about "I'm just as qualified as you are" or "the system doesn't allow equitable entry into the profession" or "they keep changing the standards."The point is, you can rage against the machine all you like, the machine is not going anywhere. 

Let's say you decide you want to become a nurse. LPN, start at the entry level. If someone who is lower on the socio-economic scale, or have challenging life circumstances that make working, caring for kids, and going to school exceptionally difficult, is the standard of entry into a school of nursing going to change? Are the pre-requisites going to change? Are the items you are expected to complete to pass a course or pass your boards going to change? Absolutely NOT. So, why do so many people say that our STANDARDS are the barrier to becoming an IBCLC? I don't think it's the standard that is the barrier. We must have a standard if we expect professional respect by other healthcare professions, as well as among lactation service providers. I think it is the ability to meet the standard that is the barrier. So what must we do then? Increase access to the things that are the pre-requisites to meet the standard. 

Are people challenged more severely by socio-economic status, those on the lower end are more underserved than those in the middle or on the upper end? Absolutely. But the thing is, standards cannot be changed. If they are, then you have no standard upon which to measure. You get this person getting special treatment, and this one not. Even more can cry foul. 

It took me 4 years to complete my college classes, 90 hours of lactation and 1000 clock hours of in person experience before I would even qualify to sit for my board examination. Then, at that time, they were only giving the exam once a year. So, after my 4 years of preparing, paying my $500ish dollars (I forget the exact amount, but it was no small some for our single income family), my examination opportunity (only once a year at that time) evaporated. 

I sat crying, seeing my dream die as the minutes ticked past on my cars dashboard. I lived in Houston and was stuck on an elevated section of the 610 loop, no on or off ramp for miles, and we sat there, at a complete standstill, for two hours. I later learned that a bus driver had a heart attack, rolled his bus, and thus blocked 3 lanes of traffic. Access was only given for emergency vehicles, the rest of us could just wait. This was before the era of smart phones, so I sat trapped in traffic, unable to move forward or back. I bawled my eyes out as I missed my exam window. 

When I arrived at the designated testing site, they turned me away. The snarky proctor made a point of saying "perhaps you should have planned better." Her caring supervisor advised that this contract was important to their institution and they couldn't jeopardize that to make an exception for me. I had to wait another 12 months and pay my $500ish dollars again. Where's the equity there? 

The thing is, as uncomfortable as that was, that was fair. Those were the rules, that was the system. No allowances were made. Whether I was late because of some MAJOR unforeseen circumstances, or whether I was late because I just overslept. They applied the rule of the law equally. I most certainly wanted those standards changed. Didn't happen. So, after 5 years, I sat for my exam and EARNED the right to put the credentials IBCLC after my name. 

When I received an email from The International Board of Lactation Consultant Examiners (IBLCE®) advising that they’d “like my opinion as they are exploring the possibility of creating additional credentials which reflect different levels of support for skilled lactation care.” My first reaction was “NO!” The world of lactation support professionals is already confusing enough. Then, I took a step back and thought for a few minutes. IBLCE is considering a way of UNIFYING all lactation service providers under one certifying body. And having two or three lactation credentials, instead of 52.

We are already struggling against so many obstacles to breastfeeding success for moms and babies.  Greater access to quality lactation care comes when we unite our strength. Yet we spend an enormous amount of energy fighting each other.

Isn't helping mamas and babies our real objective?

I am an RN, IBCLC. But I did not start there. I was a CNA(Certified Nurse’s Aide), then a La Leche League Leader, then a Licensed Practical/Vocational Nurse, then a Certified Breastfeeding Advisor, then an IBCLC, then an RN. I am now working on my MSN. If ever there were someone who has been stopped at every rung on the professional ladder, it’s me.

For much of the time I have seen that as a detriment. But in this case, it gives me an enormous amount of wisdom because I have actually BEEN that person in many of those roles. I know how it looks and feels from both sides of the fence.

I have been “just” the CNA, just a La Leche League Leader, just the Certified Breastfeeding Advisor. I have been given the title “Lactation Assistant” even though I was an IBCLC because I was an LVN and being a “Lactation Consultant” was an RN only job.

I have been told in many professional circles that I was not enough because I didn’t have the right letters behind my name. Many of us fear that we are not enough. Being told one credential is better than another taps deep into our core feelings of the need for acceptance. I have been there. I have been discounted and understand deeply the discord and resentment that can bring. That resentment of feeling “less than” and also the pride of “I finally got there, now I’m the best” can blind us to the journey of others, and at times, progress as well.

We all have a role to play, each one extremely valuable. Each one appropriate and accessible in their context. I am an RN. I look at the hierarchy in nursing and see so many parallels in lactation service providers. I have had most every job in nursing, I have had every role in lactation care. With each there is a scope, a value, and also, a limit. My role and scope as a CNA is needed and necessary.  However essential it was, the scope was not the same as that of an RN.

Having had all of these roles, I know how to stay in my lane. In my role as a La Leche League leader, I was given a clear scope of practice and a clear line not to cross. As a Certified Breastfeeding Advisor, I was not. In many of the lactation care provider roles, that line is blurred and sometimes, was never clear to begin with. This is largely attributed to the fact that every different title, designation, and certification each have their own scope, as outlined by their own certifying body, as interpreted by each person that holds said credential. When they go to their “higher ups” for clarification, that too is met with inconsistency. My role and scope as a La Leche League Leader was needed and necessary.  However essential it was, the scope was not the same as that of my role as an IBCLC.

I don't know what kind of reaction IBLCE got, but my guess is they got a lot of firm “NO's” from IBCLC’s. 

What are we to do, how are the blurred lines ever going to become straight? Giving IBLCE a firm “NO” and continuing to fight each other could be the biggest loss to the profession of lactation as a health care field. 

Just as there is ONE board of nursing. They certify CNA’s, LPN/LVN’s, RN’s, Nurse Midwives, and Nurse Practitioners. All of them are “nursing service providers” with different scopes of practice. We are being given the opportunity to have ONE certifying body, ONE board of directors, ONE vision for leadership, ONE certification source for lactation designations that will acknowledge the hard work, and valuable contribution of peer support, certified support, and professional support, all under one roof. Nursing professionals have ONE certifying board. ONE place to go for clear roles, rules, and expectations.

Just like there are national boards of nursing, all those standards are the same. But, where you go to school is up to you. Where you get your lactation education is up to you, and what standard that education meets will be clear, and will also serve as a pathway to IBCLC designation, if that is what you are going for. 

We have that opportunity here. IBLCE is making that an option. If you previously said NO, email IBLCE and say YES to IBLCE and UNITE the Lactation Service Providers!

Ingrid Dixon, BSN, RN, IBCLC

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