Pamela Drynan, RN, BScN, IBCLC, Ontario
In the newest Clinical Lactation journal, Diane C. Powers provides insight on some role differences of the IBCLC profession in her research article “IBCLC Role Differences: Inpatient and Outpatient Practitioners”. The article highlights inpatient and outpatient challenges, painting a picture of what our peers may be experiencing within their work setting. Powers (2019) suggests that IBCLC’s should learn about their peers’ roles in order to recognize and reflect on how our remarks and actions may have an impact on others and the profession as a whole. Powers (2019) quotes “Could there be an elephant in the middle of the room of our profession, causing both sides to get defensive?” As Kathleen Kendall-Tackett states in her 2017 editorial from Volume 8 Issue 2, “We’re on the same side”. Kendall-Tackett (2017) describes that even amongst peers from the same setting, LC’s can bully each other and furthermore, they have been known to cyberbully each other. Topics that have been fuel for the fire include the World Health Organization (WHO) Code and tongue-tie (Kendall-Tackett, 2017). But how could there be this divide within a profession that is only 34 years old?
As I sat here drafting this article, I have been reflecting on my own experience within the lactation and breastfeeding support profession, thinking about how in the years of being a health care professional (HCP), I have had the pleasure of working in the community and also the hospital setting. I am also a nurse, which is a profession known to “eat their own”. It’s not unusual that I hear HCPs remark negatively about another HCP from a different organization on how they cared for a family in regard to infant feeding. And to be honest, I have caught myself in situations thinking “Geez, how come that HCP did that or didn’t do that?” Even thou our community breastfeeding coalition over the past few years has brought numerous community and hospital staff together to learn about best practices for infant feeding support, the divide still exists. Should we have more playdates in order to better understand each other? Does this scenario sound familiar to you? Can you relate to this reflection from your community?
Powers (2019) reported in her article that some IBCLCs from a hospital setting, shared with her at a presentation that they felt “discouraged” and “dejected” by IBCLCs who work in an outpatient setting. Powers provides some insight into some the diverse challenges commonly known to the inpatient setting as follows: multiple care tasks required by the hospital staff, lack of time spent with family, conflicting messages from the other HCPs involved with the family, visitors that overstay their time leaving less time to visit with family, the family only stays 24-48 hours in the hospital, various distractions such as mobiles, parents who feel that they don’t need the support at this time as they “…have it all under control…”, and the variety of medical issues such as hypoglycemia, jaundice, excess weight loss etc. Powers (2019) describes commons scenarios an IBCLC in the outpatient setting may work with and highlights that in the outpatient setting, they often have more time to discuss, educate, and solve problems than their peers in inpatient who have a fraction of the time allotted to care for the family. Some of the medical scenarios seen in the outpatient are also dealt with as an inpatient, but careful consideration must be given to the different organizational structure that shapes the care provided in each setting as well as age of the mother-baby dyad. These differences were highlighted in greater detail in a research dissertation by Aimee R. Eden (2013)
“…research shows that much more than professional background, the organizational structure in which an IBCLC works influences daily practice and determines job responsibilities. IBCLCs working in different contexts have different levels of professional autonomy, different routines, different client populations, and different types of relationships with patients… The organizational or institutional structures and cultures may match or clash with the occupational culture and professional identity of lactation consultants, but in either case, influence both, and therefore influence IBCLC practice. Practice setting determines job duties, how many clients an IBCLC sees each day, the amount of time spent with clients, and access to other health professional.” Pg. 289
As I read through this research paper, I came across a great reminder, that despite where an IBCLC works, they all write the same exam and are required to follow the same standards of practice (Eden, 2013). Reading this research dissertation also inspired me to look at an older article from the Clinical Lactation journal by Tapia & Powers (2011) From Volunteer to Professional, as it humbled me to learn about the struggles some of the frontiers endured as they took the practice from a peer setting to a clinical setting, with their belief “…that we could really make a difference in the lives of breastfeeding women, one mother at a time”. Learning about the history of the IBCLC profession can remind us that just 34 years ago there was no IBCLC profession, and the founders of the IBCLC professionalization had a vision for all persons who had breastfeeding knowledge, skill, and experience to be given an opportunity to be recognized as skillful HCPs within the health care system. The founders endured long and hard journeys to obtain respect from other health care colleagues, and as IBCLCs, we can honour that journey and further expand on the rooted work started over three decades ago, by recognizing the importance of all IBCLCs roles within the health care system (Eden, 2013).
For myself, I look forward to the upcoming CLCA-ACCL 2019 Conference in Richmond, BC to meet fellow IBCLCs who have various professional backgrounds, and in some special way, contribute to supporting the breastfeeding family. This conference supports all professionals from all backgrounds that want to learn more about supporting breastfeeding dyads and families. I look forward to seeing you there and hearing your stories too.
Please check out the CLCA-ACCL conference webpage for updates and information on registration. Also you can follow CLCA Facebook, Twitter, and Instagram for updates.
Eden, Aimee R. (2013). The Professionalization and Practice of Lactation Consulting: Medicalized Knowledge, Humanistic Care. Graduate Thesis and Dissertation. Https://scholarcommons.usf.edu/etd/4477
Kendall-Tackett, K. (2017). Should Lactation Consultants Be Mean? Let’s Bring Civility, Kindness, and Professionalism Back Into Our Discourse. Clinical Lactation, 8(2), 45-47
Powers, D. (2019). IBCLC Role Differences: Inpatient and Outpatient Practitioners. Clinical Lactation, 10(2), 74-80
Tapia, V. & Powers, D. (2011). From Volunteer to Professional: This Journey to Becoming Lactation Consultants. Clinical Lactation, Vol. 20-3