A few decades ago, breastfeeding rates fell to an unacceptable minimum because artificial milk was advertised as better than breast milk and as a liberating measure for women. Thanks to the research, it became known, little by little, that what was supposed to be a breakthrough turned out to be a setback, because artificial milk did not turn out to be better and babies lost breast milk defenses and many associated characteristics, since breastfeeding is not just a food.
When mothers returned to breastfeeding, there was a lack of knowledge at the social and health level and women who had problems with breastfeeding did not obtain adequate answers in the medical consultation. This made some women decide to support each other, ultimately resulting in the figure of the lactation consultant.
Now this figure exists and makes a commendable and much needed voluntary function. However, some of the consultants have been unmarked charging for their services and knowledge and there has been a great controversy among the advisors because: Is it a volunteer or a paid profession?
The knowledge gap of health professionals
It happened and it still happens. We have already commented on several occasions in Babies and more. Pediatricians, nurses and midwives are expected to be breastfeeding experts, but not yet. Or at least not yet the majority. Palace things go slowly and there are many who, not being recycled, have lagged behind. There are pediatricians who give inflatable sheets, there are nurses who do not know what they are talking about and are dedicated to perpetuating myths and midwives who are in the same situation.
If this is now, imagine 30 or 40 years ago. A mother went to the doctor or pediatrician with breastfeeding problems and received the indication to supplement with a bottle or to breastfeed for only 10 minutes every 3 hours in order to cure the cracks, for two examples. Breastfeeding was getting worse, women felt unassisted and thus born groups of mothers who came together to explain their problems and possible solutions, in a selfless way.
The passage of time, new studies, new knowledge and new problems meant that the support groups no longer served that: "This works for me", "I know one that did this and that went well." The problems were increasingly concrete and complex and the mothers needed more knowledge and experience. Thus emerged the figure of the lactation consultant (in the League of Milk is called a monitor), a woman, mother, who was breastfeeding or had given it, who had some knowledge and experience that endorsed him to have authority and credibility in the dynamization of the groups.
The training of lactation consultants
A few years ago, federations of support groups began offering courses on breastfeeding consultants. In theory they were offered to women who wanted to be advisors, but enrollment was open and could be done by anyone who wanted to know more about breastfeeding (mothers, future mothers, healthcare professionals, etc.).
I did it myself obtaining the title in 2008. Now, on the first day, as soon as I entered, they explained it very clearly: breastfeeding consultants are mothers, volunteers, who have decided to train to spend their time helping other mothers. They are mothers who have breastfed their children, because in support groups all women have to have the same characteristics. Come on, in a second they told the men present (I think we were three), that we could not be part of any breastfeeding support group and everyone present that the title was just a training to be able to one day be an advisor in a group.
I had no problem with it. My intention, as a nurse, was to learn. I got the title, like the rest, I imagine, and so happy. I paid for it, I paid for the trips and I dedicated hours of my life because that interested me, as everyone else did. Mothers who wanted to be advisors in a group already had one of the requirements: the title.
I say one of the requirements because each association has its own, but in the majority the title is not the only, far from it. If we look at the requirements to be an advisor to Alba Breastfeeding we see that in addition to the title and being a mother who has breastfed for at least one year, you must do a tutored practical training in the groups and that does not succeed until the board decides. There are women who can take up to two or three years to achieve it because in the end the most important thing is the experience, having dealt with many mothers, having seen many problems, having found solutions and even being wrong, to continue learning. Do not forget that bad advice can be decisive to end breastfeeding, just as bad advice from professionals can achieve.
And one good day, some decided to charge for it
Breastfeeding groups have a schedule. They usually meet once a week, at the same time in a fixed place. For "emergencies" there is usually a mobile phone after which an advisor, also a volunteer, helps mothers who cannot wait for that day.
However, there is a demand for mothers who ask for help at home, and there is the consultant who decides whether to go or not. Many do not (logical, it is a trip by car, a particular time and we continue talking about volunteering), but there are others that do. And in that yes do, there are women who have decided to charge for their "urgent" services. Something like "come to the group the day we meet, but if you need me before or want to see you, you will have to pay for it."
Similarly, there are women, mothers or not, who obtain the title to offer their private services as lactation consultants, usually accompanied by other titles such as portage consultant, doula, yoga, child massage and the like. Some do it at home and others have their own centers where in addition to these services they sell backpacks, scarves, etc.
Is breastfeeding counseling a profession?
Now, can you do it? Should they do it? It is the million dollar question. Many defend the collection for the expense that the training or the place where they carry out the consultancy has brought them. A money they invested without receiving any economic reward. But they are not right. As I have explained, I also paid for the course in his day, as I pay for the congresses I go to, the books I read, the trips and the stays. And I do not charge more as a nurse in the consultation, nor for the added knowledge I charge more to a mother who has been asking for help because her breastfeeding is not going well.
But it's not just that, it's that the title of advisor is, as I say, a training to be able to volunteer. It is not done to have a profession, and if someone is announcing a lactation consultant course and then work as an advisor, charging for it, is lying and offering false expectations.
But, there are women who need them and would pay anything
I do not deny it. Many consultants are because in their day they had problems with breastfeeding and an angel offered their selfless services saving their breastfeeding. I went with my wife to an advisor's house, in this case matron, who helped us a lot, and that He didn't charge us anything for it, and we would have paid without a doubt.
There is a demand, mothers urgently need this help, including home visits, why can't they charge the consultants for those services?
Payment implies professionalization
It is one thing to be a volunteer, that you present yourself as an advisor to the association to which you belong and another thing is to present yourself as an advisor, charging. The moment you ask for money for your function, you are no longer an advisor to that association, you cannot present yourself as such. So you introduce yourself as a lactation professional, or so it is supposed.
But there is no profession of lactation consultant, it is not recognized. The function of professionally advising on breastfeeding issues is a function of midwives, pediatric nurses, pediatricians and I imagine that they also work for gynecologists. It is within these functions to go home to help nursing mothers, and many midwives are doing it privately, because It is a function that should be exercised by the midwife of primary care centers, but many centers do not have a midwife and when they do, they are not available for it. Come on, it takes many more midwives in primary care to respond to the demand (or that there are more midwives doing that work on a private level).
Why do midwives do and breastfeeding consultants do not?
The breastfeeding council is a health function. If done at the voluntary level there is no real danger at the level of responsibilities, because they are support groups from mother to mother. You are being informed by a nursing woman who speaks to you based on her experience and knowledge.
If it is done on a professional level, that is, charging, you are exercising a profession that, in this case, does not exist. The title does not guarantee you to do it and when they give professional health advice they have a responsibility and some competences.
At the level of competencies, nurses have ours published in the BOE, and we also have them when we specialize in pediatrics (in these we can read, for example: "Promote as an expert breastfeeding. Advise and support in the beginning and maintenance, explain the technique and act in the face of difficulties."). The midwives, likewise, their competences are published in the BOE, where breastfeeding is very present in their functions and pediatricians, as well. However, there is no competency framework, there is no definition of the advisory profession, There is no such work.
At the level of responsibility, health professionals pay a school annually and consequently we have civil liability insurance. If a problem arises from our activity, we are covered by our school. If a woman or mother wants, she can claim. You can put a claim in the health center, for that are the sheets created with that intention. And if you want and consider it necessary or timely, you can report for malpractice.
If a counselor who appears as a professional (charging) has a problem with a mother, she is alone. I have commented that they have the knowledge and the ability, but of course, if there are people who comply with the title and do not have the experience advising, or as a mother, there is the possibility of error. Even the most trained and experienced advisor can make a mistake and give wrong advice, if even the best doctors are wrong!
If you make a mistake as a volunteer your association answers for you, and in any case, I don't think any mother can claim too much, because you don't act as a healthcare professional, you are a mother who is trying to help another. If you are wrong in your work, charging, it is different. Who does the mother claim? Who do you report? Who answers for you? Nobody, you are giving professional health advice without being health personnel and without being covered by any civil liability insurance.
But then, why become an advisor?
Normally a woman, mother, becomes an advisor because in her day, as a nursing mother, she had a problem and someone helped her. Or he had no problem, but he went to the support groups and there he found a place to be heard and to share experiences. This is not a health professional who can match it because in our case the treatment is individual and there is no peer-to-peer relationship, there is no mother talking to another mother, there is a professional talking to a mother. To what I was going. The mother who goes to a group feels good, grateful and at some point decides return everything you received, or part of it, through the same function, becoming a voluntary advisor and dedicating the time she decides to do so.
If a woman becomes a lactation consultant thinking that in this way she will have a job opportunity, she is making a mistake in the objective and intention because, again, there is no profession of lactation consultant and the title was not created to receive financial compensation for the work of an advisor, but for volunteering, to create a network of mothers that will help other mothers who need that space, so that these helped mothers also felt the need to collaborate and that space, that moment, that place, would be perpetuated.
And the IBCLC?
An Accredited Breastfeeding Consultant, which in English is known as IBCLC (International Board Certified Lactation Consultant) yes she is a professional lactation expert who obtains the degree through an international exam.
The problem is that in Spain there is no profession. It is not recognized and, consequently, also lacks the aforementioned framework of competencies and professional college. They are in the same situation at the level of responsibility, although if there were a complaint they would surely have fewer problems due to a degree issue. We are talking about a profession that does exist in many countries, only here it has not yet been recognized.
What is happening is that more and more health professionals are accredited as IBCLC (nurses, pediatricians, midwives, etc.) and being a degree that must be renewed every 5 years The constant updating of the knowledge of these professionals is guaranteed and there are centers that are promoting this qualification for their workers. And an IBCLC healthcare professional is protected by his school, but not by being a professional, but by being a healthcare professional and being, after all, carrying out one of his skills.
Photos | Thinkstock
In Babies and more | Are you pregnant and want to breastfeed? Head over to a breastfeeding support group, Tips for first-time parents: look for your breastfeeding support group, New website of the Catalan Federation of Breastfeeding Support Groups
