Birthing the Profession

Linda J. Smith, BSE, FACCE, IBCLCFeb. 25, 1998

I found my "calling" to the lactation field as a La Leche League Leader in San Antonio in the early 1970's. I quickly realized that many of the problems in breastfeeding were (1) preventable and (2) often caused by under-educated and misinformed professionals giving poor advice. I vowed to "change the health care system." HA! Little did I expect that I would be a major creator of an entire new profession.A military assignment took my family to Canada where I became a childbirth educator, partly to help prevent breastfeeding problems through prenatal education. Moving back to the US, hundreds of families at Ft. Belvoir heard my message. Other places, other classes . . . yet I still encountered the same preventable breastfeeding problems, over and over, in city after city. Obviously prenatal education wasn’t the whole answer. The "system" still needed fixing.In 1982, LLL announced the new Lactation Consultant Program, and I jumped in. 60-hour volunteer workweeks over three years culminated in the first IBLCE exam in 1985. I developed the first proctor’s manual; proctored the first exam, and was one of the 6 who wrote the first 200 exam questions. Literally over lunch one day, I realized the need for a professional association and took a major role in making this happen too. I was the first ILCA Secretary because I was the only person on the first board who owned a computer. (Bet you didn’t know that the ILCA membership database was conceived by my computer scientist husband Dennis Smith and born on our Commodore 64 computer using "The Consultant" software! And did you know he soon raised it to a high professional standard, using dBase software on an early personal computer.)More moves. I opened private lactation practices in several more cities, and found the same old problems. I gave inservices to hospitals when I could - but those were just a few drops in a mighty big bucket of professional under-education and mis-education. In 1991, I had to actually TAKE the IBLCE exam along with the other "grandparents" of the original exam, so I started a study group. This grew into the Lactation Consultant Exam Preparation Course©, the first course that specifically used (and still uses) the exam grid as a model for the curriculum. To date, I’ve trained over 1000 people including physicians, midwives, nurses, dietitians, social workers, peer counselors, and pharmacists who in turn influence their colleagues and institutions to change clinical practices.

Better, but not enough. Policies needed to change too. Touring my state on a consulting contract, I was shocked at the low level of professional knowledge of breastfeeding, and even more disturbed by the fragmentation of maternal and child health services. Using the Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding as a framework, I analyzed all currently available breastfeeding policies and position papers and placed them on the Ten Steps grid. The not-so-amazing result: a high level of corroboration! Using this model, comprehensive breastfeeding policies were developed for all public health services in the state, including job descriptions and "recommendations and competencies" for breastfeeding peer counselors. An 8-page guide to evaluating breastfeeding educational materials helps staff avoid unhelpful audiovisuals, and an Annotated Catalog of educational resources identifies useful products. ILCA later incorporated this catalog into its "Professional Resources for Lactation Consultants." The state maternity licensing unit was intrigued, which raised awareness and interest. The two-day basic training program I developed was later implemented and won a national award.

Not all of this was easy, fun or lucrative. I was labeled "subversive" by one supervisor, and "a zealot" by another. Instead of quietly licking my wounds, I started publishing the Fact Packs and Fact Calendars which present published research, stated from the "breast is normal" viewpoint. Over 6 years, 72 different Facts about breastfeeding help professionals and parents to think differently about breastfeeding. My daughter Hannah started the "For Zealots Only" business, which has evolved into the Bright Future Lactation Resource Centre which my husband and I own and operate. (Check out our web site.)

Things were getting better with the LC profession firmly established. However, in my community, breastfeeding mothers were still coming to see me for easily avoidable problems. I began sending multiple-page educational reports to their providers, complete with footnotes and research articles. Gradually the silly problems diminished as providers became increasingly skilled. My community now boasts IBCLC’s at every local maternity hospital including the military base, at the WIC and public health clinics, and the home care agencies are starting to send their staff for training.Onward and upward. I now serve on the Council of the Coalition to Improve Maternity Services (CIMS) which developed the Mother-Friendly Childbirth Initiative. CIMS is working to change the labor and birth system, where breastfeeding is often compromised by unnecessary and overused birth medications and procedures. I am also a member of the US National Breastfeeding Committee which grew out of the National Breastfeeding Leadership Roundtable in January 1998. USBC’s mission is to guide national policy development on breastfeeding. Breastfeeding is now included in the National Performance Measures of Title V Maternal and Child Health Block Grant partly because of the Roundtable’s work.My "business" for the past 16 years has been to build the very foundation of "breastfeeding-related businesses:" starting the LC profession; establishing the credential; forming the professional association; and creating/changing health policy. I now spend gratifying days preparing and training new lactation professionals, lecturing health workers professionals on updating and improving the breastfeeding "piece" of their knowledge, and educating anyone who will listen on the importance of breastfeeding and the science of lactation management. Oh yeah - I still help mothers and babies directly in my private practice.