Current Scope of Practice for Breastfeeding and Lactation: Q&A with the Lead Author
In the Academy of Breastfeeding Medicine’s new position statement, we describe the scope of the field, who practices in the field, the problems addressed, challenges faced, and some cases that exemplify this work. Paula K. Schreck, MD IBCLC FABM, contacted the lead author on the position statement, Casey Rosen-Carole, MD NABBLM-C MPH MSEd FABM, to gain more insight into the topic.
Dr. Rosen-Carole, what would you say is the defining characteristic of the breastfeeding and lactation medicine (BFLM) provider?
Great question, and one that I think we are still working out as a field, so I’ll answer from my perspective. I believe BFLM providers are experts in interpersonal physiology and the social dynamics of care. We understand that at least two physiologies are at play in most of our patient encounters, and their interplay is fraught with its own joys and challenges! Moreover, because breastfeeding is both a physiological process and a socially determined behavior, we must be very good at promoting health through motivational interviewing, trauma-informed care, counseling, and advocacy.
Diving a little deeper, what do you think differentiates BFLM training from the training profiles of other workers in the breastfeeding space?
Because BFLM training has been difficult to achieve, it takes a lot of passion to pursue it. This means that breastfeeding and lactation is a field with an extremely committed workforce! Other workers in the breastfeeding space tend to focus on practical management of lactation, counseling, education, and advocacy, which are all extremely important. BFLM providers have the additional need to be trained in the anatomy, physiology, pathology, and medical care of children (especially infants), lactating parents, and the physiological interface between the two (the latch). Also, there is the understanding of how human milk is made, passes from lactating parent to child, what it can carry with it, and how it can be used. The list is long!
How does this scope of practice tie in to “Recommended Core Competencies for Specialists Practicing Breastfeeding and Lactation Medicine,” published in 2022 and still displayed on the ABM website?
Yes! This is the next step in our publication strategy for the field. First, we needed to really define as a group what it is that we should know and be able to do, which is the “Core Competencies” document. The scope of practice article reviews the role that BFLM providers play in clinics and communities worldwide. It is also a paper that helps to explain to those with little exposure what the value of our field may be.
How would you suggest an individual interested in joining or advancing in the field of breastfeeding and lactation medicine use this scope of practice?
Step 1 is to share it! Give talks on it! Put the figures into your talks. Go to administrators when trying to build a program and share the paper. I am regularly contacted by people requesting this type of information, and heretofore have been sharing it informally. This is our opportunity to make it official and include perspectives from practitioners all around the world doing this work.