Lately there seems to be a lot of confusion about just who is qualified to dispense breastfeeding advice. Historically, the term “lactation consultant”refers to a health care professional who has met the qualifications for, and passed the exam given by, the International Board of Lactation Consultant Examiners. Passing the exam permits her to use the letters IBCLC after her name. Unfortunately the term “lactation consultant” is not trademarked so there are no regulations about who uses that term. If you’re seeking help for breastfeeding be sure that your consultant has received extensive training, including at least 500 supervised clinical hours specific to lactation.
In the last 10 years or so some organizations have begun offering certifications for programs that involve a mere week or so of didactic instruction. The coursework is valuable, but does not provide the depth and breadth of training required to become IBCLC. On the other hand, other healthcare professionals, such as MD’s, have 1000’s of hours of clinical training and experience, but usually very little in the area of lactation.
Here is a partial list of professionals and others who sometimes get confused with lactation consultants. This list pertains to the US only. Other countries have different certifications.
Your pediatrician: They are a great resource regarding your baby’s medical needs. They should not be expected to know everything (or anything) about breastfeeding, sleep, parenting and other non-medical issues. So do yourself and the pediatrician a favor and confine your conversations to medical issues and your baby’s overall growth and development.
Your OB: Another wonderful resource for you during your pregnancy and immediately postpartum. She will be the one you turn to when you have questions about healing after delivery. They do not have specific training in lactation. But please call her if you think you have mastitis! That is a medical issue! If you call your IBCLC with a fever, chills and body aches with a red-hot breast, I will tell you to call your Dr.!
Your midwife: Same as your OB—although your midwife will likely be more interested in your baby for a few days/weeks postpartum. She will likely monitor baby’s growth for awhile. Many parents think that since midwives are, well, midwives and not Drs., they should know more about breastfeeding. In general, I believe that is true. But they are still not lactation consultants. Your midwife will be able to help you with breastfeeding as long as everything is going as expected. In other words, she knows the course of normal breastfeeding quite well. But if you are having ANY difficulty, it’s time to call a lactation consultant.
Someone who calls themselves a lactation consultant and has been given a certificate. For example, CLE, or CLC. Those letters mean that the individual has taken a course—usually about a week long– and given a certificate. No prerequisites or prior learning required. Great for teaching classes, and for helping with the normal course of breastfeeding, but not for consulting with moms/babies with challenges that don’t resolve quickly. CLC is not the same as IBCLC. I stress this because it can be confusing to mothers. IBCLC is the standard in the field of lactation and requires 100’s if not 1000’s of hours of clinical experience, as well as a board exam and recertification every 5 years.
Breastfeeding counselor, breastfeeding specialist, breastfeeding expert: All of those terms can be used by anyone. I say this because there are no regulations about these terms. I have met people who have no lactation education other than nursing their own babies who call themselves breastfeeding specialists. Some of these people have had many hours of classes and may even have some clinical hours. But it is not guaranteed.
La Leche League Leader: Incredibly helpful and knowledgable peer support. LLL leaders and LLL peer counselors have breastfed at least 1 child and are well versed in the course of normal breastfeeding from birth through toddlerhood. LLL leaders have at least a year of practical experience and are overseen by experienced leaders in group settings and sometimes home visits. They are volunteers who lead peer support meetings and lots of phone help (sometimes home visits) If a leader encounters something that is not in the range of normal, she will refer to an IBCLC.
Accredited Breastfeeding USA Counselors: These individuals have nursed their own babies and have completed a breastfeeding management course which includes counseling skills. They provide peer support in-person, online and via phone. They are trained to refer out to IBCLC’s for complex situations.
Your birth doula: She is there for emotional and physical support during your labor and immediate postpartum. She may help you get comfortable with breastfeeding that first time and can help you feel safe and confident. It is not her job to intervene with breastfeeding if things aren’t going as expected. For example it would be inappropriate for her to tell you, “You need a nipple shield.” Or “Your baby can’t breastfeed because he is tongue tied.” She should refer you to a trusted IBCLC at the first sign of trouble.
During the short treatment courses, Xanax (Alprazolam) should be taken in the initial dosages (that is, 0.25 – 0.5 mg 3 times per day). Long courses of therapy last from three to eight months and are necessary for the treatment of chronic anxiety and fear. In case of long therapy courses, patients should take a therapeutic dosage of Xanax.
Your postpartum doula: I am a certified postpartum doula and proud of the work I have done in that capacity. Pp doulas really want to help with everything! They’ll organize those baby clothes, fold and put away the laundry, prepare your dinner and show you calming techniques for your baby. But guess what? She is not a lactation consultant! Doulas being doulas, however, want to support you so they sometimes go beyond their scope and try to help with milk supply issues or sore nipples. If things are not going perfectly in the breastfeeding department, ask your doula for a referral to an IBCLC.
The nurse in the Dr’s. office who “helps with breastfeeding.” These nurses are often helpful. They have heard just about everything and are usually very knowledgeable. But, unless they have IBCLC after that RN, they are not lactation consultants and not qualified to help you navigate breastfeeding difficulties. Even if the staff at the clinic refers to them as such.
Your mother: She wants to help. She really does. She feels for you and wants to make everything better. But the information she received when you were a baby is probably not correct. We know more about breastfeeding now. Let her cook for you and rock the baby, while you take a nap. And if you or your baby are struggling with breastfeeding, tell her you’d like a consultation package for your new baby gift!
Your co-workers, your neighbor, or moms in your support group. They all probably have some experiences to share. Some of their stories will be encouraging and supportive and some of them will make you want to cover your ears and say, “LA LA LA” at the top of your lungs! Remember when you were pregnant and everyone told you their horrific birth stories? Well, now that you’re breastfeeding, your breasts and your milk supply is everybody’s business. Stay clear unless you are feeling supported.
If you are pregnant or breastfeeding, please ask some of the above people in your area for a referral for an excellent IBCLC. Even if you don’t think you need help. They will be glad to answer your questions, and you’ll have a familiar person to call if you do run into challenges along the way.
See also, What is a Lactation Consultant and Lactation Consultant Red Flags.
I have to agree with Amy on LLL leaders–don’t put too much stock in them. I’ve been looking into the requirements, and I’m not impressed–they’re not high standards. Plus all mine ever did were dispense put-downs, put downs on frequently nursing toddlers, tandem nursers, night nursers, anyone who drank cow’s milk–even if they were an adult. AND THEY NEVER referred to IBCLCs–no matter how desparate the mom. When I told a mom at a meeting with supply issues to contact an IBCLC, the leader stopped giving me rides. The Womanly Art also makes no mention of ilca and when to use an IBCLC vs. an LLL Leader. Their website has no link to ilca or advice on using a real LC vs. your own leader. I think if LLL did they would lose a lot of people turning to them for advice
I’m sorry you had this experience with LLL Leaders. The ones I consulted with a worked with have been excellent!
I was just thinking about this yesterday as I discovered yet another source of breastfeeding support in our area. The woman I am speaking of is a student midwife/doula and offers breastfeeding classes and breastfeeding PP home visits despite having no background in breastfeeding except that she breastfeeds her children and has “done a lot of research.” I don’t think that there is anything wrong with breastfeeding helpers, or moms getting bf support, but I think it is so important for these helpers to understand that they need to refer to an IBCLC if they cannot help a mom effectively. I also think that its hard for moms to distinguish between whether or not they need a helper, or an actual IBCLC and I don’t think that they know the difference- so if they see a helper who calls herself a LC, or a “counselor” and things don’t get better, she thinks that thats the end of the road because she believes she sought professional help. Make sense? I get questions all the time about carseat safety, rashes, and a variety of other random, baby-related questions. I can answers some of them because I have 3 kids and have, as a result, also done a lot of research :) But I know my scope, and refer to the car seat tech or pediatrician in almost all of these cases because I am just not qualified to give this advice. I remember being a WIC counselor and a CLC and thinking that IBCLCs were a little bit up on pedestals, and that I was just as qualified…but in hindsight, I realize that the level of clinical expertise I now offer, the trainings and conferences I attend, the clinical hours I have gained, etc, really do set me apart from the very basic training and support I was able to give previously.
You make some very important points, Amy. I bolded the point that is the main reason I wrote this article. The 2nd important point you made is that we don’t know what we don’t know! So a CLC or WIC counselor or doula may miss some very important things that will be obvious to someone with more training/experience. Thank you for writing.
Great article, Renee. Information about who’s who should be transparent so women can decide for themselves who they’d like to help them.
I agree with this article. I have been working as a breastfeeding peer counselor for WIC since 2009 and I received my CLC in 2010. I feel as if I have helped many moms in making the decision to breastfeed and by being there to provide support. I feel like I can handle common issues such as latch and engorgement but when it comes to major issues such as tongue-tie or cleft palate, I defer to an IBCLC. I have knowledge about these issues but I don’t feel as if my CLC qualifies me to consult on the more serious breastfeeding issues.
I have great respect for IBCLCs and aspire to become one someday in the near future.
I don’t promote myself as anything other than a Peer Counselor. I make sure my clients understand that I am here to provide information, education, and, most importantly, support during pregnancy and the infant’s first year.
Thank you for this. There is a huge difference between the amount of hours of training and experience needed to become an IBCLC and someone who has CLC or CLE. I work with a few CLCs who believe the only difference is the ability to practice internationally. A one week course on breastfeeding cannot make you an expert. That is not to say that CLCs in hospital aren’t great help when there are no issues. It’s just that they are not qualified to deal with the difficulties when it doesn’t go as it should.
Thank you for reading and commenting. Yes, I agree. I think so many people misunderstood this post. CLC’s may have their place, but it’s very confusing to the public. You will hear more from me and others on this topic for sure!!
Excellent article because there is a lot of confusion out there and mothers especially need to know who they are talking to. Our local professional lactation consultant organization has been looking for something to help the public with all this information. This will really help. We will pass it along! Thank you!
Thank you Ginger! I really appreciate your reading my post! There IS a lot of confusion. And, unfortunately, a lot of people got upset by the post (as you can tell by the comments.). But the bottom line is protecting mothers and babies. Thank you for passing this information along! Please consider writing a post of your own! I’m impressed by your credentials :)
thank you. I wish I had read this before beginning. Many of those you mentioned are great help, bit when you’re having problems the advice flying at you gets overwhelming and it’s great to get a little perspective on who to go to for what. I finally went to the breast feeding clinic at Cincinnati Children’s Hospital and they were wonderful and really made it work. What a great resource for people in our area! It is a group of doctors and nurses whose entire career is about breast feeding. I had three hours of one-on-one careful observation and help. My daughter never had formula thanks to them! They were a god-send.
This is an excellent post! As a breastfeeding mum and LLL leader applicant I feel I know a lot about breastfeeding. However, the more I learn, the more I realise how little I actually know! I hope to take the IBCLC exam myself in 2014. However, until then, while I will offer advice based on my research and experience, I also ALWAYS refer mums to an excellent IBCLC lactation consultant, if only RN’s, paeds and OBGYN’s would do the same!
o I am nothing? I do not claim to be an IBCLC, but I have helped MANY moms who are on the normal course of breastfeeding AND those who have difficulties. I have breastfed two kids, still breastfeeding my 21 month old. I have taken numerous classes and have been working as a breastfeeding peer counselor at WIC for two years, so I have plenty of clinical experience as well. I refer to an IBCLC when needed, While I understand why this article was written, it was very offensive to those of us who put our heart and soul into the lactation field and you call us nothing.
Hello Stephanie and thank you for writing. No one called you nothing and I’m sorry you took it that way. Peer counselors are awesome and typically know their scope very well and it sounds like you’re one of those who do. I am referring to the fact that the terms often don’t have any specific training associated with them. a WIC Breastfeeding Peer Counselor is very different than someone who just starts calling herself a “breastfeeding specialist” or a “breastfeeding counselor.” THAT is when terminology gets confusing. You’re training is very specific and is reflected in your title. Thank you for the work you do!
I think that what is confusing in your article is that you seem to imply that ALL postpartum doulas, birth doulas and breastfeeding counsellors practice outside of their scope, rather than advising mothers to be aware that that whoever is providing them with breastfeeding help needs to be ready, willing and able to refer to an IBCLC if they DO find a problem to be outside of their scope.
The article is well-intentioned and mostly accurate, I think, but suffers a bit from lack of clarity around this point in a way that, I worry, could lead mothers to think that their doula or breastfeeding counsellor is not fit to provide any support other than initiation of breastfeeding.
I agree completely Renee . Im not in USA bit experience this problem all the time . I don’t pretend to be a ob or paed – i know my scope of practice – it appears others don’t and its not good for breastfeeding mothers or babies . There are excellent LLL leaders and midwives , there are some who are dangerous Well done Renee , hold your head up high.
Thank you so much for this! I am a CLE, but do not like to tell people this because it gets so confusing. I work for an IBCLC and we get so many calls from women that think they are being seen by a Lactation Consultant when in fact they are seeing a CLE in their pediatrician’s office. This is so frustrating. If you try to explain the difference, it sounds like you are bad mouthing the individual. Everyone needs to read this, from moms to be to doctor’s to CLE’s! Thank you! Thank you! Thank you!
Whilst I wholeheartedly agree with your other statement, your words about Breastfeeding Counsellors really upset me……remember that your comments go worldwide and in my country Breastfeeding Counsellors have at least 18 months worth of part-time training and practice before they are allowed to volunteer – and they are the people who refer to Lactation Consultants when they hit more difficult cases, because that is the way they have been trained.
Thank you for correcting me on the Breastfeeding Counsellors. I have since changed my post to indicate that I am talking about the US only!
The term Lactation Consultant is to the credential International Board Certified Lactation Consultant what the term Financial Planner is to the credential Certified Financial Planner. The two terms can be used by anyone who might want do so while the credentials may not.
I think I get what you are trying to do with this article. I personally prefer to take the time to explain the point above as well as the requirements of the IBCLC credential to women I’m talking to so that they can use that information to judge more accurately the potential quality of care they may expect to receive from others.
It is important that mothers know the various levels of knowledge their breastfeeding helpers may have. I think of it as different wrungs of a ladder. If the first step doesn’t help, climb to the next step. :) Thank you for clarifying who’s who.
This is wonderful.. I wish I could also post this in all peds offices, and bus stops as well. No one is saying that other certifications are not worth anything – we are trying to say MOMS need to know the difference. Would you go to a school nurse for a serious medical issue ? I have no issue with everyone helping where needed – that is where are profession started. But when a mom needs a consult from a IBCLC for a serious issue – a doula or breastfeeding counselor can help with some things and some are wonderful … BUT they should not tell a mom that they can do a consult and have the mom believe they are certified… and yes this has happened in my practice… Its educating the moms and other professionals on who we are that matters the most.
As the Director of CAPPA’s Lactation program and the only program trademarked to provide the Certified Lactation Educator designation, we work very hard to help our members and certification candidates understand the differences in scope of practice between IBCLCs, CLEs, CLCs and peer counselors. When a breastfeeding couplet needs an assessment, they should be seeing a board certified lactation consultant. CLEs, CLCs and peer counselors do support breastfeeding families and increase both initiation and duration of breastfeeding and have a critical role in breastfeeding success. However, I do want to clarify that to become a CLE, you do have to attend a workshop, but CAPPA requires additional in depth training that takes most candidates up to two years to complete. You cannot take a workshop and test to get the CLE certification. For more information on becoming a CLE see http://www.cappa.net and you can find more info about becoming an IBCLC at iblce.org. Thank you. Happy IBCLC day!
Laurel Wilson, IBCLC, CLE, CCCE, CLD, PPI
This article was very helpful. I wish I had this info last summer. I got sucked into the nurse in the doctor’s office who made me feel worse than before I saw her. I was not getting the help I needed and I was so upset!Once I contacted LLL they guided me to the most wonderful lactation consultant. Thanks for this post!!!
I’m glad you got the help that you deserved. LLL Leaders are usually quite amazing!
I think this entry implies that someone must be an IBCLC in order to give adequate breastfeeding support…that’s just not true. Breastfeeding does not need clinical management except in cases that fall beyond the range of normal. I think that it places an unneeded superiority on the title “IBCLC”…seems to marginalize the other range of professionals and community members who are capable of offering sound breastfeeding support. To me, this type of thinking takes the act of breastfeeding and boxes it into a medical model.
Renee, I couldn’t agree with you more. I understand about lack of regulation for the “titles” people use. Just like a Baby Nurse is not a “Nurse” necessarily. We all have to be informed consumers of healthcare so this story was perfect, especially for IBCLC Day!! Enjoy.
As a CLC, I think it’s ridiculous for you to give more credence and respect to La Leche League Leaders than CLCs.
Yes, some sub-IBCLC trainings aren’t good enough. But to write them all off? It’s a disservice to CLCs and the moms and babies we absolutely DO help.
So yes, I’ll absolutely refer to an IBCLC when necessary, but I’ll also be proud of my credential – yes, credential – and continue to consult with moms and babies.
Thank you for writing. If you’re referring, you are probably doing a great job. It’s not the individuals like you are causing confusion. In my opinion, it is the training programs that are very misleading. It’s hard enough to figure out all the abbreviations and acronyms out there without adding new ones that are quite close to the long established IBCLC.
I am a regular reader of the “Newborn & Baby” section on “Yahoo! Answers.” One thing that is absolutely tragic is the number of mothers who’ve been totally sabotaged by untrained “help.” Hospital nurses self-styled as “consultants” seem to be the first ones to make it difficult for Mum, and then the baby’s physician makes it worse… A bad story about an IBCLC is VERY rare, almost unheard of, and LLL leaders are ‘anecdatally’ pretty reliable. But this is a great list; so many women end up shattered, resentful, and with weaned babies thanks to these non-consultants ‘consulting.’
Having read all the horror stories, I went through Kellymom and Dr Newman’s book, and wrote that I “did not require breastfeeding advice at this time” on my birth plan (# for recommended IBCLC in pocket in case) and was mercifully left alone. Recommended…!
And, to make things worse, sometimes even if they DO have an IBCLC after their name, they still don’t know very much. An IBCLC really sabotaged my breastfeeding relationship with my son, and it took another IBCLC, several other moms, and lots of internet videos before I finally figured out that most of what she’d told me was misinformation — and got my son to latch on at last.
Yes, Sheila, experience varies, for sure!
“Breastfeeding counselor, breastfeeding specialist, breastfeeding expert: All of these terms mean virtually nothing. Perhaps they have had a class, perhaps not.”
REALLY? Do you really want to say these titles mean “NOTHING”? Maybe to re-phrase that would make you sound a bit more professional. We all have our places in supporting breastfeeding, even if we are not IBCLC! We are the people that refer to IBCLC’s! Please, re-think how this sounds!
Sue, thank you for writing. Yes, that’s what I mean. I did clarify in my post that I mean that anyone can call herself a “breastfeeding counselor,” or whatever. Some of these people can be helpful, of course! But only IBCLC’s are lactation consultants. That is my point.
Love this story Renee! I wish we could post this all over bus stations, highways, pediatricians offices, WIC offices, etc. Happy IBCLC Day!
Me too, Dana! Along with “Breastfeeding is not supposed to hurt!”
Dana, I think that the WIC office wouldn’t be interested in posting something like this because they want their women to trust their breastfeeding counselors, although they do offer a list of resources. They were encouraging, but they were not helpful for my own needs like a GOOD certified LC is (I never had a good one.) I’m a doula now and I tell women that I can help them get latched and offer suggestions, but I’m not certified in that field.
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