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.