Hearthside Maternity Services

pregnancy, birth & lactation services… at home

Lactation Guidance- What’s in a Name?

Originally Posted on Friday, June 17, 2011 11:11 PM

As a newly minted Certified Lactation Counselor, I’m being asked by friends and family “What’s that? Is it like the lady who helps you breastfeed in the hospital?”  There are a ton of ‘alphabet’ credentials out there in the lactation guidance world- IBCLC, CLC, CBE, and CLE are just a few among many.  What do each of these designations really mean to families who are in need of information or lactation assistance?  How do these credentials compare?  Which letters signify the breastfeeding expert?
I’m going to attempt to answer these questions. I say attempt because the answers are both practical and political and maybe aren’t as clear as those of us ‘in the know’ would like to believe.
Let’s begin with the Certified Lactation/Breastfeeding Educator (CBE/CLE). A CBE/CLE is a person who has undergone specific training to learn how to teach breastfeeding classes to expectant parents. A certificate in lactation/breastfeeding education may be obtained from one of many institutions and generally shows that the instructor has demonstrated mastery of the material and teaching methods discussed during training. CBEs/CLEs share information- they do not assess breastfeeding dyads nor do they suggest solutions to specific lactation difficulties. CBEs/CLEs are theorists- they share the principles and facts about breastfeeding so parents are as prepared as possible prior to birth.
Next are the International Board Certified Lactation Consultants (IBCLCs). IBCLCs are certified via exam after completing one of three training ‘pathways’:
Pathway 1 is tailored for people who are currently working (paid or volunteer) with breastfeeding women (think WIC counselors, Le Leche League Leaders, etc.). To sit for the exam, candidates on Pathway 1 must complete 14 ‘General Education’ courses (ie: psychology, sociology, anatomy & physiology, etc), 90 hours of lactation specific training and log 1000 hours of contact with clients.
Pathway 2 is for people graduating from an IBCLE approved university program with a degree in Human Lactation. Upon completion of the program, the candidate is eligible to sit for the exam.
Pathway 3 is for health care professionals. Doctors, nurses, etc. must complete 90 hours of lactation specific courses and then log 500 hours of contact with clients under the supervision of an IBCLC. Their certifying body is the International Board of Lactation Consultant Examiners (IBLCE).
Note: The above descriptions are of the NEW training requirements that will be in place for anyone sitting for the exam in 2012 and beyond. Currently, only 45 hours of lactation specific education is required for Pathways 1 and 3 and no general education classes are required at all. That means, all current IBCLCs have qualified for their exam under what is, apparently, less stringent training than what will be required starting in 2012.
But what exactly does an IBCLC do?  According to their website (www.americas.ibcle.org):
The International Board Certified Lactation Consultant (IBCLC) credential identifies a knowledgeable and experienced member of the maternal-child health team who has specialized skills in breastfeeding management and care. The IBLCE certification program offers the only credential in lactation consulting and is available globally.
IBCLCs have passed a rigorous examination that demonstrates the ability to provide competent, comprehensive lactation and breastfeeding care. Attainment of the IBCLC credential signifies that the practitioner has demonstrated competence to:
  • work together with mothers to prevent and solve breastfeeding problems
  • collaborate with other members of the health care team to provide comprehensive care that supports, protects and promotes breastfeeding
  • encourage a social environment that supports breastfeeding families
  • educate families, health professionals and policy makers about the far-reaching and long-lasting value of breastfeeding as a global public health imperative.

With a focus on preventive health care, IBCLCs encourage self-care, empowering parents to make their own decisions. IBCLCs use a  problem solving approach to provide evidence based information to pregnant and breastfeeding women and make appropriate referrals to other members of the health care team. The IBLCE has established Professional Standards for IBCLCs and IBCLCs must renew their certification every five years, either through continuing education or by re-examination.

Finally, there’s the Certified Lactation Counselor (CLC)– that’s my credential. A CLC is a person who has been trained by Healthy Children’s Center for Breastfeeding (www.healthychildren.cc) and has passed a two part exam administered by the Academy of Lactation Policy and Practice (www.aalp.org) An explanation from the website as to the history and purpose of the CLC:
The Certified Lactation Counselor (CLC) credential identifies a specialist in lactation counseling who has successfully passed an examination based on identified work-place competencies derived from role delineation studies. The latest ALPP role delineation study was in 2005.
The CLC credential signifies that the holder has demonstrated the necessary skills, knowledge and attitudes to provide breastfeeding counseling and management support to families who are thinking about breastfeeding or who have questions or problems during the course of breastfeeding/lactation. CLCs are dedicated to the promotion, protection and support of breastfeeding and human lactation in their work to prevent and solve breastfeeding problems. They understand that breastfeeding works best in when it is the cultural norm and when the provider of lactation support and services is culturally competent. Obtaining the CLC credential is a way of demonstrating your knowledge and skills in lactation management. Certification is open to applicants who successfully complete Healthy Children Project’s 45 hour evidence based, comprehensive lactation course, and awarded those who successfully pass the comprehensive examination. The Code of Ethics for ALPP CLCs is available by clicking here. If you have a concern about the ethical actions of a CLC, please feel free to fill out this form and mail it to ALPP. You can read the policy of the practice and disciplinary procedures in the Candidate Handbook.
CLCs work in counseling model understanding that breastfeeding decisions are made by the mother, who may have values and goals different from the counselor. A counseling approach is used to elicit information and provide appropriate support to the mother and her family. The CLC works as part of the US health care team, assuring appropriate referrals and recommendations. CLCs provide breastfeeding counseling and lactation management in
  • Maternity units in hospitals and birth centers,
  • Neonatal intensive care units and special care nurseries,
  • Outpatient lactation clinics,
  • WIC programs,
  • Visiting nurse programs
  • Maternal and child health services at the state, county and local level,
  • Parenting centers including military family support centers
  • Physician and midwife offices
CLCs are members of the health care team who can provide knowledge and counseling about optimal and sub-optimal breastfeeding.  Research has shown that the education required of CLCs prior to certification is associated with improved breastfeeding outcomes.
Whew! That’s a TON of information! Ok, let’s break this down.
A CLE/CBE teaches theory in a classroom using appropriate teaching methods and materials.
IBCLCs work directly with breastfeeding dyads-that’s the mother and the baby- to identify breastfeeding problems and to suggest solutions to those problems. Professionally, the IBCLC works to protect, promote and support breastfeeding within the community.
CLCs do the exact same thing.
Cue record scratching audio. Wait. So the IBCLC and CLC credentials are EQUAL? They are BOTH the experts when it comes to lactation and the only qualitative difference is which group certifies them?
Stay tuned for Part II in which we’ll discuss the relationship between IBCLCs and CLCs.

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This entry was posted on February 26, 2012 by in Uncategorized.
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