Originally posted June 18, 2011

In the first part of this series, we discussed the ‘job descriptions’ listed for the various lactation professionals and discovered that, according to their respective website, IBCLCs and CLCs do exactly the same job. Each works to prevent or treat lactation difficulties and promotes, protects and supports breastfeeding in the public realm.

I likened challenging the idea that IBCLCs are the best lactation professional available to women today to walking through a farm yard without stepping in a cow patty.  That’s because it would be so easy to fall into a simplistic view of lactation training- some people are trained and qualified and some are not. But the truth is much more complex.  Many ‘flavors’ of lactation guides share educational programs, faculty and resources, but end up with different certifications at the end of their training.

In fact, the association between IBCLCs and CLCs may be closer than some realize. Consider this: Healthy Children’s CLC training course is listed by the IBLCE (International Board of Lactation Consultant Examiners) as approved to provide the currently required 45 hours of lactation specific education needed prior to sitting for the IBCLC exam (www.americas.iblce.org/upload/Directory%20of%20CERP%20Providers%202010.pdf). Apparently, the IBLCE thinks the course is of high enough quality to educate its certificate candidates.

As of 2012, 90 hours of lactation specific training will be required of IBCLC candidates prior to sitting for the exam (that is, for those not qualifying through a university based program), and Healthy Children- the group who trains CLCs- is an approved trainer for the 90 hours of training. It is, therefore, possible that an IBCLC and a CLC would have completed the exact same lactation specific didactic training. Now consider this: of the 15 faculty listed on the Healthy Children website, 13 are IBCLCs themselves. So it is more than likely that every CLC who is trained is being trained by at least one IBCLC. It seems to me that there is quite a bit of ‘cross pollination’ happening between the IBCLC and CLC professionals even if the certifying bodies remain separate.

Now, some might think ‘Well if the IBCLCs are the trainers, then aren’t THEY the more advanced professional?’ Well… No.  Remember, there are those on staff at Healthy Children who aren’t IBCLCs and they still qualify as IBCLC educators.  In fact, according to materials passed out during Healthy Children’s CLC training:

We were then told that when we had completed our course, we would be able to effectively handle 95% of the lactation cases that came our way. Any cases we could not handle on our own merits would be because a multi-disciplinary team (ie: neonatologists, pediatricians, etc.) would be necessary to treat the client.

As we’ve seen, the job descriptions for IBCLCs and CLCs are nearly identical. The certifying bodies for the credentials use common professionals and educational materials. There is one area, however, in which IBCLCs may appear to have an advantage over CLCs- training methodology.

CLC candidates receive the same didactic lactation education as current IBCLCs, but are required to demonstrate proficiency in both counseling techniques and lactation assessment prior to certification. I cannot find that IBCLCs are required to prove counseling ability or assessment skills prior to sitting for their exam. IBCLCs do have a Clinical Competencies document found here http://www.iblce.org/upload/downloads/ClinicalCompetencies.pdf which details the specific skills IBCLC candidates are to have at the time of certification (note: CLCs are trained to do the exact same things).  A lack of definitive testing of counseling and assessment skills is likely because IBCLC candidates would learn and demonstrate these skills during a required apprenticeship to a practicing IBCLC. IBCLC candidates will have somewhere between 500 and 1000 client contact hours during this apprenticeship.

These hours of required apprenticeship are the major difference between the training of IBCLCs and CLCs. Does this mean that IBCLCs have more experience and are therefore more qualified than CLCs?  Not necessarily.

The only thing the pre-exam training requirements prove is that a brand new IBCLC will have at least 500 hours of client contact hours.  A CLC who has been in practice for many years (the first was certified in 1993) may have many times the experience of a new IBCLC- some women may take their CLC exam after many years providing counseling to lactating women.  Neither exam truly demonstrates how much counseling experience the candidate has had with clients prior to qualifying for the exam.  If client contact hours are the major difference between a brand new IBCLC and a brand new CLC neither of whom had any lactation guidance experience prior to credentialing, that disparity will disappear as each works with clients over time.

In 2012, IBCLC candidates who choose to train under Pathways 1 or 3 will also have to complete ‘general education’ courses to qualify to sit for the certification exam. The classes include such titles as ‘Anatomy & Physiology’, ‘Psychology’, ‘Cultural Sensitivity’, and ‘Child Development’. These classes might be important for an IBCLC to have although all current IBCLCs are NOT required to have this information- does this mean their ability to help women breastfeed has been impaired? Will the IBCLE require current IBCLCs to return to school to fill in their apparent gaps in knowledge? However, I again fail to see how superiority is proven in the IBCLC designation. How does the comsumer know that a CLC does NOT have this education background? As a CLC and was not required to take thses classes, but I DID take these same classes while in college- and several times since. So again, the certification itself proves little of the professional’s actual experience, education and abilities.

So then, why does the IBCLC ‘gold standard’ myth persist?  My theory is that IBCLCs are perceived as being more competent lactation caregivers because they are a part of the medical system. In order to obtain the hundreds or thousands of hours of client contact hours needed, most IBCLC candidates apprentice to hospital- or clinic-based IBCLCs.  In 2007, 80.8% of IBCLCs were also RNs (http://www.uslcaonline.org/enews/0808conf1.html).  It may be assumed that most of the IBCLCs were trained as nurses BEFORE they trained as Lactation Consultants. After the 80.8% of RN/IBCLCs, the next largest group was Certified Childbirth Educators at a whopping 7.6% of the IBCLC population.

This shows a huge imbalance in the background of IBCLCs in the Americas.  Could it be because RNs ‘belong’ to the medical establishment and because the majority of IBCLCs are RNs that IBCLCs are the most acceptable variety of lactation providers to the general public?  Could the perception that IBCLCs provide the highest quality of care in the lactation field have nothing to do with client outcomes, but rather with their medical pedigree? And how much does money impact the perception of care?  If almost 8 out of 10 IBCLCs are nurses and can bill insurance companies as nurses for home visits after hospital discharge, does this cause a perception that IBCLCs are more bona fide because ‘insurance will pay for them’?

Stay tuned for Part III of this series!