Frequently asked questions include: What is the difference between a lactation consultant/counsellor and one that is internationally board certified? What kind of training does an IBCLC have? What is an IBCLC qualified to do?
For those who appreciate detailed answers, please keep reading! I have attempted to answer as comprehensively as possible, drawing upon information provided on the website of the International Board of Lactation Consultant Examiners.
What is the difference between a self-described lactation consultant/counsellor and one that is internationally board certified?
The International Board of Lactation Consultant Examiners (IBLCE) establishes the highest standards in lactation and breastfeeding care worldwide and certifies individuals who meet these standards.
To maintain the IBCLC certification, certificants must recertify every 5 years. Five years after last passing the exam, IBCLC certificants have the option to recertify by completing 75 Continuing Education credits or re-examination. Re-examination is mandatory 10 years after last passing the exam. Only those who keep their credentials current with IBLCE have the right to use the “IBCLC” designation. To check if credentials are current, visit the public registry at www.iblce.org/public-registry .
What kind of training does an IBCLC have?
Usually an IBCLC will have a Bachelor’s degree in a field of science; if not, 8 university-level courses must be obtained in health science subjects which include:
Before writing the exam, candidates must receive at least 90 hours of lactation education and 1000 hours of clinical experience.
In order to be certified as an IBCLC, a qualifying exam must be written which includes the following content (updated January 2016; for more information, please visit www.iblce.org):
Development and Nutrition
Infant:
Physiology and Endocrinology
Pathology
Infant:
Pharmacology and Toxicology
Psychology, Sociology, and Anthropology
Techniques
Clinical Skills
Equipment and Technology:
What is an IBCLC qualified to do?
International Board Certified Lactation Consultants (IBCLCs) demonstrate specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).
The six Clinical Competencies encompass the responsibilities/activities that are part of the IBCLC’s practice. The aim of these Clinical Competencies is to inform the public of the field in which IBCLCs can provide safe, competent and evidence-based care. The Clinical Competencies are applicable in any country or setting where IBCLCs practice. It is understood that the IBCLC will practice within the boundaries of her/his training, expertise, culture and setting.
Clinical Competencies for the Practice of International Board Certified Lactation Consultants (IBCLCs)
(Updated September 15, 2012; for more information, please visit www.iblce.org)
1. The IBCLC has the duty to uphold the standards of the profession and will:
2. The IBCLC has the duty to protect, promote and support breastfeeding and will:
3. The IBCLC has the duty to provide competent services for mothers and families and will perform a comprehensive maternal, child and feeding assessment related to lactation, such as:
History Taking and Assessment Skills
Skills to Assist Breastfeeding Dyad
General Problem-Solving Skills
Use of Techniques and Devices
Develop, Implement and Evaluate an Individualized Feeding Plan in Consultation with the Mother
4. The IBCLC has the duty to report truthfully and fully to the mother and/or child’s primary health care provider and to the health care system and will:
5. The IBCLC has the duty to preserve client confidence and will:
6. The IBCLC has the duty to act with reasonable diligence and will:
For those who appreciate detailed answers, please keep reading! I have attempted to answer as comprehensively as possible, drawing upon information provided on the website of the International Board of Lactation Consultant Examiners.
What is the difference between a self-described lactation consultant/counsellor and one that is internationally board certified?
The International Board of Lactation Consultant Examiners (IBLCE) establishes the highest standards in lactation and breastfeeding care worldwide and certifies individuals who meet these standards.
To maintain the IBCLC certification, certificants must recertify every 5 years. Five years after last passing the exam, IBCLC certificants have the option to recertify by completing 75 Continuing Education credits or re-examination. Re-examination is mandatory 10 years after last passing the exam. Only those who keep their credentials current with IBLCE have the right to use the “IBCLC” designation. To check if credentials are current, visit the public registry at www.iblce.org/public-registry .
What kind of training does an IBCLC have?
Usually an IBCLC will have a Bachelor’s degree in a field of science; if not, 8 university-level courses must be obtained in health science subjects which include:
- Biology
- Human Anatomy
- Human Physiology
- Infant and Child Growth and Development
- Introduction to Clinical Research
- Nutrition
- Psychology or Counselling Skills or Communication Skills
- Sociology or Cultural Sensitivity or Cultural Anthropology
- Basic Life Support
- Medical Documentation
- Medical Terminology
- Occupational Safety and Security for Health Professionals
- Professional Ethics for Health Professionals
- Universal Safety Precautions and Infection Control
Before writing the exam, candidates must receive at least 90 hours of lactation education and 1000 hours of clinical experience.
In order to be certified as an IBCLC, a qualifying exam must be written which includes the following content (updated January 2016; for more information, please visit www.iblce.org):
Development and Nutrition
Infant:
- Feeding behaviours at different ages
- Food intolerances/allergies
- Anatomy and anatomical/oral challenges
- Introducing complementary foods
- Low birth weight
- Milk banking – formal and informal
- Normal infant behaviours
- Nutritional requirements - preterm
- Preterm development and growth
- Skin tone, muscle tone, reflexes
- Term development and growth
- WHO growth charts with gestational age adjustment
- Breast development and growth
- Breast surgery
- Composition of human milk
- Anatomical challenges
- Nutritional status
- Nipple structure and variations
Physiology and Endocrinology
- Diabetes
- Infertility Issues
- Maternal metabolic and hormonal disorders (e.g., thyroid, Polycystic Ovarian Syndrome)
- Maternal autoimmune disorders
- Multiples
- Newborn hypoglycemia
- Pregnancy and breastfeeding – tandem
- Relactation
- Stooling and voiding
Pathology
Infant:
- Allergies
- Ankyloglossia (tongue tie)
- Cleft lip and palate
- Congenital anomalies (e.g., gastrointestinal, cardiac)
- Gastroesophageal Reflux Disease (GERD), reflux
- Hyperbilirubinemia (jaundice)
- Acute disease (bacterial, viral, fungal, systemic)
- Neurological disabilities
- Small for Gestational Age (SGA), Large for Gestational Age (LGA)
- Breast abscess
- Milk ejection reflex ‘dysfunction’
- Acute disease (bacterial, viral, fungal, systemic)
- Chronic disease
- Physical and neurological disability
- Mastitis
- Milk supply, low or over
- Nipple and breast conditions
- Nipple pain and trauma
- Post-partum hemorrhage
- Pre-eclampsia / pregnancy induced hypertension
Pharmacology and Toxicology
- Alcohol and tobacco
- Contraception
- Drugs of abuse
- Galactogogues
- Gel dressings/nipple creams
- Medication (prescription, over-the-counter, diagnostic and therapeutic procedures)
- Medicinal herbs
Psychology, Sociology, and Anthropology
- Transition to parenthood
- Birth practices
- Employment – returning to work
- Identifying support networks
- Maternal mental health
- Safer sleep
- Weaning
- Cultural competency
Techniques
- Effective milk transfer (including medically-indicated supplementation)
- First hour
- Latching
- Managing supply
- Milk expression
- Positioning
- Refusal of breast, bottle
- Skin-to-skin (Kangaroo care)
- Test-weighing
Clinical Skills
Equipment and Technology:
- Feeding devices (e.g., tubes at breast, cups, syringes, spoons)
- Handling and storage of human milk
- Nipple devices (e.g., shields, everters)
- Pacifiers
- Pumps
- Scales
- Communication technology
- Websites
- Active listening / Empowerment / Emotional support
- Care plan development and sharing, which includes:
- History taking
- Determine goals
- Assessment
- Document
- Develop a plan
- Evaluate
- Work with other medical providers
- Documentation
- Educating families, professionals, peers, and students
- Extending the duration of breastfeeding
- Group support
- Breastfeeding in public
- Scope of Practice
- Code of Professional Conduct
- Principles of confidentiality
- WHO code – advocacy and policy
- Apply research in practice
- Appraise and interpret research results
- Use research to help develop policies and protocols
- Advocate for Baby-Friendly Hospital Initiative (BFHI)
- Advocate for compliance with World Health Organization International Code of Marketing of Breastmilk Substitutes (WHO Code)
- Advocate for nursing dyad in healthcare system
- Develop breastfeeding-related policies
What is an IBCLC qualified to do?
International Board Certified Lactation Consultants (IBCLCs) demonstrate specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).
The six Clinical Competencies encompass the responsibilities/activities that are part of the IBCLC’s practice. The aim of these Clinical Competencies is to inform the public of the field in which IBCLCs can provide safe, competent and evidence-based care. The Clinical Competencies are applicable in any country or setting where IBCLCs practice. It is understood that the IBCLC will practice within the boundaries of her/his training, expertise, culture and setting.
Clinical Competencies for the Practice of International Board Certified Lactation Consultants (IBCLCs)
(Updated September 15, 2012; for more information, please visit www.iblce.org)
1. The IBCLC has the duty to uphold the standards of the profession and will:
- conduct her/himself in a professional manner, practicing within the framework defined by the IBLCE Code of Professional Conduct for IBCLCs, the IBLCE Scope of Practice for the IBCLC, and the IBLCE Clinical Competencies for the Practice of IBCLCs
- critique, evaluate and incorporate evidence-informed findings into practice within the laws of the setting in which s/he works
- obtain continuing education to enhance skills and maintain IBCLC certification
2. The IBCLC has the duty to protect, promote and support breastfeeding and will:
- provide evidence-informed education through various means including development of client information fact sheets, counseling, curriculum development, and multimedia campaigns to women, families, health professionals and the community about breastfeeding and human lactation
- participate in the development of policies at global, national, and local levels which protect, promote and support breastfeeding or breastmilk intake in all situations, including emergencies
- advocate for breastfeeding women, children and families in all settings and promote breastfeeding as the child-feeding norm globally
- support practices which promote breastfeeding and discourage practices which interfere with breastfeeding and will:
- promote the principles of the Baby Friendly Hospital Initiative
- carefully choose a method of feeding when supplementation is unavoidable and use strategies to maintain breastfeeding to meet the mother’s goal
- promote the principles of the World Health Organization Global Strategy for Infant and Young Child Feeding
3. The IBCLC has the duty to provide competent services for mothers and families and will perform a comprehensive maternal, child and feeding assessment related to lactation, such as:
History Taking and Assessment Skills
- obtain the mother’s permission to provide care to her and her child
- ascertain the mother’s goals for breastfeeding
- utilize appropriate counseling skills and techniques
- respect a mother’s race, creed, religion, sexual orientation, age, and national origin
- obtain a lactation history
- identify events that occurred antenatally, during the pregnancy, labor and birth process that may adversely affect breastfeeding
- assess the breasts to determine if changes are consistent with adequate function/lactation
- assess maternal physical, mental and psychological states
- assess social supports and possible challenges
Skills to Assist Breastfeeding Dyad
- promote continuous skin-to-skin contact of the newborn and mother
- provide education to assist the mother and family to identify newborn feeding cues and behavioral states
- assess oral anatomy and normal neurological responses and reflexes
- assist the mother and child to find comfortable positions for breastfeeding
- identify correct latch/attachment
- assess effective milk transfer
- assess for adequate milk intake of the child
- assess for normal infant behavior and developmental milestones
- provide suggestions as to when and how to stimulate a sleepy baby to feed
- provide evidence-based information to assist the mother to make informed decisions regarding breastfeeding
- provide education for the mother and her family regarding the use of pacifiers including the possible risks to lactation
- provide appropriate education for the mother and her family regarding the importance of exclusive breastfeeding to the health of the mother and child and the risk of using breastmilk substitutes (formula)
- provide information and demonstrate to the mother how to perform manual expression of breastmilk
- provide information and strategies to prevent and resolve painful, damaged nipples
- provide information and strategies to prevent and resolve engorgement, blocked ducts and mastitis
- provide information and strategies to minimize the risk of Sudden Infant Death Syndrome (SIDS)
- provide information regarding family planning methods including Lactation Amenorrhea Method (LAM) and their impact on lactation
- assist and support the mother and family to identify strategies to cope with peripartum mood disorders (prenatal depression, “baby blues”, postpartum depression, anxiety and psychosis) and access community resources
- provide information regarding introduction to appropriate family foods
- provide information regarding weaning from the breast when appropriate, including care of mother’s breasts and preparation and use of breastmilk substitutes according to World Health Organization Guidelines for Safe Preparation, Storage and Handling of Powdered Infant Formula
- calculate an infant’s caloric/Kilojoule and volume requirements
- assess the mother’s milk supply and provide information regarding increasing or decreasing milk volume as needed
- assess the breastfeeding child’s growth using World Health Organization adapted growth charts
- provide education to the mother related to normal child behaviors; signs of readiness to feed, and expected feeding patterns
General Problem-Solving Skills
- evaluate potential or existing challenges and factors that may impact on a mother to meet her breastfeeding goals
- assist and support the mother to develop, implement and evaluate an appropriate, acceptable and achievable breastfeeding plan utilizing all resources available
- facilitate breastfeeding for the medically fragile and physically compromised child
- evaluate how each breastfeeding dyad and situation is unique, and their affect on breastfeeding
- provide anticipatory guidance to reduce potential risks to the breastfeeding mother or her child
- assess and provide strategies to initiate and continue breastfeeding when challenging situations exist/occur
Use of Techniques and Devices
- critique and evaluate indications, contraindications and use of techniques, appliances and devices which support breastfeeding or may be harmful to continued breastfeeding including alternative feeding methods
- evaluate, critique and demonstrate the use of techniques and devices which support breastfeeding, understand that some devices may be marketed without evidence to support their usefulness and may be harmful to the continuation of breastfeeding
- evaluate and critique how techniques and devices may be used to ensure initiation and/or continuation of breastfeeding in certain circumstances
- provide evidence-informed information to the mother regarding the use of techniques and devices
Develop, Implement and Evaluate an Individualized Feeding Plan in Consultation with the Mother
- use adult education principles
- select appropriate teaching aids
- provide information on community resources for breastfeeding assistance
- provide evidence-informed information regarding a lactating mother’s use of medications (over-the-counter and prescription), alcohol, tobacco and street drugs, including their potential impact on milk production and child safety
- provide evidence-informed information regarding complementary therapies during lactation and their impact on a mother’s milk production and the effect on her child
- integrate cultural, psychosocial and nutritional aspects related to breastfeeding
- provide support and encouragement to enable mothers to successfully meet their breastfeeding goals
- use effective counseling and communication skills when interacting with clients and other health care providers
- use the principles of family-centered care while maintaining a collaborative, supportive relationship with clients
- support the mother to make evidence-informed decisions for her child and herself
- provide education and information at a level which the mother can easily understand
- evaluate the mother’s understanding of all information and education provided
4. The IBCLC has the duty to report truthfully and fully to the mother and/or child’s primary health care provider and to the health care system and will:
- obtain the mother’s consent for obtaining and disclosing of information as needed or as specified by local jurisdiction
- provide written assessments as required
- maintain documentation of all client contacts, assessments, feeding plans, recommendations and evaluations of care
- retain records for the time specified by the local jurisdiction
5. The IBCLC has the duty to preserve client confidence and will:
- respect the privacy, dignity and confidentiality of mothers and families except where the reporting of a danger to a mother or child is specifically required by law
6. The IBCLC has the duty to act with reasonable diligence and will:
- assist families with decisions regarding feeding their children by providing evidence-informed information that is free of any conflicts of interest
- provide follow-up services as required and requested
- make appropriate referrals to other health care providers and community support resources in a timely manner depending on the urgency of the situation
- work collaboratively with the health care team to provide coordinated services to families