BFC, IBCLC, LC, CBC, CLC… Confused about the differences?

Certified Lactation Specialist Designations

One of the most common questions we’re asked is the difference between a Lactation Counselor and a Lactation Consultant. First, a bit of an explanation of the different designations commonly used.

CBC=Certified Breastfeeding Counselor
BFC=Breastfeeding Counselor
CLC=Certified Lactation Counselor or Certified Lactation Consultant
LC=Lactation Counselor or Lactation Consultant
CLE=Certified Lactation Educator
IBCLC=International Board Certified Lactation Consultant

Other lactation specialists may be called a Breast/Chestfeeding Peer Supporter or a Lactation Specialist.

Essentially, all lactation specialists are supporting families with breast/chestfeeding, but their experience and knowledge might be quite different. A Lactation Educator, for example, may have completed training that primarily focuses on how to teach a class about lactation and has little knowledge about complex lactation challenges. A Lactation Counselor may have completed a training program that provides them with the skills and knowledge to support families with common lactation problems, or they might have many years of experience and training that enables them to support more complex problems.

If you’d like to learn more about becoming a lactation specialist and explore all the different options and the steps required, check out our Becoming a Lactation Professional mini-course, available on a pay-what-you-can basis.

Why doesn’t everyone just use the same designation?

It would make it a lot easier to understand!

People can only use the IBCLC designation if they have met the requirements laid out by the International Board of Lactation Certification Examiners (IBLCE). The IBCLC designation isn’t a training program but a recognition of a person’s lactation education and experience.

The designation CLC has been trademarked by a lactation training organization, preventing any other organization from using it. We use Certified Lactation Counselor (LC) so we don’t violate that trademark in the United States.

What’s Included in Lactation Training?

It’s hard to generalize because there is no regulation of lactation training programs and each organization decides for themselves what to include. A program that is going to provide you with a good level of knowledge would include:

  • the physiology of lactation
  • anatomy relevant to lactation (both in the parent and the child)
  • establishing lactation
  • common and complex challenges with lactation
  • feeding a preterm infant
  • drugs and toxins in human milk
  • expressing human milk
  • breast/chest surgery and lactation
  • lactation counselor skills
  • equipment and supplies for feeding
  • ethics and professionalism related to lactation
  • global initiatives to encourage and support breast/chestfeeding

Ideally, the training program would also provide you with the opportunity to gain some experience in working with clients.

The content of a lactation course differs from one training organization to the next. Some courses will provide 90 hours or more, while others will provide 45 hours or less. The designation used by the training organization does not tell you how many hours of education are provided so it’s important to clarify that before you start. This is especially relevant if you plan to go on in the future to become an IBCLC which requires a minimum of 90 hours of lactation-specific education. If you want to compare different organizations, we’ve made a handy chart for you to look at each organization side by side.

Becoming an IBCLC

Once you have completed your lactation education, you might want to take a further step to become an IBCLC (International Board Certified Lactation Consultant). The IBCLC designation, awarded by the International Board of Lactation Certification Examiners (IBLCE), is not a training program but a recognition of the education and experience of a lactation professional who meets the IBLCE requirements. To be awarded the IBCLC designation, an individual must complete the following:

  • 90 hours of lactation-specific education (e.g., CBI’s Lactation Counselor course if doing pathway 1 or pathway 3) within the five years before completing the exam
  • 300-1000 hours clinical hours supporting lactation (hours differ depending on the pathway chosen)
  • Completing one academic semester in eight health science courses at an accredited higher education institution (unless a nurse, midwife, doctor etc.)
  • Completing six continuing education health science courses (medical terminology, basic life support, medical documentation, occupational safety, professional ethics, universal precautions and infection control)
  • Completing at least five hours in communication skills
  • Successful completion of the IBCLC exam (closed book) with 175 multiple-choice questions

Lactation-Specific Education

The lactation education taken must be through a training organization, be specific to lactation, and be at least 90 hours in length. The IBLCE doesn’t recommend or review training programs. A common approach to achieving the IBCLC designation is for a person to begin by completing a Lactation Counselor course and gaining experience as a Lactation Counselor while working on completing the health science courses.

Clinical Hours

Before you can sit for the IBCLC exam, you must have completed clinical hours in providing lactation support. The number of hours you complete depends on the pathway you choose. There are three pathways – the requirements for each are the same except for the clinical hours.

You can download a chart outlining the different IBCLC pathways here.

Health Science Courses

The health science courses are often the most challenging part of completing the IBCLC requirements. The IBLCE do not recommend or review any specific health science programs. They provide a basic description of what each of the health science courses might include. Health professionals do not need to complete the health science courses as these topics would already have been covered in their health professional education.

Some people meet the health science requirement through face-to-face programs that are run in colleges, while others complete they through online learning by organizations recognized as higher education learning providers. It can be a good idea to reach out to others who have already completed their IBCLC requirements to find out what programs they chose. We provide a Facebook group that is open to anyone where you can discuss the requirements for becoming a Lactation Consultant: Becoming a Lactation Consultant

IBCLC Exam

The IBLCE runs the exam, typically twice a year, in specific locations. The IBLCE does not provide the required education or experience – these must be completed elsewhere before sitting the IBCLC exam. The IBCLC exam assesses knowledge of complex lactation problems, so extensive education on lactation and experience in working with breast/chestfeeding families is necessary to pass the exam.

Roles, Responsibilities, and Limitations

A Lactation Counselor and an IBCLC can:

  • support a parent with establishing lactation or lactation challenges
  • run lactation classes and support groups
  • provide education on lactation
  • work in hospitals, clinics, or private practice
  • evaluate the parent-baby dyad to help a client understand whether the baby is effectively transferring milk
  • explore the options available to a client if they are experiencing feeding problems
  • explain the symptoms of a range of problems
  • together with the client, develop a feeding plan
  • provide a client with referrals for medical diagnosis or treatment

A Lactation Counselor might refer a client to an IBCLC if the challenges their client is addressing are beyond their knowledge or experience. Because of the more extensive experience an IBCLC might have, they may be able to understand, explain, and support a client in resolving a wider range of problems than a Lactation Counselor. Some Lactation Counselors though may have extensive experience and be competent in helping a client to resolve complex problems.

Both a Lactation Consultant and an IBCLC might refer a client to a medical care provider (e.g., pediatrician, dietician, pediatric dentist, family doctor) if the problem a client is facing requires diagnosis or medical treatment.

Neither a Lactation Counselor nor an IBCLC can:

  • give medical advice
  • give a medical diagnosis
  • prescribe medication
  • carry out treatment

Can I prepare treatment or care plans if I am supporting clients as a lactation professional?

Preparing a treatment or care plan is a nursing or medical task. If you have a separate qualification as a nurse, midwife, or doctor, the preparation of a treatment plan would fall under that scope of practice. You can work with a client to explore their options and support the client in making choices or developing a feeding plan. This is not the same as a treatment or care plan where an individual is providing or recommending treatment. This can be confusing. It’s really about what information you’re providing, and how you’re providing it. For example, both a Lactation Counselor and an IBCLC, could say:

You mentioned that you have some nipple pain. I noticed that the baby has some white patches in its mouth and a little diaper rash. In some cases, these can be symptoms of thrush. You could go and see the doctor and ask them to take a look. If they diagnose thrush, they can explain the treatment options. You might want to ask them about medication for thrush, and also dietary changes that can be helpful in eliminating thrush. I can give you a list of doctors that are supportive and knowledgeable about this if you like?

It would be inappropriate for a lactation professional who is not also a healthcare provider to say:

The nipple pain and white patches in your baby’s mouth are thrush [diagnosis]. How about we use some gentian violet and make dietary changes where you eliminate sugar from your diet for a while [treatment plan and recommendations].

Do you have to be an IBCLC if working in a hospital?

That would depend on the requirements stipulated by the hospital themselves. There’s no legal reason why a hospital might not employ a Lactation Counselor who hasn’t completed the IBCLC requirements. It’s common for a Lactation Counselor to be working within the hospital setting while they build their clinical experience hours, particularly for Pathway 1 as an IBCLC. Both a Lactation Counselor and an IBCLC could be part of the team within the hospital supporting breast/chestfeeding parents as allied health professionals. But neither of them would be medical caregivers (unless they are medically trained in another role such as a nurse or midwife).

Does a Lactation Counselor or Consultant have to follow ethics standards?

That depends on the organization they trained or are accredited by. CBI has its own standards that require a Lactation Counselor trained with us to behave ethically. The IBLCE has a code of ethics that they require all IBCLC’s to adhere to. Lactation Counselors and IBCLCs do not have to adhere to medical ethics boards since they are not medical caregivers. If they were employed by a hospital they might have ethical standards required of them by their employer.

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