BFC, IBCLC, LC, CBC, CLC… Confused about the differences?
One of the most common questions we are asked about CBI’s Lactation Counselor course is the difference between a Lactation Counselor and a Lactation Consultant. First a bit of an explanation on the different acronyms.
CBC=Certified Breastfeeding Counselor
CLC=Certified Lactation Counselor (or consultant depending on the organization)
LC=Lactation Counselor (or consultant)
CLE=Certified Lactation Educator
IBCLC=International Board Certified Lactation Consultant
Other lactation specialists may be called a Breastfeeding Peer Supporter or a Lactation Specialist.
Training and Certification
Part of the confusion comes from the differences between training and certification.
Training is the learning that you do in a course. The organization offering the training decides on the length of the course and the topics to be covered. Because there is no recognized standard for lactation specialist training, each course is very different. Training may also be “on the job” training like an apprenticeship. Some courses offer certification in addition to training, while others offer only training. Some education programs will be more of an introduction, while others will be very comprehensive. One guideline is to look at the number of hours of education that are provided, together with the course syllabus. Be aware though that a syllabus does not necessarily tell you how in-depth the topic is addressed.
Certification is a set of requirements used to determine when an individual has achieved a certain level of knowledge and skills. The organization providing the certification may or may not be accredited with other bodies. Certification typically requires a set number of education hours, assessment through exams, and hands-on skills developed through experience.
Becoming an IBCLC
An International Board Certified Lactation Consultant (IBCLC) is a recognition of education and experience. The IBCLC designation is awarded by the International Board of Lactation Consultant Examiners (IBLCE). The IBLCE does not provide training of any kind. They review the experience and education of an individual to determine whether it meets their standards and run an exam to assess knowledge. The education or training taken must be through another organization, be specific to lactation, and at least 90 hours in length. Childbirth International’s Lactation Counselor training and certification program meets these requirements and can be used for the lactation education component determined by the IBLCE (in Pathway 1 and Pathway 3). The IBLCE does not recommend or review training programs.
To qualify as an IBCLC, you are also required to have completed 8 health science courses of one semester in length from an accredited institute of higher learning, and 6 health science courses from an accredited institute of higher learning or a continuing education program. CBI offers the Safety and Infection Control and Prevention course to meet one of these requirements. Any person applying for the IBCLC exam after November 2020 is also required to complete at least five hours in Communication Skills. The CBI Effective Communication module meets this requirement.
Finally, an IBCLC will have completed at least 300 hours of clinical experience, depending on which pathway they chose. Pathway 1 requires 1,000 hours of clinical experience that must be supervised by someone who has knowledge of lactation (not necessarily an IBCLC). Pathway 2 requires 300 hours of clinical experience that is directly supervised by an IBCLC and is part of the lactation education program that is being offered. The education program must be recognized as an institute of higher learning (typically a college or university). Pathway 3 requires 500 hours of directly supervised clinical experience from an IBCLC mentor and must be pre-approved by the IBLCE.
Becoming a Lactation Counselor
A lactation counselor or a lactation specialist is an individual who has taken a training program specializing in providing lactation support to parents. They may or may not be certified. The course length varies from one program to the next. The CBI Lactation Counselor course provides 130 hours of lactation-specific education and this can be used for the lactation education requirement for IBCLC. The education covers communication skills, counseling skills, and knowledge of physiology in relation to lactation. In order to certify with CBI, you will:
- Provide lactation support to clients for a total of 30 hours. This can be used as part of the IBCLC clinical experience if it is documented and supervised by a person who is knowledgeable about lactation (pathway 1) or if it is supervised by an IBCLC mentor (pathway 3). Students are responsible for arranging this supervision themselves.
- Carry out a survey of local lactation services
- Complete two reflective communication assignments
- Respond to lactation case studies
- Read or watch three readings or videos and critique them
- Successfully complete an open book exam (119 multiple choice questions)
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.
Generally, the fundamental differences between a lactation counselor and a lactation consultant relate to their experience and the amount of health science education they have completed. In summary, in order to apply to become an IBCLC, an individual must have:
- 90 hours of lactation specific education (e.g., CBI’s Lactation Counselor course if doing pathway 1 or pathway 3) within the five years prior to completing the exam
- 300-1000 hours clinical hours supporting lactation (hours differ depending on the pathway chosen)
- Completion of one academic semester in eight health science courses at an accredited higher education institution (unless a nurse, midwife, doctor etc.)
- Completion of six continuing education health science courses (medical terminology, basic life support, medical documentation, occupational safety, professional ethics, universal precautions and infection control)
- Completion of at least five hours in communication skills
- Successful completion of the exam (closed book) with 175 multiple choice questions
Roles, Responsibilities, and Limitations
Both a CBI Certified 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 for a range of problems (because of the more extensive experience an IBCLC may have, they may be able to understand and explain a wider range of problems than a lactation counselor)
- together with the client, develop a feeding plan
- provide a client with referrals for medical diagnosis or treatment
Neither a Lactation Counselor nor a Lactation Consultant can:
- give medical advice
- give a medical diagnosis
- prescribe medication
- carry out treatment
The fundamental differences between the two roles are the completion of health science courses and the number of hours that each has supported clients with lactation.
Other lactation specialists may be educated in supporting uncomplicated feeding relationships, such as offering education on healthy practices that support lactation.
Can I prepare treatment or care plans if I am a CBI Lactation Counselor or an IBCLC?
Preparing a treatment or care plan is a nursing 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 is really about what information you are providing, and how you are 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 either a Lactation Counselor or an IBCLC 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].
Is a Lactation Counselor or an IBCLC part of the medical team in a hospital?
That would depend on the requirements stipulated by the hospital themselves. There is no legal reason why a hospital might not employ a Lactation Counselor who has not completed the IBCLC requirements. It is 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/chest feeding 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).
Does a Lactation Counselor or an IBCLC 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 may have ethical standards required of them by their employer.