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 of the different designations commonly used.
CBC=Certified 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 Breastfeeding Peer Supporter or a Lactation Specialist.
Essentially, all lactation specialists are supporting families with breast/chestfeeding, but their experience and knowledge may 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 may have many years of experience and training that enables them to support more complex problems.
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 open book exams (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.
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
The lactation education taken must be through a training organization, be specific to lactation, and be at least 90 hours in length. Childbirth International’s Lactation Counselor training and certification program meets the requirements for lactation-specific education and can be used for two of the IBCLC pathways. Childbirth International also can provide five hours of communication skills education and a safety and infection control course, which meets the requirements for one of the health science courses. The IBLCE does not 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.
You can download a chart outlining the different IBCLC pathways here.
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.
Certified Lactation Counselors and the CLC Designation
A common question we’re asked is why CBI Certified Lactation Counselors use the designation LC and not CLC. CLC has been trademarked by another organization providing lactation education, preventing us from using this as designation. We use Certified Lactation Counselor (LC) so that we don’t violate their trademark in the United States. It’s important to carefully review the number of hours each training organization provides and the skills being taught before you make a decision about which organization to train with. It can be really confusing to make comparisons of each organization and decide which is the right one for you to train with. This is especially important if you plan to go on to become an IBCLC which requires a minimum of 90 hours of lactation-specific education to qualify for sitting the IBCLC exam. To help you, we’ve made a comparison of each organization so you can see how they compare side by side.
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 (because of the more extensive experience an IBCLC may have, they may be able to understand, explain, and support a client in resolving 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
A Lactation Counselor may refer a client to an IBCLC if the challenges their client is addressing are beyond their knowledge or experience. Both a Lactation Consultant and an IBCLC may 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 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 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 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/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).
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 may have ethical standards required of them by their employer.