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

One of the most common questions we are asked about CBI’s Breastfeeding Counselor course is the difference between a Breastfeeding Counselor and a Lactation Consultant. First a bit of an explanation on the different acronyms.

CBC=Certified Breastfeeding Counselor
BFC=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 breastfeeding specialists may be called a Breastfeeding Peer Supporter or a Lactation Specialist.

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.

Certification is a set of requirements used to determine when an individual has achieved a certain level of knowledge and skills. CBI offers both education in the knowledge and skills we believe are important in the role of a Breastfeeding Counselor and certification once all the requirements have been met.

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 Breastfeeding Certification program meets these requirements and can be used for the lactation education component determined by the IBLCE. The IBLCE does not recommend or review training programs.

A breastfeeding counselor is an individual who has taken a training program specializing in supporting breastfeeding parents. The course length varies from one program to the next. The CBI Breastfeeding Counselor course provides 130 hours of education and this can be used for the education requirement for IBCLC. Basically, a CBI breastfeeding counselor has the same number of hours of lactation specific education as an IBCLC. The education covers communication skills, counseling skills and knowledge of physiology in relation to lactation. In order to certify with CBI, you will:

• Support breastfeeding clients for a total of 30 hours
• Carry out a survey of local lactation services
• Complete a reflective assignment
• Respond to breastfeeding case studies
• Read three books
• Successfully complete an open book exam (119 multiple choice questions)

The content of a breastfeeding 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 breastfeeding counselor and a lactation consultant relate to their experience and the amount of health science education they have completed. In order to apply to become an IBCLC, an individual must have:

• 90 hours of lactation specific education (e.g., CBI’s Breastfeeding Counselor course if doing pathway 1 or pathway 3) within the five years prior to completing the exam
• 300-1000 hours of supporting lactation problems (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, infection control)
• Successful completion of the exam (closed book) with 175 multiple choice questions

Scope of Practice

Both a CBI Certified Breastfeeding Counselor and an IBCLC can:

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

Neither a Breastfeeding Counselor or 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 have supported breastfeeding clients for.

Other lactation specialists may be educated in supporting uncomplicated breastfeeding relationships, such as offering education on healthy practices that support breastfeeding.

Can I prepare treatment or care plans if I am a CBI Breastfeeding 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, 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 treatment. This can be confusing. It is really about what information you are providing, and how you are providing it. For example, it would be within the scope of both a Breastfeeding Counselor or an IBCLC, to say:

You mentioned that you have some nipple pain. Also, 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 breastfeeding if you like?

It would be inappropriate for either a Breastfeeding Counselor or an IBCLC to say:

The nipple pain and white patches in your baby’s mouth seem to be thrush. This could be treated with gentian violet and dietary changes where you eliminate sugar from your diet for a while.

Is a Breastfeeding 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 Breastfeeding Counselor who has not completed the IBCLC requirements. Both a Breastfeeding Counselor and an IBCLC could be part of the team within the hospital supporting breastfeeding parents. But neither of them would be medical professionals (unless they are medically trained in another role such as a nurse).

Does a Breastfeeding 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 Breastfeeding Counselor trained with us to behave ethically. The IBLCE have a code of ethics they require all IBCLC’s to adhere to. Breastfeeding Counselors and IBCLCs do not have to adhere to medical ethics boards since they are not medical professionals. If they were employed by a hospital they may have ethical standards required of them by their employer.

At the end of this module, you will be able to:

• Explain the six trauma-informed principles
• Compare and contrast trauma-informed with care that is not trauma-informed
• Analyze the social culture in the workplace and how safety is, or is not, protected
• reflect on personal strategies for enhancing a supportive environment in the workplace
• Analyze the client experience within the workplace
• Describe the elements of trauma-informed care
• Evaluate the workplace and determine whether or not it is providing trauma-informed care
• Explain burnout in relation to birth and health professionals
• List the stressors that can cause professional burnout
• List the symptoms of professional burnout
• Describe the nine organizational strategies that can reduce burnout rates
• Reflect on personal risk factors for burnout
• Define resilience
• Explain the five factors that affect resilience
• List the benefits of empathetic care
• Compare and contrast affective and cognitive empathy
• List eight components of empathetic care
• Reflect on own skills in providing empathetic care
• Identify strategies for improving personal skill in providing empathetic care
• Describe a NICU that provides family-integrated support
• Identify the behaviors of a trauma-informed doula

At the end of this module, you will be able to:

• List six different strategies for healing after trauma
• Reflect on personal approach to offering peer support
• Explain what narrative therapy is
• List eight coping strategies for managing internal and external triggers
• Explain how hormones affect the nervous system
• Implement strategies for increasing beneficial hormones in times of stress
• Describe how EMDR therapy can reduce disturbing thoughts in the individual with trauma
• Explain the premise behind Cognitive Behavioral therapy
• Discuss the relevance and importance of culture in therapies used to address trauma
• Identify three strategies for improving sleep
• Explain the elements of trauma-informed care in yoga
• Explain the role of prayer and meditation in healing
• Develop client resources for community-based therapeutic practitioners

At the end of this module, you will be able to:

• Identify nutritional factors that promote healing in the trauma-injured brain
• Compare and contrast different types of fats
• Discuss the effect of omega fats on the brain and factors that impact omega fat levels in food
• Identify five strategies for improving carbohydrate intake
• List ten foods that are high in protein and suitable for a vegetarian diet
• Explain how vitamin and mineral deficiencies impact healing in the trauma-injured brain
• Explain the microbiome
• Identify the factors that damage the microbiome
• Identify the factors that feed the microbiome
• List eight strategies for improving the microbiome
• Reflect on dietary changes that would improve an individual’s nutritional status
• Compare and contrast a food desert and a food swamp
• Develop resources that would improve food access and availability for at-risk clients

At the end of this module, you will be able to:

• Define obstetric violence
• Explain the seven categories of institutional disrespect
• Examine and discuss behaviors that constitute obstetric violence
• Reflect on modifications to the work environment that could humanize birth
• Analyze work environments to determine whether they are culturally safe
• Build resources that provide culturally safe care
• Describe the elements of informed consent
• Provide client resources that outline informed consent
• Reflect on the normalization of negative hospital experiences
• Discuss the issues that impact obstetric violence
• Evaluate the workplace strategies and support for care provider trauma
• Identify the factors that prevent obstetric violence from being eliminated
• Reflect on personal biases
• Document reporting procedures for complaints related to obstetric violence

At the end of this module, you will be able to:

• Evaluate the risk factors for developing trauma
• Reflect on the cultural differences that affect how individuals perceive mental health problems
• Predict how adverse childhood experiences impact physical and mental health in adulthood
• Explain the relationship between fear of pain and experience of pain
• Recognize the different types of abuse an individual might experience
• Build resources for hospital services available for clients at risk of PTSD
• Recognize the birthing practices that can trigger memories of previous rape
• Build resources for clients who have experienced sexual assault
• Discuss the impact of nutritional deficits related to the risk of PTSD
• Evaluate the modifications to a diet that would lessen the risk of PTSD

By the end of this module, you will be able to:

• Modify language to provide empathetic support to an individual experiencing a challenging event
• Provide support that builds trust with a client
• Build resources for community support for those caring for individuals with PTSD
• Build resources that provide information on family-centered services for those experiencing domestic violence
• Implement modifications to own practice that addresses birth trauma
• Build resources for prenatal support of at-risk clients
• Build resources for community support of clients at risk of suicide

By the end of this module you will be able to:

• Recognize the symptoms of PPTSD
• Differentiate between external and internal triggers
• Reflect on personal triggers and evaluate potential triggers from a client’s perspective
• Consider strategies that can lessen the potential for a client to encounter a trigger
• Reflect on the practices that increase the risk of partner trauma
• Reflect on own feelings that might arise if a client felt violated during birth
• Identify the elements of empathetic responses to a client divulging trauma
• Explore the different ways that secondary wounding can occur
• Develop strategies for avoiding secondary wounding through language
• Evaluate screening tools used for PTSD