Breastfeeding Counselor versus Lactation Consultant

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.

Learning Outcomes