When seeking help with breastfeeding, it's important to understand the meanings and qualifications associated with all of the initials and titles that various professionals and lay counselors use. There is no central authority or law regarding the use of titles or claims for breastfeeding helpers, so understanding common designations will allow nursing mothers to contact and select a qualified breastfeeding helper most closely aligned with their individual needs and philosophies. It will also ensure that mothers understand the approaches and potential limitations of that helper.
Lactation Educators (CLE, CLEC, CLC, LC, CBC)
Lactation Educators are generally qualified to educate on and assist mothers with the normal course of breastfeeding and commonly experienced challenges and problems. In some settings, such as hospitals, they may hold additional titles (such as RNs) and be empowered by their employers to provide additional support. Most programs that certify or certificate Lactation Educators provide approximately 40 hours of formal instruction (and sometimes additional assignments, homework or other requirements) on topics such as the experience, science and physical process of breastfeeding (some training programs do require less). Most programs also require clinical hours for those not already working in post-partum settings.
Educators may offer breastfeeding education or group support, but do not always offer individual client counseling. They may offer individual support for clients who need assistance with the “normal course of breastfeeding.” This means general assistance with position and latch and common concerns such as nipple pain, plugged ducts, or other support. If more complex intervention is needed, educators would refer to an IBCLC. Those seeking assistance with less common situations including but not limited to nursing multiples, induced lactation or breast reduction should probably consult an IBCLC. Most Lactation Educators in clinical settings work in cooperation with and/or under the supervision of IBCLCs (see below) or other appropriate health professionals.
Titles can vary widely for Lactation Educators, depending on the certification or certificate granted by the organization offering the training. Some common titles include CLE (certified or certificated lactation educator), CLC (certified or certificated lactation counselor – different from IBCLC below), LE (lactation educator), or CLEC (certified or certificated lactation educator/counselor). Others may also be in existence.
Lactation Specialists (LS)
Lactation Specialist (LS) is a designation that generally requires only 16-20 classroom hours of education, with no clinical training specifically to receive the certification, associated with training for nurses, doctors or other staff in hospitals qualified by the World Health Organization's Baby Friendly Hospital Initiative. The quality support offered by a Lactation Specialist can vary widely. Some may be incredibly knowledgeable nurses and doctors, but some may have little interest in breastfeeding and have sat through the course simply because the hospital required it. If receiving help in the hospital from a lactation specialist, be alert to where in this spectrum your helper seems to fall.
International Board Certified Lactation Consulant (IBCLC)
An IBCLC is the gold standard practitioner of lactation support. These professionals are certified by the International Board of Lactation Consultant Examiners (IBLCE). Training involves a minimum 45 hours of formal instruction on all aspects of the breastfeeding process, significant supervised clinical experience, and a successful trial of the difficult IBLCE Exam. All consultants must complete continuing education for recertification each 5 year period and retake the exam every 10 years. In addition to anything a peer counselor or educator is qualified to do an IBCLC is qualified to assist with all manner of breastfeeding problems and challenges from the simple to the incredibly unusual or complex.
IBCLCs are often in private practice or work on staff in hospitals to support new mothers (sometimes along with or supervising educators or peer counselors). They may work directly with pediatricians to solve normal or challenging newborn feeding difficulties. They may work in neonatal intensive care units to try and support breastfeeding and the supply of breast milk to compromised or otherwise challenged babies. They are not doctors, and can not prescribe medicine, but have a wide range of roles and responsibilities in clinical settings. As some states consider requiring insurance companies to cover lactation services, this will no doubt involve the use of IBCLCs.
It is a good idea to involve or consult an IBCLC in any complex or abnormal breastfeeding situation, especially if the baby is challenged or not feeding properly in the early days or weeks. That said, many women find all the support they need from peer counselors , specialists or educators. My first personal experience with lactation support was with incredibly wonderful and experienced lactation educators who expertly helped my struggling baby and made it possible for me to breastfeed.
The most important thing if breastfeeding is a challenge is to seek help!. Most breastfeeding problems or challenges can be resolved by the appropriately qualified helper or professional.