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.

Mother-to-Mother Peer Counselors

There may be many local versions of programs which involve mother-to-mother breastfeeding support, not the least of which is an experienced breastfeeder assisting another mother. Of course, the scope of available assistance in this case is limited by the personal experiences of the helpers. There are, however, at least two programs nationally or internationally that train peer counselors – USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and La Leche League International (LLLI or LLL).

WIC Peer Counselors are local WIC mothers who have successfully breastfed. They complete a 20-hour training course and are qualified to assist with the experience and basic challenges of a normal course of breastfeeding. Challenges or problems outside of the norm must be referred to an IBCLC (see below) or other appropriate health professional. Peer counselors may work at WIC sites, at hospitals or other appropriate locations, and sometimes make home visits. WIC peer counselors may be paid by WIC or may be volunteers. WIC peer counselors are available at no cost to WIC mothers.

LLL leaders are accredited by an internal process of the organization. There is no formal classroom instruction, but there is a quite impressive leader-to-leader training program which averages about a year in length and involves education on a wide range of breastfeeding and counseling issues. Some claim that LLL leaders are as experienced (and sometimes more experienced) than some IBCLCs. However, they are empowered only to provide information and education, often coupled with recommendations and ideas, but they *do not* provide medical advice and are not medical professionals. They are well-educated in area resources if further referrals are needed. LLL leaders hold regular meetings in their local areas and also provide phone and mother-to-mother support as needed and appropriate. Meetings and most leader services are free to mothers, although LLL membership is encouraged.

Lactation Educators

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). Educators may offer breastfeeding education or group support, but do not usually offer individual client counseling. 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 Specialist (LS) is a designation that generally requires less classroom hours and is associated with training for nurses, doctors or other staff in hospitals qualified by the World Health Organization's Baby Friendly Hospital Initiative.


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 or educators. My first experience with lactation support was with incredibly wonderful and experienced 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.