What is an IBCLC, and why might you want to hire one?
In many parts of the world an IBCLC, or International Board Certified Lactation Consultant, is a fairly standard part of perinatal care. Certainly in places like the US where health care is private you would likely have access to an IBCLC covered by your insurance plan. However, here in the UK its highly unlikely that your local NHS trust employs even one IBCLC. Its even less likely that the majority of parents would recognize when they may need this extra support, nevermind know where to find someone able to give it! Even if you know what an IBCLC is, and where to find one, you are quite likely to come across opinions such as “you don’t need to pay for breastfeeding support.” Or “If they were that good they’d be available on the NHS.” (Like osteopaths… oh… wait… hmm.) According to a quick poll over on Breastfeeding Twins and Triplets UK, around a 3rd of those who responded didn’t know the difference between an IBCLC and other breastfeeding support.
So lets begin by explaining exactly what an IBCLC is. According to the International Lactation Consultant Association:
“An International Board Certified Lactation Consultant ® (IBCLC ®) is a healthcare professional who specializes in the clinical management of breastfeeding. An IBCLC is certified by the International Board of Lactation Consultant Examiners ® (IBLCE ®), independently accredited by the National Commission for Certifying Agencies (NCCA) of the Institute for Credentialing Excellence (ICE). An IBCLC works in a wide variety of settings, providing leadership, advocacy, professional development, and research in the lactation field.”
Thats a whole lot of words to basically say that an IBCLC is a breastfeeding specialist who works in different places, including hospital and community. So what actually makes us “specialists” anyway? Well, becoming an IBCLC is no walk in the park. It’s not something you do by attending a weekend course – its a huge commitment, and meeting the criteria to even sit the exam takes a minimum of 2 years – if you’re quick, have access to money (or, ahem, your husband’s credit card) and someone like the afformentioned husband is willing and able to keep small children out of your way while you study. This is going to take some explaining…
First up, you have to meet the prerequisites. Before you even think about applying to sit the IBLCE exam you need to either be a recognised health care professional, such as a nurse or Doctor, or (like me) you need to run around like a crazy person collecting 14 (yes, FOURTEEN) Health Science Courses at college level. These courses are:
Basic life support
Occupational safety for health professionals
Universal safety precautions and infection control.
IBLCE don’t offer a course to complete all of this. You have to go out and find your own courses, in your own time. Plus, IBLCE won’t even verify if a particular course meets their criteria, so you are often stabbing in the dark and hoping you’ve found a good one. Its stressful, expensive, and very time consuming.
The next thing you need is a minimum of 90 hours Lactation Education, from an approved provider. The face to face ones in the UK are few and far between, but they do exist. They usually meet for one day a month for an entire year. The online ones are self paced – I completed mine online in 3 months – using a lot of my annual leave from my then job. These training programs are very in depth. We have to cover how to support preterm babies, mothers without very much breast tissue or who have had surgery, babies who need special care… we have to know a thing or two about how drugs enter the milk supply, breast abscess, allergies, everything under the sun that might make a nipple sore (hint: there are a lot of things that might make a nipple sore), relactation or inducing lactation, pumping, feeding a baby who can’t latch, assess suck function, know roughly what a tongue tie looks like, be able to notice a high palate, how to support transgender or same sex families, know about and respect the feeding practices in different cultures… and then there are the counselling skills – from your everyday “how do you feel about that top up?” To “I’m so sorry about your loss – what was your baby’s name?” All of that is crammed into 90 hours of classroom or online education, and is backed up with reams of recommended reading. I read 4 text books to prepare for my exam. Each one was around 800 pages long, and each one covered nothing other than lactation. That is a LOT of information about breasts, babies, and milk.
Next up you need 1000 hours of experience supporting families. And someone willing to vouch for you. These hours need to be through a structured service – you don’t get to just randomly go to baby groups or your mates houses and call it an hour or 2. You have to volunteer or work through something like the NHS, a peer support charity, or one of the big 4 UK breastfeeding charities. IBLCE will give you 500 hours a year automatically if you do your hours with one of these recognised bodies – I’ll admit I think its a weak point in the certification, but at least in my case I am confident that I did genuinely have over 1000 hours of supporting time behind me when I applied for the exam.
Finally, you get to apply… possibly sit through an uncomfortable two weeks if your application is selected for audit, and then… well then you spend six months studying because £500 is a loy of money to throw away if you fail. IBLCE are very clear that we aren’t allowed to talk much about the exam – its like Fight Club for Breastfeeding. But I can tell you its 4 hours long and it reduced me to tears. Me, who scored very nearly 91%. It messes with your head and its made worse by the AGONISING nearly 3 month wait for the results.
And THEN, after we pass and set up our insurance and start seeing clients, we have to recertify with continuing education credits at 5 years and by sitting the exam again at 10 years. Even Nursing doesn’t require you to resit your exam every 10 years, but IBCLCs have to in order to maintain our credential.
So, thats what an IBCLC is – an incredibly qualified individual when it comes to breasts and milk. We have well and truly proven ourselves to be allowed to use the title IBCLC (and yes, I make sure all my post is addressed to Lucy Ruddle IBCLC after all that damned work!) To put this into perspective, the average GP has attended one seminar on breastfeeding. Your average Midwife is doing considerably better, but its unlikely they’ve had training (or are given the time) to support anything remotely out of the ordinary. Which is where in other countries the IBCLC would enter the scene. Here in the UK, that is rare. Instead you have to figure it out on your own and, if you have the money, you may decide to find and hire one yourself. IF you know we exist and how we’re different from other support.
A peer support group is Mothers who have had some training (generally several hours) to offer support, information, and a friendly ear regarding common worries. They can probably spot an iffy latch, and a skilled Peer supporter can help you tweak it. They can tell you where to get more info if your GP has said you can’t take a certain medication, and they can share their own experiences with you.
A Breastfeeding counsellor has had about 18 months – 2 years of training and their main bag is to counsel mothers. You don’t call one of the national helplines (which are all run by BFCs) and have a question answered in 2 minutes. They give you a safe space, hear your story, and then make suggestions. They know about self help for mastitis and thrush, how to express, they can help you with a baby that isn’t latching well, and they know where to signpost you for more support.
And THEN we come to IBCLC. Often the last resort in the UK. When no one else knows how to help you, we may be invited to offer up our skills. Would breastfeeding be easier if we could support as standard on the NHS? I think it would, but thats nothing more than my own opinion. As it stands, we are there for you if you have exhausted all other avenues, or, for the aware few, if you can afford to have us in during the first week to catch any problems before they develop. We are very well qualified – we HAVE to be to call ourselves IBCLC. We are not money grabbing monsters trying to take advantage of new mothers. We have a unique and rare skill set we have dedicated years to acquiring – and we live in a country that doesn’t deem lactation support important enough to be available courtesy of our free at the point of contact health service… I wonder why our breastfeeding rates are so low?