This post was most recently updated on June 5th, 2018
OK, before we start, here’s a disclaimer: this is a rant. A rather personal one – although there are many people in the same situation and it does have ramifications for breastfeeding support in this country (UK). I’ll do my best not to come across as a moaning minny and to find the positives as I go along. I’m writing this to help others understand what a Board Certified Lactation Consultant is and the future of this title in the UK. I am not an IBCLC and I am not privy to the internal workings of the organisation, so, if I’ve made any mistakes or omissions, please do let me know.
So, what is a Lactation Consultant? More accurately titled an International Board Certified Lactation Consultant, an IBCLC is the pinnacle of breastfeeding support qualifications available. According to the International Lactation Consultant Association,
“An International Board Certified Lactation Consultant (IBCLC) is a health care professional who specializes in the clinical management of breastfeeding. An IBCLC is certified by the International Board of Lactation Consultant Examiners®, Inc. under the direction of the US National Commission for Certifying Agencies. An IBCLC works in a wide variety of health care settings, including hospitals, pediatric offices, public health clinics, and private practice.”
Traditionally, IBCLCs came from a variety of backgrounds. Some were health professionals, such as nurses or midwives, who wished to further their breastfeeding support knowledge and skills. Many others, especially in the UK, came from our thriving lay support community. Breastfeeding Counsellors from ABM, LLL, BfN or NCT found it possible to become IBCLCs because they gained enough experience working with mothers and babies and it was recognised that the training and ongoing learning of a Breastfeeding Counsellor was adequate grounding to go on to become a Lactation Consultant.
Becoming an IBCLC has always meant proving your credentials in terms of lactation education, your hours of experience working with mothers and babies and then taking an exam. It’s not to be sneezed at and deserves its reputation as the gold standard in lactation qualifications.
But let’s look at this definition again – an IBCLC is a “health care professional” who specialises in the “clinical management” of breastfeeding. So there is an inherent difference between the roles of BFC and IBCLC. As a BFC, I provide emotional support, information, counselling and suggestions to a mother struggling with her breastfeeding relationship. I am definitely not a ‘Health Professional’.
To take my breastfeeding education to the next step and to gain a ‘gold standard’ qualification, apparently I have to become a Health Professional.
And this is is more than just name alone. The eligibilty criteria are set down by the International Board of Lactation Consultant Educators. Like the World Series in Baseball, ‘international’ appears, to all intents and purposes, to mean ‘America’. Not much notice seems to be taken of the difference around the world, in breastfeeding support or, in fact, the educational opportunities available – or how much that education might cost the candidate – and not just financially.
Here’s a list of the courses I would need to undertake. At the time of writing, we in the UK are still trying to ascertain whether all of these courses are actually available, whether the cost of them are within the budget of an ordinary person and whether the time scales involved would mean any of us non-Health Professionals could qualify as an IBCLC before we die – unless I had, for example, A Level Biology and did an BSc at university – which I didn’t.
- Human Anatomy & Physiology
- Infant and Child Growth and Development
- Introduction to Clinical Research
- Psychology or Counselling Skills or Communication
- Sociology or Cultural Sensitivity or Cultural Anthropology
- Basic Life Support
- Medical Documentation
- Medical Terminology
- Occupational Safety and Security for Health Professionals
- Professional Ethics for Health Professionals
- Universal Safety Precautions and Infection Control
So, I can see that I would want to have more education in some of these subjects before becoming an IBCLC. If I were a midwife, I would have verifiable qualifications and experience in numbers 1, 2, 4, 8, 9, 10, 11, 12 and 13. BUT perhaps a midwife or a doctor wouldn’t have much learning or experience in number 5 and 6 or 7. I, however, have been studying, teaching and using number 6 & 7 for ten years as a Breastfeeding Counsellor (there’s a clue in that title…)
Thing is, it appears to the outsider that this counts for nothing. The message is that they don’t really want lay breastfeeding supporters to sit the exam. As far as they are concerned, if you can’t access the education, you can damn well BECOME a Health Professional in order to be eligible:
“You may be wondering where you can obtain the Health Sciences Education. Given that the IBCLC certification is international and that educational systems vary from country to country, there is no one easy answer to that question. In some countries, it may be necessary for you to enroll in a course of study that educates you in one of the Recognised Health Professions.”
So, I’m aware that I must sound very much like I’m stamping my foot and yelling, “it’s not fair” in a rather petulant voice. After all, it is up to IBCLE how they set their criteria. If they want all IBCLCs to be health professionals, then surely there’s good reason for that, I hear you ask.
Mmmm, well I’ve been thinking about that. Long. and. hard.
Fine. Then choose your pathways and stick to them. Applicants in Europe are bending over backwards to fulfil the criteria, only to be told at the eleventh hour that the rules have changed. And what are we saying about the kind of support that the VAST majority of woman need during their nursing journeys? And how much do we medicalise a normal function, such as human lactation, by making those who support it into medical practitioners?
IBCLCs do deal with the more complex problems, so I’m not saying they shouldn’t know more about the science and anatomy of lactation. My assertion is that I can achieve that without having to find those 13 courses (difficult) and pay for them (impossible).
And here’s where I stop being self-centred and start thinking about the future of the International Lactation Consultants Association. I see a future where there are only midwives and nurses in the organisation. No artists, musicians, poets. No poor women, few black woman, fewer single mothers, no tandem nursers, no grandmultips. No variety of personal experience. No variety of breastfeeding support experience! How many Health Professionals in this country have experience of working in drop-ins, breastfeeding helplines or women’s own homes?
The first and most important thing a breastfeeding mother needs is high quality listening and counselling skills – however medical her problem. And I’m sorry to say this but I just don’t see these qualities in many Health Professional IBCLCs.
When you put a qualification out of reach financially and practically you run the risk of throttling the profession. No new blood means things quickly whither and die.
The IBCLC qualification in the UK will just be another feather in the cap of those who work (or worked) within the NHS. Yet again, lay wisdom is downgraded, ignored and given low status.
IBCLCs coming in via the lay route have always brought such a wealth of experience, knowledge and wisdom. Not more or better wisdom than the health professionals, but different. And lovely. And necessary.
We don’t HAVE to dance to the American’s tune. Who fancies setting up a lactation education and accreditation body for the UK that results in an ability to work in private practice?
I think I’m happy as a Breastfeeding Counsellor and doula. Hoop jumping just doesn’t turn me on.
I wrote this post back in 2014 and I thought it warranted a little bit of a revisit and an update. So here we are in 2016 and not much has changed…BUT I must applaud the lactation consultant profession for at least embracing this issue and attempting to address it. There has been much talk about accessibility and inclusivity. Some lactation consultants have spoken out about the future of the profession if it is effectively closed to breastfeeding counsellors and the US-centric thinking that seems unable to understand that gaining the educational credentials in the UK and Europe is just not as simple as it is in America.
I’ve even seen evidence that people are beginning to understand that the professional opportunities for LCs here in the UK are so rare (unless you are willing the risk of going self-employed) that investing in training is beyond the capabilities of most ordinary people; student loans are not available for this unrecognised and unregulated course of study.
I have heard whispers of affordable, accessible online training courses. I really hope these rumours turn out to have some substance.
After all, if all our aims are the same: more IBCLCs, ideally many more working within the NHS so women can access them for free and those in private practice aren’t so overwhelmed they can’t give mums the time they need, we need more of EVERYONE to enter the profession – those from lay and health professional backgrounds – in order to meet the obvious demand. The Infant Feeding Coordinator role should be filled by an IBCLC in every hospital. There should be one in every GP surgery and midwife-led clinic and birth centre. We need at least one or two in every postnatal ward in the land to handle the more complex cases. Let’s face it, breastfeeding isn’t going to get any easier whilst birth intervention rates remain so stubbornly high, so we need infant feeding specialists on every damn street corner if we have any hope of supporting mums to reach their feeding goals.
So I await announcements of progress with baited breath. Parents deserve to be supported by people who look and sound like them and who are readily accessible. 125-odd LCs in the whole of England, Scotland and Wales is just not enough to tackle the momentous task we have ahead of us. Meanwhile, the unpaid, volunteer Counsellors and Peer Supporters are picking up the slack.
Lastly, I’d like to address a comment below. No, I don’t think the ‘soft skills’, the creative talents, the interpersonal skills so important to breastfeeding support are restricted only to lay people. I have the pleasure to know many wonderful IBCLCs who are, or have been, health professionals. But what I would say is that lay counsellors have had the luxury of being able to cultivate those skills with the time and focus that not working in the NHS affords them. So I stand by my assertion that it seems a shame for all that knowledge and skill to be barred from benefiting the art and science of lactation consultancy.
I’ll leave the last word to Alice Farrow, whose open letter to IBCLE eloquently sums up the barriers facing those of us in Europe who may aspire to become IBCLCs. If you are at all interested in this suject, I urge you to read it.
Alice Farrow’s Open Letter
It’s now June 2018 and what’s changed? Well not much, really. I have recently been told that, with some digging, it is now possible to find the 14 Health Science courses IBCLE demand. It is estimated that the cost is coming in at around £2000. I’ll leave you to decide whether this is a step in the right direction towards accessibility and ultimately an increased diversity in the profession.