Because breastfeeding can have a positive lifelong effect on your baby’s health and development as well as your own health, its importance is widely recognized in the health-care field. However, many mothers find themselves unsure where to turn for help or information when problems related to breastfeeding arise. New mothers may be especially overwhelmed by the volume of information that is shared with them or confused by conflicting advice given by different caregivers. This article presents a guide to the different types of breastfeeding support specialists you may seek out or encounter as you begin your breastfeeding journey.
Your family, friends, and community may influence your decision to breastfeed and will be an important source of support after your baby arrives. Sometimes you simply need a little encouragement, a nutritious meal (that you didn’t have to prepare), or the company of a friend to keep you going through breastfeeding challenges. Your partner, mother, grandmother, auntie, friend, or even a stranger on the internet can help you find information you need or offer “been there, done that” advice. If you need more specialized information, help, or connection to the social support of a breastfeeding group in your community, trained breastfeeding specialists are available to fill the need.
There are many different training programs available to the aspiring breastfeeding support specialist or volunteer. The resulting “alphabet soup” of initials can be downright confusing, even for people who work with breastfeeding moms! Understanding what the initials stand for, as well as what training, education, and experience is required to earn them, may help you choose whom to call if you need breastfeeding help and support.
Professional Fellowship and Certification
Professional fellowship and certification requires post high school education, including health education that provides an understanding of whole body systems and how they affect lactation. Professionals perform clinical evaluations of breastfeeding and create and oversee a plan of care, which may involve more than one type of health-care provider. One factor that sets professionals apart is the requirement to follow an ethical code of conduct overseen by the organization that provides the fellowship or certification.
Breastfeeding Medicine Specialist (Fellow of the Academy of Breastfeeding Medicine–FABM)
Breastfeeding Medicine Specialists are Medical Doctors (MD or DO) who have completed additional training in breastfeeding and human lactation and specialize in this field. They are able to treat complicated breastfeeding issues that require evaluation by a physician such as failure to thrive (a baby not gaining weight, not growing as expected), tongue tie, breast abscess, low milk production that is not resolved by more frequent nursing/expressing, and breast or nipple infections. They are also able to assist with common and ordinary breastfeeding problems as well as concerns that relate to the normal course of breastfeeding.
Breastfeeding Medicine Specialists often work in either private or group physician practices. They may work entirely in the field of breastfeeding medicine or use their breastfeeding expertise while working in another medical speciality such as obstetrics, pediatrics, or family medicine. Most often, mothers are referred to FABMs by an IBCLC or another physician who recognized an issue that required their expertise. As with most physicians, however, mothers may self-refer.
Education and experience:
An applicant must have completed the required education and training to become a physician, additional education in lactation science and management, as well as the required clinical experience hours working directly with breastfeeding mother-baby pairs.
Breastfeeding Medicine Specialists are recognized by the Academy of Breastfeeding Medicine to have “demonstrated evidence of advanced knowledge and skills in the fields of breastfeeding and human lactation. FABM denotes that the physician has ongoing specialized professional activities related to clinical expertise, research or teaching experience, and/or significant advocacy efforts in the field of breastfeeding medicine.” See the full reference here. Breastfeeding Medicine Specialists must apply to maintain their fellowship every 10 years.
Breastfeeding Medicine Specialists can:
- make a medical diagnosis
- prescribe medication
- order and perform medical testing
- perform medical procedures
Find a Breastfeeding Medicine Specialist:
Currently, a publicly accessible database is not available. You may call the Academy of Breastfeeding Medicine and ask how to contact the closest Breastfeeding Medicine Specialist to you.
International Board Certified Lactation Consultant (IBCLC)
Certification by the International Board of Lactation Consultant Examiners (IBLCE) is recognized as the gold standard credential for professionals who work with breastfeeding mothers.
IBCLCs are allied health professionals who have completed extensive, comprehensive education in breastfeeding and human lactation, education in health sciences and related subjects, and the required hours of supervised clinical experience. By passing the IBLCE exam, they have demonstrated they are qualified to work with breastfeeding mother and baby pairs as clinicians. IBCLCs can help mothers overcome common breastfeeding difficulties such as sore nipples, mastitis, and milk production concerns. They can also provide assistance with more complex issues, such as breastfeeding with illness or disability, low weight gain, and tongue tie. IBCLCs also help with concerns related to the normal course of breastfeeding (sleep, returning to work or school, etc.).
IBCLCs may work in private practice, group practices, hospitals, birth centers, health clinics, parenting centers, WIC clinics, physician practices, midwives practices, chiropractic practices, or multi-faceted practices such as perinatal clinics. They are part of the maternal-child health team and coordinate care with physicians and other health-care professionals. Additionally, IBCLCs may work in research, advocacy (including policy-making), non-profit management, or as volunteers. IBCLC is a stand alone credential, though many practicing IBCLCs are also licensed professionals such as physicians, registered nurses, or registered dietitians.
Education and experience*:
At least 90 hours of education specific to breastfeeding and human lactation
At least 1000 hours of supervised clinical experience working with mother and baby pairs, or 300-500 hours of directly supervised clinical experience with a mentor
A degree in one of the health sciences OR completion of the following courses:
- Human Anatomy
- Psychology or Counseling or Communication Skills
- Human Physiology
- Introduction to Research or Statistics
- Infant and Child Growth and Development
- Sociology or Cultural Sensitivity or Cultural Anthropology
- Basic life support
- Medical terminology
- Medical documentation
- Occupational safety and security for health professionals
- Professional ethics for health professionals
- Universal safety precautions and infection control
The eligibility requirements above were implemented in 2012. Please note that these requirements have changed several times since the exam was first administered in 1985. See this presentation from IBLCE for full details. Depending on which year an IBCLC took the exam, and which pathway was taken, the candidate was required to acquire between 1000-8000 supervised clinical experience hours or 300-500 clinical experience hours that were directly supervised by an IBCLC mentor before applying for the exam. It is also of note that many candidates have more lactation-specific education hours than required at the time of application not only because they attend conferences and webinars earning Continuing Education Recognition Points (CERPs) while working towards eligibility, but also because it takes many hours to cover all the topics in the exam blueprint. For example, one of the most popular comprehensive education programs available to IBCLC hopefuls is the 120-hour Health e-Learning BreastEd course.
The IBLCE exam contains 175 multiple choice questions of which 100 include clinical photos. The exam covers all aspects of breastfeeding and human lactation as well as related topics such as child development, pharmacology, nutrition, anatomy and physiology, and ethics. All IBCLCs must recertify every five years by CERPs (a total of 75 hours) and at least every 10 years by exam.
IBLCE is the only certification program in lactation accredited by the National Commission for Certifying Agencies. The NCAA is a regulatory body that provides volunteer oversight for allied health professions.
- take a complete lactation history including evaluating breast anatomy and function and assessing factors related to breastfeeding such as maternal condition, social support, and potential challenges
- assess the baby’s facial and oral structure and evaluate neurological responses and reflexes
- assess for developmental milestones and normal infant behavior
- perform a comprehensive, clinical evaluation of breastfeeding efficiency and effectiveness including assessing latch/attachment, milk transfer, and milk intake
- assist the mother to find comfortable and effective positions for breastfeeding
- assess the mother’s milk production and provide education and assistance regarding adjusting milk volume if necessary
- use the appropriate World Health Organization growth chart to assess the breastfeeding child’s weight and growth patterns
- evaluate and demonstrate the use of breastfeeding techniques and devices and provide evidence-based information to mothers about their use
- write a comprehensive evaluation of a mother’s lactation history and breastfeeding assessment and work with the mother to develop and implement an appropriate and achievable breastfeeding plan
- assess and provide strategies for initiation and continuation of breastfeeding in challenging circumstances such as a medical condition in mother or baby, compromised lactation, or emergency situation
- provide information and strategies for overcoming breastfeeding challenges such as painful nipples, mastitis, and engorgement
- empower mothers and families with information, support, and appropriate referrals to help them cope with peripartum mood disorders
- educate mothers and families about normal baby behavior including signs of hunger and expected feeding and sleep patterns
- provide current, unbiased, evidence-based information to assist the mother in decision making
- obtain the mother’s consent to gather and disclose information and written assessments to pertinent health care providers
Find an IBCLC:
ILCA: Find a Lactation Consultant Directory-IBCLCs who are also members of the International Lactation Consultant Association may choose to have their contact information listed on this page. Due to that limitation, it may not be a comprehensive listing of all IBCLCs in your area.
Department of Public Health or WIC breastfeeding resource directory-Search your state Health Department or WIC website for this valuable listing of breastfeeding support resources in your community. It is usually updated annually.
Search-Most IBCLCs in private or group practice have a website and/or a Facebook page that is searchable using a web search engine such as Google or Bing. Searching for IBCLCs in a specific city or geographic region may help you narrow down the results. (For example “IBCLC New York, NY” or “IBCLC Bay Area CA.”)
Word of mouth and referrals-If you need the services of an IBCLC, you can ask your physician, nurse, or nutritionist for a referral. Your insurance company may have a referral list of IBCLCs that are covered under your plan. You may also find recommendations from from other women through parenting groups, breastfeeding support groups or meet-ups, and online groups.
Experienced mothers are trained in basic breastfeeding management, modeling optimal breastfeeding practices, and sharing (or facilitating the sharing of) information and experiences with pregnant and breastfeeding women individually and in group settings. Mother-to-mother support gives mothers the opportunity to talk with other women about their concerns in a way that might not otherwise be possible in today’s world. Women are empowered to explore options that are the foundation of a personally satisfying breastfeeding experience. Mothers often find it easier to share their concerns with other mothers; this mutual sharing of experiences and information builds trust and respect. Mother-to-mother support has the following benefits:
- It is community-based and easy to access.
- It provides an essential complement to existing health care and social services systems.
- It counters incorrect or misleading breastfeeding information with accurate, evidence-based information.
- It enables and empowers mothers to make informed choices about breastfeeding and parenting.
- It provides a social outlet for mothers (group meetings).
WIC Breastfeeding Peer Counselor (WIC BFPC or WIC PC)
Through the federal Women, Infants, and Children program, WIC Breastfeeding Peer Counselors provide mothers with breastfeeding information and support from pregnancy through weaning. During pregnancy, they visit with mothers by phone and in person to provide them with basic breastfeeding information, answer questions, and offer anticipatory guidance to help make breastfeeding easier. After a mother’s baby is born, her BFPC will continue to make regular contact with her, answer her questions, and offer practical suggestions to help her reach her breastfeeding goals. Depending on the policies of her state or tribal program, BFPCs may also facilitate support groups, teach breastfeeding classes, dispense breastpumps, certify participants for the WIC program, and make home or hospital visits.
Breastfed for at least 6 months, WIC participant
Education and training:
20-hour on-site training that covers all aspects of the normal course of breastfeeding and human lactation as well as communication skills. Training activities include role play and demonstration of necessary skills including assisting moms with using common breastfeeding tools and equipment (such as breastpumps).
1 hour per month minimum; additional requirements vary by state
Volunteer Breastfeeding Counselors
The following volunteer organizations offer one-to-one breastfeeding counseling (which may include online or text communication and home visits), group meetings, and online resources. Counselors are educated and mentored within the organization before beginning to work with mothers. They may be supported by a network of professionals in the field of lactation that works as a sounding board for complicated situations.
La Leche League Leader (LLLL)
Breastfed for at least 9 months at time of application; Please see additional requirements here.
Education and training:
Applicants must complete required reading, writing exercises, and role play which covers all aspects of the normal course of breastfeeding and human lactation, as well as communication skills. For full details, please see here.
Leaders are expected to keep up-to-date and are strongly encouraged to continue their education. Proof of completion is not required. To fill the need for continuing education, Chapters, Area Networks, and Regions regularly provide education opportunities such as seminars, conferences, lunch and learns, as well as informative publications such as Leaven and newsletters.
Breastfeeding USA Counselor (BfUSA Counselor)
Breastfed for at least 1 year at time of application.
Education and Training:
Training varies based on experience. Includes reading, online training activities, and role playing.
Minimal number of credits every 3 years
Nursing Mothers Counsel Counselor (NMC Counselor)
Requirements vary by chapter. Please see the chapter website for specific information.
The following programs offer similar preparation to individuals who may provide mothers with information about the normal course of breastfeeding and basic breastfeeding support. After completion, they will be prepared to:
- answer questions about common breastfeeding concerns such as prevention of sore nipples, preparing for return to work or school, and milk production issues
- offer practical tips for helping mothers fit breastfeeding into their lifestyle
- provide anticipatory guidance about common breastfeeding situations and problems
- provide education to help mothers prepare to breastfeed or return to work or school
- recognize when breastfeeding is going well and when more help is needed
- recognize when a breastfeeding issue is beyond their scope of practice and refer to the appropriate professionals.Many certificate program graduates use their education in their occupations as nurses, nutritionists, midwives, labor doulas, postpartum doulas, baby boutique and pump rental station employees, or WIC Breastfeeding Peer Counselors. Some work as part of a group practice, usually with an IBCLC as the lead, while others start businesses to support women in their communities directly.
Certified Lactation Counselor (CLC)
Exam, certificate, and renewal administered by Academy of Lactation Policy and Practice, a division of Healthy Children’s Project, Inc. The ALPP certificate is accredited by the American National Standards Institute. ANSI accreditation means that the testing process of the certificate program has been found to be fair, valid, and reliable.
5 day on-site breastfeeding education (45 credit hours), role play, competency check (example: watch a short video and describe what action the CLC would take) and pass a 100 question exam with 75% or better immediately after program; Program information
Renewal: Every 3 years with 18 hours of breastfeeding education, plus required fee
Advanced Lactation Consultant (ALC) and Advanced Nurse Lactation Consultant (ANLC)
Healthy Children’s Project, Inc (please see CLC listing above)
45 hour course; Program information
Prerequisites: RN license and CLC or IBCLC
Prerequisite: CLC or IBCLC
Certified Lactation Specialist (CLS)
5 day on-site education and training (45 credit hours), complete assigned homework and readings, and pass final exam immediately after program; Program information
Certified Breastfeeding Counselor (CBC)
Mentored online training, required reading and exercises, create portfolio of local breastfeeding resources, provide 30 hours of breastfeeding support, and complete final open book exam; Program information
Breastfeeding Counselor (BC)
Distance learning course (95 hours), read required text, complete study questions and role plays, and pass final exam; Program information
The following certificate programs prepare candidates to provide breastfeeding education rather than support. Please see the program requirements and accompanying documents for more details, including the scope of practice of the certificated educators for each program.
Certified Lactation Educator (CLE)
Complete all assignments and read all required texts/books, write one-page essay, attend 20-hour training (a distance track is also available), attend 2 breastfeeding support group meetings, attend 1 breastfeeding class, submit 2 letters of recommendation, develop breastfeeding class outlines and handouts, create local breastfeeding resource list for families, complete part 1 of HUG your baby training, and pass final online exam with 85% or better; Program information
Every 3 years with 15 hours of breastfeeding education, required evaluations, reports, reviews, and fee. Details
Lactation Educator (LE)
5 day on-site education and training (45 hours), written breastfeeding project (homework), write study guide on breast anatomy and physiology, participate in quizzes, case studies and role plays, evaluate program; Program information
Lactation Educator Counselor (LEC)
University of California at San Diego Extension: Breastfeeding Education by Gini Baker, RN, MPH, IBCLC
5 day on-site education and training (45 hours) or online (60 hours). Complete assignments including internet resource, nutrition, clinical, and counseling problems, review 4 research studies, observe a breastfeeding class, develop breastfeeding class curriculum, read required text, satisfactorily complete periodic testing; Program information
For more information about, and a comparison of, the various breastfeeding support specialists in the USA please see The Landscape of Breastfeeding Support by the Massachusetts Breastfeeding Coalition.
Because of the immense importance of breastfeeding to both individuals and public health, it is imperative that our communities support and empower mothers both to initiate breastfeeding after birth and to continue breastfeeding as long as desired, ideally through the first year and beyond.
While it is helpful for mothers and community members to be aware of the diversity in breastfeeding specialists, these practitioners only represent one part of the larger picture of essential support for mothering. Breastfeeding specialists, community advocates, and health-care providers must work together with families in order to ensure that women have access to the accurate, evidence-based information and support they need to develop and meet their own breastfeeding goals.
Thank you to all the colleagues and friends who shared information to make this resource as comprehensive as possible. Special thanks to Adrienne Uphoff, IBCLC for her time and patience while editing and updating this article, as well as for the generous gift of her wordsmithing wizardry.
© Jolie Black Bear, IBCLC 2012– All Rights Reserved