Ever wonder what the letters after the lactation professionals you see really mean? Probably not, let's be honest! Here's why you should, though- they mean something!
Let's break it down.
CLE: A Certified Lactation Educator as designated through CAPPA- It is a person who can give support, education and counsel about breastfeeding but does not work in a clinical capacity at all- this means they are not within their scope to do an exam, assessment of oral function or latch, pre and post weights, or take a health history or notes at your visits. These are folks you'll find doing classes or running support group meetings, though sometimes lactation professionals from other designation do these things too.
With us so far? It's easy to see how someone can become confused!
LLLL: This is a La Leche League Leader- they agree to assist mothers free of charge at support groups that are based on peer-to-peer support. La leche League International produces a book for Leaders called The Breastfeeding Answer Book, and some LLLL's will use Breastfeeding Made Simple, which is a bit mroe current. These books (written by IBCLCs) guide them in their answering of questions from basic to complex- however, they're not a subsititute for direct clinical assistance- they offer exclusively education and support.
BC: A Breastfeeding Counselor is designated through Breastfeeding USA and is a person that is typically certified in an additional lactation designation and provides exclusively lactation education and support. These folks do not provide clinical support (weights, oral assessments, etc) but only offer peer counseling and support- like groups and classes.
CLC: This means a few things, depending on where it's issued. It can be a Certified Lactation Counselor- which is a designation given by The Academy of Lactation Policy and Practice through various education vehicles like The Healthy Children's Project and others. This credential is 45 hours of education and 0 required contact hours. WIC Peer Counselors are CLC's via this designation, though WIC offices also keep an IBCLC on staff for complex issues.
Then there's the Certification in Lactation consultation- designated by Birthingway College of Midwifery. It's 15 quarter credit hours in Lactation-Specific Courses, 18 quarter credit hours in Health Science Courses, and 10-17 quarter credit hours in Clinical Training Credits- totaling to about 43-47 quarter credit hours. Obviously, one CLC does not equal another in experience and training!
IBCLC: This is widely regarded as the "Gold Standard" of Lactation Consulting- It is overseen by the International Board of Lactation Consultant Examiners and is the only international credential listed here. Their scope of practice is the most comprehensive and includes education, evidence based information, support, competent assessment and examination of the lactating parent and child (including clinical assessments and pre/post weights), and developing a comprehensive care plan for the family with appropriate follow up as needed. To become an IBCLC takes years of study, practice, and direct contact hours with families via internships or clinical rotation. It is the the most rigorous certification in terms of requirements of study and hours received for certification, as well as difficulty of exam.
The difference here, that I would like to point out-- at the risk of sounding biased-- is that the IBCLC credential requires years, not weeks or hours of study. This is the main difference- though you'll find stark contrasts in the scope of practice documents between the credentials, as well. Many find themselves credentialing with CLC or CLE on the pathway to becoming an IBCLC- and this is an excellent way to gain practice hours and education- so long as they're not stalling at the CLC or CLE and beginning to accept money for practice outside their scope. Many find they've learned quite a lot along the pathway and feel they can adequately serve families- the pitfall, of course, is that you cannot know what you do not know!
A CLC can practice under the guidance of an IBCLC for follow-up appointments or in teaching groups and classes, but independently they are outside their particular scope if they, for example, begin assessing for tongue tie or other complicated issues. If a CLC is working with a family that is experiencing dysphagia in their newborn, how can they know where to get help? These things (apart from referral to an outside practitioner) are beyond the depth of a CLC- whereas an IBCLC would be able to refer to appropriate services and continue to work with the family, having had the training and knowledge to handle the difficulty as it relates to breastfeeding.
This is what you're paying for when you hire an IBCLC!
Specifially, when you hire from the Doula My Soul collaborative, you are guaranteed an IBCLC at your initial visit, alongside an intern who has had advanced-level training and experience before entering your door. You are assured the best of what our community has to offer, both in training and expertise, and this is no accident! A solid practice will have carefully selected among the credentialed practitioners in the area, those who strive to stay current with the latest reserach and who maintain an understanding of issues facing our communities' families. IBCLCs should go above and beyond the IBCLC credential with additional credentials in bodywork, movement, or other modalities. This can be very beneficial when working with families- something which benefits a client directly.
Doula My Soul has a CLC (Jessi) who provides business management, insurance billing, and lactation consult follow ups for Bryna, an IBCLC. Jessi describes her role as the following:
"I have completed all of my required coursework and contact hours for the IBLCE exam- and feel quite ready to take on the challenges presented by families who are striving for breastfeeding success and are following a comprehensive care plan laid out by Bryna. What sets me apart from other CLCs is the training I have received in addition to my foundational coursework at the university. I have clocked so many direct contact hours under Bryna specifically that I feel I have a deep understanding of the care she provides families and can function as an extension of that care in a conciliatory and supportive aspect. I spend time listening to how the care plan has gone and discovering where it should lead next. I consult with Bryna over our next steps and feel comfortable helping our families get there. I'm a lot like scaffolding- you'll only see me when there's work to be done, but I'm gone and the solid structure remains. This is my best hope for a family when they graduate from our care- a strong foundation and growth that we can help support but never direct."
Bryna describes her role as an IBCLC as:
"The foundation of care- we go in and define the problem, and decide what must be done. It is not an easy thing to tease apart the issues that face a breastfeeding dyad- there is much that must be considered. Is there an inflammation issue or engorgement? Is there a low supply or transfer problem? These must be quickly and carefully assessed and a care plan must be comprehensive but- above all- sustainable. It does not matter if a care plan is the greatest in the world, it cannot be impossible for the family to achieve or it will be ignored and the problems will persist. There is so much more to breastfeeding than biological nurturing or laid-back positioning. Many families find lots of great help online- but without a highly-educated navigator, they can often be steered wrong. This is what we do as IBCLCs- we suss out the issues , triage, and create a roadmap that families can follow to reach their definition of breastfeeding success."
Not only that, but a solid team works closely with the care providers who are best-suited to a family's situation and can refer with certainty to the best fit for a family. They make it their business to know which practitioner has experience with infant loss or fertility challenges, and which will be the most understanding to their chosen parenting styles. This is the mark of a competent care provider- one who can refer out when needed to high-quality services that will fit the family's needs.
Your team should consist of competent, caring, and driven individuals who are committed to more than cuddling babies (though, admittedly, that is a great side benefit!). They should be invested in your family's success, however you define it. Make sure you know who you're hiring and what you're paying for when you book with a lactation professional!