I. B. C. huh?

by: Laura Dunn, LPN, IBCLC
June 28, 2010

No wonder the public is mixed up, there are so many confusing letters behind the names of people who are 'breastfeeding helpers.'

CBC, CBE, CLC, CLE, CLS or IBCLC?

CBC- Certified Breastfeeding Counselor

CBE- Certified Breastfeeding Educator  (not to be confused with Childbirth Educator, sheesh)

CLC- Certified Lactation Counselor (nothing to sniff at, it's what I was before 2009)

CLE-Certified Lactation Educator (Through CAPPA, the labor doula certifying organization)

CLS- Certified Lactation Specialist

IBCLC, LC or RLC- International Board Certified Lactation Consultant or Lactation Consultant or Registered Lactation Consultant (If someone is one of these, they are all three, they are used interchangeably) 

Here's why I care so much.
Well, you see, I have the top credentials for my field, IBCLC, and I only recently earned the privilege of putting those letters behind my name in 2009.  That was after many years of school, extensive self directed study, work experience and finally, a grueling exam.

 There are big differences in training, experience and scope of practice that totally sets apart the IBCLC from the rest of these certifications.  It would've been unethical misrepresentation to call myself an LC before 2009, because I wasn't.  Now that I have the credential, when people do this, I feel like my hard work is not being valued as being beyond these other certifications, which is the case.
 
I have nothing against people with these certifications and I applaud anyone who just wants to further their education on breastfeeding, no matter how far they intend to take their education.  Many take these paths as the beginning stepping stone to get to the LC level, myself included.  Before 2009, which is when I passed the exam, I was and still am, a nurse (LPN) who had the CLC certification (certified lactation counselor).

I worked in the lactation department of a hospital where I had worked as a postpartum nurse for years and before that as a nurse tech.  I referred to myself as a Lactation Nurse, because I am a nurse who worked in the lactation department, or a Lactation Counselor because that's what I was, a Certified Lactation Counselor.  A Lactation Counselor is very different, my friends, from a Lactation Consultant and I was respectful not to call myself an LC before I earned the right.  I worked to inform other birth professionals like nurses, doctors, doulas and childbirth educators, usually by simple correction or explanation of the differences between a CLC and an LC when they misunderstood my title, amount of training or scope of practice.

 More confusion:  LC isn't short for CLC but for IBCLC. They sound very similar, I know, but it's like the difference between a B.A. and a Ph.D.  Many people still continue to mix up lactation counselor and lactation consultant, I mean why wouldn't LC also stand for a lactation counselor?  It makes sense; but to call oneself an LC implies the IBCLC or lactation consultant credential.  Again I have nothing against those who have these certifications who are practicing appropriately within their scope of practice.

Here's another reason why I care when people unethically use the letters:
In the IBLCE Code Of Ethics under Principles of Ethical Practice state that LCs will:
"14.  Present professional qualifications and credentials accurately, using IBCLC only when certification is current and authorized by the IBLCE, and complying with all requirements when seeking initial or continued certification from the IBLCE"
(Code of Ethics for IBCLCs, page 2 Effective December 1, 2004)  Available for download here by clicking 'Code of Ethics'

In fact, as an LC, I could be subject to disciplinary action by the board if I helped someone misrepresent themselves as an LC if they were not authorized by the IBLCE to use the credential.  So I don't take it lightly. 

I don't blame anyone, it is soconfusing and it was for me too, but I also feel a mission to teach others.  It's not just about me and what I've earned either.  I want to inform professionals and the public for the sake of getting correct information and skilled help to breastfeeding families.  The public could be misled in a way that may potentially stagnate any progress that has been made in the field, in a way that could damage breastfeeding relationships.  That grieves me. 

I'd like to start with those who really should know the difference, that is those in the business of childbirth: doulas, nurses and childbirth educators and maybe even those who carry the CBC, CBE, CLC CLE or CLS credentials themselves.  How can we expect the average person to understand if professionals in the field don't?

My favorite resource for explaining the differences in the professional breastfeeding supporters is broken down here by one LC,  'Alphabet Soup'  .  She goes a bit into more detail about each certification.

Most of these certifications are 2-3 day courses and completing one doesn't necessarily qualify someone to 'put out a shingle,' as they say, to counsel mothers.  These courses are valuable for people who are already doulas, doctors, educators or nurses so the participants just add their new breastfeeding knowledge to what they already practice.  My CLC course was 5 days and it was made very clear to me that by itself, it didn't qualify me to go out and counsel as a profession; it was extra education on the topic  of breastfeeding for those who already worked in the field.  (With the exception of WIC counselors, that's the government's Women Infant and Children Program)(1) 

2-3 day courses?  Seriously?  So, in addition to class hours, guess how many hours of direct breastfeeding counseling practice that I had to have to even qualify to sit for boards?  4,000.  Four. Thousand.(2) I'm not talking about observing someone counsel, but actually counseling.  Thanks, I worked my butt off for that.  Even if someone has nursed 7 kids, even if she is 15 years older than me, if she hasn't put in the work to earn those letters behind her name, she still shouldn't promote herself as an LC or allow the public or her colleagues to misunderstand her qualifications.(3)


To give you an idea about the exam we take, it's not unlike the state board exams that nurses have to take after graduating from school before they can put the letters LPN or RN behind their name and practice as such.

Just thought I'd share that there are some differences between nursing state boards and the exam to be an LC:

• our certification is internationally standardized and recognized
• we have to RETAKE the exam every 10 years and sometimes every 5 years depending on the fulfillment of the required continuing education 
• It's not yet computerized and there are tons of pictures
• you can contest the questions.
•  It takes months for the exam to be hand graded
• it's only given once a year  by the International Board of Lactation Consultant Examiners, (IBLCE) and everyone all over the world takes it on the same day.  

  That's right, you can contest the questions; so even though LC's 'provide holistic, evidence-based breastfeeding support and care' ( Scope of Practice for IBCLCs Adopted March 8, 2008, page 1) which seems to be a lot about facts, breastfeeding still remains an art.

Tidbit:  Did you know that there is only one LC in the country of Nigeria?  I heard a presentation from her at the Global Online Lactation Discussion 2009 conference.  There was a Japanese presenter at the conference too.  I also learned that in 1996, when I lived in Japan, there were no LC's in the country. 


Speaking of continuing education
I think it's safe to say, especially for a lot of non-hospital LC's like me (I do private practice now), we barely break even when you compare our income to what we spend on our required continuing education, which includes books.  I mention that to say, I've never met an LC who didn't passionately love what they do, and they kind of have to when you look at it from a financial point of view.  That includes me, I love it too, the education and all!

Apart from loving what I do, I am very good at it.  I am very proud of what I have accomplished to be officially counted among such honorable professionals as a lactation consultant.


(1)Shout out to WIC peer counselors: God's going to bless you my sisters, please press on with your work.

(2)Soon after I applied, the requirement for my pathway was decreased to a 2,000 hours with a change in the requirement that it be within the last 5 years instead of 10.  That wouldn't have affected me either way, but I share that to say, it really was a 4,000 hour requirement when I applied.

(3)By all means please seek help from someone who has nursed 7 kids or is a lot older than me or whomever you want, even if they don't have IBCLC behind their name, if that resonates with you.  Not being an LC certainly doesn't mean that they aren't good at what they do.  They may have let their LC license lapse or never bothered to seek the credential even though they have all of the counseling experience under their belt.  Or perhaps they are on a path to be an LC, (it takes a long time) and they need to counsel people to get all their hours and they might have any combo of a variety of certifications or licenses already.  In seeking counsel, also look at the other credentials they have like RN, CPM, LMT, CLD etc.  Those say a lot too, but they don't necessarily say 'breastfeeding friendly.' Though if any of the breastfeeding helper initials are behind a practitioners name, they probably are breastfeeding friendly.


more letters
CPM- Certified Professional Midwife
LMT- Licensed Massage Therapist
CLD- Certified Labor Doula
LPN- Licensed Practical Nurse
CNM- Certified Nurse Midwife
FNP- Family Nurse Practitioner
CST-  Craniosacral Therapist
LCCE- Lamaze Certified Childbirth Educator
LLLL- La Leche League Leader