Lactation Consultant Licensure in the United States

By Stephanie Rodriguez-Moser, IBCLC, RLC

Breastfeeding newborn

On July 3rd of 2014, something very exciting happened in the lactation world. Rhode Island passed a bill that would allow International Board Certified Lactation Consultants (IBCLCs) to be licensed providers.   A surprising number of people have no idea that this occurred, or what it means for professionals, mothers, and babies.

Licensure is something that lactation consultants have been working towards for a long time. Breastfeeding support has many faces, and this can lead to a lot of confusion for those looking for lactation services. The Massachusetts Breastfeeding Coalition has a wonderful document that goes into all of the credentials out there and what they mean, what they stand for, and what kind of services they provide. If you click on that link and download the PDF, you will see that it is really, really long.   There are 14 types of lactation help listed, and several of them use a “L” and “C” in the name, even though they all have different standards of what they are, what they do, and what their scope of practice is.

Currently, anyone practicing breastfeeding care can call themselves a lactation consultant. It’s not a protected term. This can be a problem, because a mom who thinks she is getting help from a qualified, trained professional might actually be getting help from a lay person. While I firmly believe that there is a need for many types of lactation support and assistance, I just as passionately believe that mothers have the right and need to know the training of the people that are helping them. Generally speaking, IBCLCs are the most qualified to be engaging in clinical care of the mother/infant dyad as breastfeeding is concerned. Most of the other certificates or certifications are qualified to provide education and basic counseling.

Licensure of IBCLCs protects mothers. It provides a way for mothers to know that the person they are seeking out has met the standard of qualifications dictated by the International Board of Lactation Consultant Examiners (IBLCE). This includes lactation specific training, college coursework, clinical hours, passing a comprehensive exam, and regular recertification. A licensed body means that mothers would have a board to file a complaint with if the IBCLC damaged their breastfeeding relationship or acted in an unprofessional or unethical manner.

This would also help IBCLCs be placed in more areas. There are many “lactation deserts” out there, where help and support is difficult or impossible to come by. This isn’t due to lack of IBCLCs, but it is due to lack of job opportunities and reimbursement options. The Affordable Care Act was great for breastfeeding support, but failed to define who was a trained lactation care provider that was eligible for reimbursement. IBCLCs that are non-nurses, not advanced practice nurses, et cetera, are not seen as billable licensed providers for lactation care in many states – especially through Medicaid. Hospitals and clinics are therefore often skittish about hiring someone for lactation care alone, as reimbursement can be a problem. Private practice providers have a difficult time getting insurance companies to see them as reimbursable. WIC clinics often don’t have the budget to hire IBCLCs as stand alone IBCLCs, especially in smaller areas. This leads to women in minority and/or socioeconomically challenged areas not having available help, despite the fact that these are the women facing some of the biggest challenges with breastfeeding.

We all want mothers to be supported in their unique breastfeeding goals, be that a year (or more!) or a month or even a day. Access to qualified care is one of the best ways to make this happen – and licensure is a big part of that. I encourage you to find a way to get involved in licensure efforts in your state. As someone who is chairing a licensure effort, I can assure you – we need a lot of help! Please find your state’s information below and see what you can do.

(If your state is not listed or is listed incorrectly and you know the licensure contact information for it, please let us know. We would love to include them!)

Colorado

Florida

Georgia and More for Georgia

Massachusets

Minnesota

Pennsylvania

New York

North Carolina

Utah

Is your state missing? Please contact your state breastfeeding coalition to ask what they are doing for advocacy in your area!

 

Starbaby Star Rodriguez, IBCLC, RLC is a provider in the Central Lakes, MN area.  She provides services online at Lactastic Services and in person.  She also blogs for The Leaky B@@b and volunteers her services to loss mothers at Stillbirthday.

 

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Comments

  1. Ghislaine says:

    It’s fine for them to be licensed. But there needs to be someone between mom-sister-aunt advice which is free and the IBCLC advice which can run $80/hour. There needs to be someone who is $20/hour, who knows enough to see the red flags and send a mom to the next level. I know moms who quit breast-feeding because the cost was too much for them. And maybe it was only a matter of a better latch.

    • That would be the LLL leader you can contact for free. Or many of your local WIC agencies can help families.

    • There are quite a few resources in the middle. There are breastfeeding support groups, many are free and many are run by IBCLCs, there are CLCs and CLEs which should have lower rates and refer out when they encounter a mother with issues outside of their scope of practice, and there are many online communities. There’s room for improvement but I believe licensure only contributes to improving access to lactation care all the way around. ~Jessica

  2. Marsha Walker says:

    Thank you so much for this timely look at a pressing issue. Licensure of the IBCLC is indeed very important to assure that ALL mothers have access to the level of lactation care that they need. Licensure protects consumers, encourages quality, assigns responsibility, raises professional standards of practice, and prevents unqualified individuals from practicing. It provides consumers with the tools needed to evaluate the preparation and skills of practitioners.The vicious circle continues with insurers refusing to reimburse providers of lactation care unless they are licensed and many mothers unable to access the IBCLC because they cannot afford to pay out of pocket. The United States Lactation Consultant Association (USLCA) Licensure and Reimbursement Committee works daily on securing IBCLC licensure for delivering the care that mothers need, for assuring that lactation care is reimbursed by third party payers, and for the healthcare system and policy makers to recognize the IBCLC as the top tier of lactation support. While there are numerous other short courses for obtaining lactation knowledge, none are equivalent nor require the rigor necessary to hold the IBCLC credential. USLCA has a document that may be helpful in sorting out the various sources of lactation support. See http://uslca.org/wp-content/uploads/2013/02/Whos-Who-Oct2014.pdf.

    • Thank you for the link Marsha, I appreciate it and will add it to the post. We are very excited about the progress being made in licensure for IBCLCs and agree that it will go a long way in providing access to lactation care for all moms. ~Jessica

  3. Ghislaine says:

    I wrote a comment on October 16th. It was awaiting moderation. Is there a reason this comment was rejected? Thank you.

    • I’m sorry Ghislaine, I see a comment from you on the 13th of October, today is the 14th, there are not yet comments for the 16th. Sometimes comments have a delay in moderation because I don’t get to see them either because I haven’t been on the website (work and family demands mean I can’t be here 24/7) or it got caught in the spam filter and I hadn’t checked there yet. We hold comments for moderation because of the intense amount of spam we receive. I’m sorry your comment wasn’t there when you expected it to be. ~Jessica

  4. Genae Strong says:

    Ms. Rodriguez,
    What a wonderful article on licensure.
    Thanks for your support and work on this effort. There are so many IBCLCs completely unaware of the desperate need for licensure. Your article reveals vast knowledge without personal bias on the matter. Ditto everything Marsha said. USLCA is working hard to advocate for the US, IBCLC.
    Excellent job!
    Would you be interested in submitting an article to Clinical Lactation on the topic?
    Genae

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