By Stephanie Rodriguez-Moser, IBCLC, RLC
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!)
Is your state missing? Please contact your state breastfeeding coalition to ask what they are doing for advocacy in your area!
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.