Lactation Courses and Credentials

Lactation Courses and Credentials

I am asked frequently if a course is sufficient preparation for sitting the IBLCE examination and/or becoming a lactation consultant. The following explains some of the relationships between courses and credentials, and what is needed for adequate breastfeeding support in our communities.

Part I - The nature of education and credentialing

1. A course will teach you something about a topic. For obvious reasons, a longer course such as my Lactation Management / Exam Prep Course can teach more about a subject than a shorter course. Some courses ask that the student do additional reading outside of class. Those students that complete the reading assignments will ultimately learn more, and will probably get more out of the in-class sessions as well. At the end of any course, the student will (hopefully) know more than when they started.

2. Some courses have a test at the end to see if the student mastered the material. If the student passes, they are issued a document that says "on this day, the student learned the stuff we taught." Completion documents are often used by employers as demonstrations of a certain level of competence. Example: BLS certification (Basic Life Support or Cardio-Pulmonary Resuscitation), ACLS certification (Advanced cardiac life support), Lifeguarding Certificate, Water Safety Instructor Certificate, etc. If you want to test yourself, try one or more of the three complete practice exams including clinical pictures in my book Comprehensive Lactation Consultant Exam Review.

3. Course-specific "certificates" are as good (and only as good) as the agency/association/course sponsor. Certificate courses run by nationally recognized organizations, like the American Heart Association’s BLS courses, are more valid than Joe Schmoe’s Heart Attack Rescue Course taught only in Podunk, Ohio. (phony name used for example only). To date, there are no international standards for lactation courses. ILCA has been working on this project since 1992 with the help of many people in lactation and educational fields. The lactation course directors, IBLCE and ILCA representatives are continuing to actively pursue this issue with more meetings scheduled for 1999. Comments can be sent to IBLCE@erols.com or ILCA@erols.com.

4. Passing the IBLCE examination is NOT the same as receiving a document issued at the end of a course, regardless of the title of that document, the length of the course, or even the quality of the course. There are some excellent lactation courses around of various lengths. All the lactation courses that I know of, at this writing, are decent programs as they are advertised. They are not created equal, nor designed for the same audience(s). My point is that ANY course-completion document, from any course, is NOT THE SAME as the IBLCE credential. For example, I could take a 1-semester course in basic bookkeeping through my community adult education program, pass the test at the end, and earn a Certificate in Pretty-good Accounting. This is a far cry from being a Certified Public Accountant! Would I know more about bookkeeping than when I started? Probably. Is this enough knowledge for the work I do? Maybe. Am I as good at bookkeeping as a Certified Public Accountant? Of course NOT!

6. No exam or credentialing process is perfect. There are some "false positives" in every profession. We probably all know of a nurse, dentist, lawyer, teacher, pastor, or mechanic who practices his/her profession badly. Disciplinary programs are designed to remove the bad apples that slipped through the exam, and are somewhat successful in removing the worst of the bad.

7. All teachers lead their students to the "water" of their field - in my case, research-based lactation management. Some students drink deeply and go forth nourished, excited, and motivated to improve. Other students only take a sip, and later spit out the most carefully researched information presented by the most talented, brilliant teachers. Some come to class with only a minimal understanding of the topic; others come with a long legacy of misunderstanding or misinformation, and still others come with a wealth of skill and experience. The novices are often overwhelmed, the misinformed are challenged and sometimes threatened, and the skilled are reinforced in their beliefs. The biggest challenge as a teacher is to meet the needs of ALL of these students with patience, respect, integrity, and humor.

Such is the nature of education.

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Part 2 - How much is enough education?

1. A license or certificate is one measure of assuring the public that the holder has competence in the material. Licenses are the most restrictive and are issued by governmental entities. Certificates are less restrictive and issued by various agencies, some of which are themselves certified by the National Organization for Competency Assessment. IBLCE is certified by NOCA.

2. Some licenses and certificates require the candidate to complete an accredited course of study. Other professions do not have a required educational pathway. For example, in some areas, a prospective lawyer does not have to have graduated from (or even attended) an accredited law school to take the bar exam - the candidate can prepare for the exam in a variety of ways including self-study. If the individual passes pass the bar exam, he/she is a duly licensed lawyer just like others who also hold degrees from prestigious law schools.

3. The central issue in our field is "how much education/training is enough?" More is always better. Many of us, once we began practicing, quickly realize how much more there is to be known about lactation and breastfeeding - and how little we knew last year, five years ago, ten years ago. Take an example from another field: Do you need a 1-hour lesson to learn to draw, or can anybody figure it out on their own? How about a one-week course? A 2-year college degree? Masters degree in Fine Art? Any degree at all? Apprenticing for __(how long?) with an expert? How does one determine an expert? Is an ordinary pencil good enough to start drawing? Or does everyone need $2000 worth of professional grade materials before beginning? My sister Nancy Dahlstrom holds a MFA degree and is a full Professor of Fine Art. I can draw breast diagrams well enough to illustrate a breastfeeding problem. We can both "draw," but are clearly NOT equivalent in our level of skill and knowledge. She knows breastfeeding is good for babies. So do I - in a depth and breadth far exceeding anything she ever imagined. We are clearly not equivalent in this area either!

4. The IBLCE exam was designed from the outset to be the minimum knowledge/skill necessary for anyone directly working with mothers and babies. IBLCE’s mission, as with other credentialing agencies, is to find the bottom line, below which represents unacceptable knowledge, skill, and attitudes. This task is very complex and tricky in every profession, and lactation is no exception. IBLCE has always sought and implemented the most highly respected psychometric techniques to establish this floor.

5. Recertification is one of these issues where IBLCE is using the best techniques to assure the retention of only competent providers in the field. More and more professions are re-testing their practitioners periodically because other methods have not been shown to assure the public of continuing competency.

6. For those who propose a lesser credential than IBCLC, what would you leave out???

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Part 3 - How much expertise/training/knowledge is needed to help women breastfeed?

1. ANY education/training in breastfeeding is better than none. A one-day course is better than a one-hour inservice. A one-week basic course is better than a one-day course. A longer course is generally better than a shorter one. More knowledge and skills are always better than less. In general, a full time IBCLC is qualified to provide a broader scope of breastfeeding care than someone without that credential.

2. I have a real problem with institutions that try to get by "on the cheap" by asking volunteer peer counselors to shoulder responsibilities far beyond their legitimate scopes of practice. This is unethical, dangerous and exploits the volunteer! And puts the institution and clients/patients at unnecessary risk. Asking a lactation educator - trained to teach good breastfeeding classes - to do 1:1, hands-on support in a clinical setting is asking that educator to stretch far beyond what their training was intended to accomplish. No hospital would expect, or even allow a certified childbirth educator to do the job of a certified nurse midwife. That some individuals can rise to the occasion is a testament to their skill, but NOT a justification for the practice!

3. I realize that institutions have to start somewhere, and that peer counselors and/or lactation educators are often the key to opening the door to more/improved lactation services. This is good. This is only a START, however. I hope these institutions keep going. For example, I’m told that a small Level I hospital in Virginia has a stated goal that all of the staff perinatal nurses will become IBCLC certified. ALL of them. Very cool idea!

4. Institutions are prepared (or forced) to pay for appropriately trained and credentialed providers in other areas of health care. Why should breastfeeding support be any different?