CLC, CLE, CLEC, IBCLC....OMG!! What does it all mean?

Let's face it, when you are sitting in your hospital room with a crying, screaming baby and nipple soreness you really don't care who it is who helps, you just want help! It could be from a mom, a dad (who really just wants to fix things), an auntie, a grandma, a friend, a nurse, a doctor, or someone in the lactation field.

If that kind person who helps you in the hospital or in your home is someone in the lactation field it is important that you stare strong and hard at their badge and their bio and find out what their initials are after their name. These initials are not random and like RN, MD, and APN they mean something quite significant in terms of their scope of practice, education background, and standard of practice.

Lactation Field Defined:

CLC: Certified Lactation Counselor
CLE: Certificated Lactation Educator
CLEC: Cerificated Lactation Educator Counselor

IBCLC: Internationally Board Certified Lactation Consultant

What is behind the letters?

CLC, CLE, CLEC:
These courses are NOT Board Certified nor are the Advanced Practice Certifications.

CLC: This is a 5 day class. 45 contact hours for CE provided, from flyer looks like 40-45 hours of classroom instruction, no clinical hours, no attendance at breastfeeding class. From the organization that presents CLC it is important to know that they state, "The CLC certification carries no regulatory authority for licensure. All participants should seek information about how this competency verification certification relates to employment in their community." Taken from webiste: http://www.healthychildren.cc/PDFs/4PageFlyer_2013.pdf

It is also important to note that it also states " The Certified Lactation Counselor® Exam is administered by the Academy of Lactation Policy and Practice (ALPP)" which is a division of Healthy Children Project, Inc. which is the presenter of the CLC and defines the CLC. Here is their pamphlet from 2010: http://www.talpp.org/CLC_Candidate_Handbook_2010S.pdf

CLE: 20 hours instruction time; 4 hours clinicals; Info can be found at: CAPPA; There are also course offerred as 45 CEUs (45 hours) through organizations such as this with no clinical component much like the CLC above. BASTYR Education

CLEC: 45 CEUS offered as: 45-60 hours instruction time; 4 hours clinicals; Info can be found at UCSD Lactation Program


IBCLC, RLC:
These are all Board Certified and Advanced Practice Certifications

IBCLC (often represented as RLC on hospital badge): This is an Internationally Board Certified Lactation Consultant.  Your IBCLC can be an RN, MD, OT, Speech Therapist, Dietician, RT, LPN, La Leche League Leader, or just an interested breastfeeding supporter. Their practice as an IBCLC will be greatly influenced by their other experiences, knowledge, and certifications. Which ever path leads one to be an IBCLC, remember they are an Advanced Practice Clinician and are Board Certified in lactation.

Just like your RN, LPN, RT, or MD passed an exam and stringent qualifications that included schooling and clinical experience, so too did your IBCLC! This person's scope of practice, practice, and licensure is maintained by IBLCE (International Board of Lactation Consultant Examiners) . This person has a license number that you can verify here: http://americas.iblce.org/ibclc-registry.  IBCLC is defined in this document: http://americas.iblce.org/what-is-an-ibclc. Pathways that your IBCLC followed to qualify to take the examination can be found here: Pathways to Becoming an IBCLC and a great video to watch to learn more can be found here: How to Become a Lactation Consultant  .

IBCLCs, like MDs and other healthcare professionals can apply for an NPI (national patient identifier) so that they may join a panel of health professionals and receive payment for services through health insurance.

To complicate matters further:
Now to complicate things further some programs have added more letters to the IBCLC and have intertwined CLC and IBCLC. For instance the use of ANL and ANLC. Over the past few years there has been a fair amount of controversy surrounding CLCs calling themselves consultants and making their practice equivalent to that of an IBCLC. In these courses this melding of the two is done so that an IBCLC and a CLC  can come out with ANL or ANLC at the end of their name.Healthy Children defends their argument in this document: IBCLC and CLC equal? For commentary on this debate you can turn to some fabulous blogs: Public Health Doula ; Anthro Doula ; Lactation Laura

UGH!! Like you weren't already confused, right?

Personally, I just find the creation of this mess of letters by Healthy Children is just one more way to confuse the issue and complicate the pathway for a mom in pain and desperation to find the correct assistance for her breastfeeding challenges.  As you can see from the basic qualifications required for each certification no matter what you put after your name if it is not IBCLC or RLC then you may be interacting with a professional who has had far less exposure and education on the abnormal and incredibly complex issues that can arise when breastfeeding takes a wrong turn. The definitions are also well stated and laid out in this article: http://www.bellaonline.com/articles/art63829.asp.

In the end it comes down to two things. 1. Those of us in the lactation field CORRECTLY representing ourselves and making sure a mom (and we) understands out scope of practice. 2. Moms, dads, partners, aunties, friends, sisters, and those who want to help taking the extra few seconds to ask what a persons qualifications are and quickly checking for an IBCLC certification verification online just as you would for any MD visit. (It's just that important!)

Preventing the Pump.....HUH??

Yes, the title of this note is Preventing the Pump.

First, why would you want to prevent the pump? Well, let's start with it is not the baby. It is not warm and cuddly and instead is cold and plastic and hard. It is not free and can not be popped on in a park. Instead it is constantly attached to a wall socket and usually used in a closed room separated from family, colleagues, work partners, home partners, and in general a very isolating process. It does not hide the results and it does not feed on demand. Instead it shows how much or how little or how in between your body is on that day at that moment in that time. In doing this it often increases anxiety, the push to make more which causes stress and then in turn decreases your milk production, and makes a mom 'chase the milk trail' as I often put it. And finally it is not free. In order to provide adequate stimulation and emptying of the breast one will need a high powered specifically designed hospital grade pump and there is nothing cute or easily portable about this.

So then, How do you prevent the pump?

Preventing the pump is not something you will see publicized by Gerber or Playtex or Medela or Ameda or EvenFlo or anyone making nipples, bottles, advertisements for your television, or the swing your baby loves. Preventing the pump, like all preventative medicine, is often low profile preventative action that produces high reward for those who search it out. Preventing the pump involves indepth, family specific breastfeeding education. Basically, it involves a plan for feeding your baby.

WHAT? A plan to feed my baby?

Yes, just as you planned your pregnancy and carefully chose those physicians who will take care of you while you grow that beautiful baby inside you there are many who guide you through making plans in conjunction with your wishes, wants, and dreams on how to feed your baby.

This is best done with an IBCLC well versed in the normal pregnancy and the many pregnancy complications like gestational diabetes, high blood pressure, IUGR, preterm birth, and proper management of c-sections for breastfeeding.

With an IBCLC a plan can be made for the perfect birth and then a plan for 'Oh My God What Happened Now? ' situations. A plan should include education on what an appropriate blood sugar is for a breastfeeding baby, appropriate supplementation and when and what should be used if needed, management of jaundice, and skin to skin 'when and where' it should be done. This plan should also include a discussion of pumps and which ones are most appropriate for situations like oversupply at 7-10 days or babies in the NICU or babies who have difficulty with the first latches in the first 7 days or traumatic births.

This plan should also include follow up within 48 hours of birth as well as follow up at 5-7 days postpartum and 2 weeks postpartum as mom and baby build their breastfeeding relationship and grow through the first two milestones of oversupply at 7-10 days postpartum and baby regaining birth weight by 2 weeks of age.

If you plan to prevent the pump then when you need the pump the correct pump will be used.

In preventing the pump you ensure your best chance at a positive breastfeeding experience!
In preventing the pump you ensure the best possible bonding experience with baby!
In preventing the pump you also prevent loss of money on pumps that are not appropriate or damaging to the breast when used inappropriately!

In preventing the pump you will achieve your dreams!

For more information on prenatal lactation consultations and preventing the pump please visit Prevent the Pump!


Best Wishes!
Lisa Weinshenker, RN, IBCLC
A practice of consultation and
sisterhood support for breastfeeding
families.

Pumping Tips for Moms!

Just a few ideas that I use in my practice as general guidelines for successful pumping. 

For Mom/Baby Separation 24 hours a day during the first few weeks postpartum:

1. It is advised to pump for 20-25 minutes with heat and massage 8 times in 24 hours which is every 2-3 hours with one 4 hour rest at night.
2. It is advised to use small colostrum containers from the hospital of from the Boobie Boutique when pumping in the first 3-5 days.
3. For the first 3-5 days postpartum depending on the amount of fluid you received you may or may not get any colostrum in the bottles. The purpose of pumping at this time is to provide effective and efficient stimulation to the breast to help bring your milk down to meet the baby as quickly as possible AND to signal the fluid you received in your IV prior, during, or after delivery to not enter your breasts and ‘hold your milk hostage’ and delay its flow. You NEED this 20-25 minute stimulation 8 times in 24 hours to trigger your hormonal cascade into high gear to make the appropriate amount of milk for your baby.
4. Following your 20-25 minute pump sessions it is advised to do 5 minutes of hand expression on each side. This will provide the compression needed to express the colostrum from the breast. A good 7 minute video to watch for this is the Stanford Hand Expression Video which can be found by googling or at: http://newborns.stanford.edu/Breastfeeding/HandExpression.html

For Going Back to Work:

1. It is advised that while at work you pump every 3 hours for 20-25 minutes with heat and massage.
2. Prior to returning to work, it is advised that you begin pumping and bottlefeeding 2 weeks before returning to work. It is advised that you pump 2 times a day for 10 minutes to get your body used to your pump and to create a storage of about 1-2 ounces a day. It is usually advised that baby is bottlefed once a day for two weeks prior to your returning to work. This will give both the baby and your body time to get used to the pump.
3. It is advised that while pumping you DO NOT look at the pump. Forcing your milk to flow doesn’t work, but looking at pictures of your baby, talking to your baby by phone, or use of other distractions will relieve your mind of stress and assist you to let down for your pump.