Certified Breastfeeding Counselor vs. CLC vs. IBCLC

By: Kathleen Gaines MSN, RN, BA, CBC

According to the Centers for Disease Control and Prevention's National Center for Health Statistics, there were 3.79 million babies born in the US in 2018. More than 80% of these babies were breastfed or given expressed breastmilk at some point. Lactation consultants assist these mothers throughout the breastfeeding journey. 

There are several certifying bodies that offer CBC certification and one for CLC certification. This article discusses the most popular courses that are offered and credentialed. When deciding which course to take, consider the following,

• Cost
• Location
• Reimbursement possibility from employers
• Credentialing Body
• Are you a Registered Nurse?
• Do you want to become an International Board Certified Lactation Counselor?

International Board Certified Lactation Consultants are highly trained and highly specialized individuals who promote, protect, and educate the global population regarding all things breastfeeding. 

Breastfeeding support for mothers, especially first-time moms, is crucial in ensuring their success in their breastfeeding journey. Through certification, individuals can gain the knowledge and skills needed to support these mothers. 

What is a Certified Lactation Counselor?

The Certified Lactation Counselor (CLC) certification identifies a professional in lactation counseling who has demonstrated the necessary skills, knowledge, and attitudes to provide clinical breastfeeding counseling and management support to families who are thinking about breastfeeding or who have questions or problems during the course of breastfeeding/lactation.

This certification is often seen as a stepping-stone to the International Board Certified Lactation Consultant certification.

How to become a CLC?

To become a CLC, you must sit for the Certified Lactation Counselor examination. There are three ways to be eligible for the exam. The Aggregate Pathway requires a demonstration of completed prerequisites, an application, and subsequent approval. The Alternate Pathway is for graduates of a Commission on Accreditation of Allied Health Education Programs (CAAHEP) approved, post-secondary lactation consultant program, who must provide documentation.

Or, you can attend a 5-day in-person training administered by the Healthy Children Project, Inc. – The Center for Breastfeeding at locations throughout the United States, with the final comprehensive examination administered by the Academy of Lactation Policy and Practice on the final day. The CLC course is accredited by the American Nurses Credentialing Center’s Commission on Accreditation and awards 52 continuing education hours at the conclusion of the program.

Tuition is $625, including the cost of the examination. Discounts are offered for early bird registration and group registration.

What is covered in the Comprehensive 5-day Lactation Counselor Training Course?

The comprehensive program covers a great deal of information over the week. According to the Certified Lactation Counselor training course curriculum, the information covered includes:

• The US version of the WHO/UNICEF Breastfeeding Counseling Training
• The Ten Steps to Successful Breastfeeding
• Examination of factors influencing success at breastfeeding
• Distinct weight gain patterns of breastfed babies
• Anatomy and physiology of lactation
• Composition of human milk
• Hormones of lactation, insufficient milk syndrome
• Examination of the effect on milk supply of nicotine, alcohol, contraceptives, use of paci­fiers & bottles,  engorgement, fluid intake, and diet
• Hypoglycemia, hyperbilirubinemia, and supplementation
• Medical significance of breastfeeding for the mother and infant
• Problems with infant formulas
• How to discuss breastfeeding with pregnant women
• The hospital experience: labor and delivery
• Infant self-attachment
• Collaborative feeding, infant feeding cues, normal suckling, assessing breastfeeding, strategies to use with infants who present with attachment problems
• Assessing the latch
• Enhanced effectiveness in lactation counseling, with a focus on counseling skills
• The high criticality of early support within the traditional “zone of professional unavailability”
• Sociological and psychological issues impacting breastfeeding
• Strategies for premature and ill infants, late-term preemies, multiples (twins, triplets, quads), babies with Down Syndrome, cleft lip and palate
• Breast problems (sore nipples, plugged ducts, mastitis, abscess, etc.)
• Maternal nutrition
• Effect of various foods on the nursing infant
• Postpartum mood disorders and breastfeeding
• Fertility in breastfeeding women: Lactational Amenorrhea Method, birth control, oral contraceptives
• Working and breastfeeding
• Medical problems of the mother and contraindications to breastfeeding
• Common concerns after the early weeks: developmental ages and stages in breastfeeding and child nutrition
• Weaning, nursing older babies & toddlers, breast refusal, nursing strike
• Nursing during pregnancy
• Scope of practice: professional responsibilities, ethics, and role delineation
• The Baby-Friendly Hospital Initiative in the US

Who can become a CLC?

The CLC certification is open to a wide range of individuals. Most have a nursing or medical background.

• Registered Nurses
• Hospital Staff
• Public Health / WIC employees
• Public Health Nurses
• Childbirth Educators
• Doulas
• Visiting Nurses
• Licensed Practical Nurses
• Pediatricians
• Family Practice Physicians
• OB / GYNs
• Breastfeeding Advocates
• Midwives
• Perinatal Outreach Workers
• Peer Counselors
• IBCLCs earning CERPs
• La Leche League Leaders
• Nursing Mothers Counsel Members
• Speech / Language and Occupational Therapists 

What is a Certified Breastfeeding Counselor?

A Certified Breastfeeding Counselor (CBC) certification is a specialty certification designed for individuals who recognize the specialty role of the nurse as a counselor and educator in lactation management. 

The goal of the CBC certification is to:

• Recognize the specialized knowledge, skills, and abilities of the nurse dealing with lactating women
• Strengthen the core competencies of the nurse dealing with lactation management
• Contribute to nurse educators professional development

How to become a CBC?

Designed by Prepared Childbirth Educators, Inc., the CBC course is a two-day course that has a final examination and a written assignment. This course is approved for 16 contact hours by the Pennsylvania State Nurses Association, which is accredited as an approver of continuing education in nursing by the American Nurses Credentialing Center’s Commission on Accreditation.

Tuition is $395, including the cost of the examination. PCE certification is valid for 3 years. Applicant must obtain 18 contact hours of continuing education related to lactation management in order to receive recertification and maintain the designation of CBC and pay a $50 recertification fee.

Who can Become a CBC?

• Must hold an active Registered Nursing License
• Have a minimum of one year experience working with pregnant or lactating women
• Have taken a course on lactation management in the past

What is Covered in the CBC course?

• Role of the healthcare professional
• Anatomy and physiology of the breast
• Latch on and suck assessment
• Guidelines for the first week
• Nutritional needs of the nursing dyad
• Management of common problems
• The Baby-Friendly Hospital Initiative in the US
• Special needs such as prematurity, late preterm, multiples, cleft lip/palate, neurological problems, relactation
• Medications and their effect on breastmilk
• Lactation aids
• Supporting and empowering women and their infants

What is an International Board Certified Lactation Counselor?

An International Board Certified Lactation Consultant (IBCLC) is a healthcare professional who specializes in the clinical management of breastfeeding. One of the major focuses of an IBCLC is global health and altering the importance, effects, and stigma regarding breastfeeding and breast milk.

The impact of IBCLCs on global health are:

• Improve breastfeeding outcomes
• Lower health costs
• Improve consumer satisfaction
• Improve the institution’s image
• Improve consumer trust
• Improve breastfeeding programs and policies

An IBCLC works independently and in collaboration to empower mothers, children, and families to meet their breastfeeding goals. This is the most comprehensive lactation certification.

How to Become an IBCLC?

There are three pathways for individuals who want to become an IBCLC. In order to sit for the examination, all criteria in one of the pathways must be met. These pathways are VERY specific, and it is important to make sure all aspects of the pathway are met. The examination board will not allow individuals to sit for the IBCLC examination if they are not. 

Pathway 1 (Recognized Health Professionals and Recognized Breastfeeding Support Counselors):

• Minimum of 90 hours of lactation-specific education within the five years immediately prior to examination application
• Minimum of 1000 hours of lactation specific clinical practice in an appropriate supervised setting within the five years immediately prior to examination application.
• Clinical practice in an appropriate supervised setting to include the following:
  • Hospital
  • Birth Centre
  • Community Clinic
  • Lactation Care Clinic/Practice
  • Primary Care Practitioner’s Practice/Office

Pathway 2 (Accredited Lactation Academic Program):

• Minimum of 90 hours of lactation specific education within the five years immediately prior to examination application.
• Minimum of 300 hours of directly supervised lactation specific clinical practice within the five years immediately prior to examination application.
• Pathway 2 IBCLC applicants must have completed the accredited lactation academic program within the five years immediately prior to their examination application. 
• Only the following specific programs are eligible. Each academic program has unique admission and completion requirements. You must contact these schools directly for more information about their precise requirements.
  • Drexel University
  • Johnson C. Smith University
  • Portland State University
  • University of North Carolina Gillings School of Global Public Health
  • Union Institute and University
  • University of California San Diego Extension
  • Georgia Northwestern Technical College-Rome
  • Henry Ford College

Pathway 3 (Mentorship with an IBCLC):

• Minimum of 90 hours of lactation specific education within the five years immediately prior to examination application.
• Minimum of 500 hours of directly supervised lactation-specific clinical practice as described in the Pathway 3 Plan Guide and obtained within the five years immediately prior to examination

Regardless of the pathway, all IBCLC candidates must take the required healthcare courses. This can be done by either taking the fourteen approved health education courses  OR having medical or nursing training. 

Who can become an IBCLC?

• Dentist
• Dietician
• Midwife
• Nurse
• Occupational Therapist
• Pharmacist
• Physical Therapist or Physiotherapist
• Physician or Medical Doctor
• Speech Pathologist or Therapist

What is covered in the IBCLC examination?

The IBCLC examination is 175 multiple-choice questions broken into two parts over the course of four hours. Most of the questions in Part Two are associated with an image. 

The examination is offered twice a year in April and October. The initial fee for the examination is $660, while the reexamination is $330. The monetary value associated with the exam differs throughout the world. In some countries, the fee is as low as $255 in countries such as Haiti, Honduras, Kenya, Kiribati, Kyrgyzstan, Lesotho, Liberia, Madagascar, Malawi, Mali, Marshall Islands, Mauritania, Moldova, Mozambique, Myanmar (Burma), Nepal, Nicaragua, Niger, Nigeria, North Korea, Pakistan.

Recertification for the IBCLC is every five years. The initial recertification is done by completing 75 continuing education recognition points (CERPs) or equivalent individual CERPs. Re-examination is mandatory within ten years after passing the examination.

What does a CBC, CLC, or IBCLC do?

• Support a breastfeeding parent
• Run breastfeeding classes and support groups
• Provide education on lactation, breastfeeding, and breastmilk
• Work in hospitals, clinics, or private practice
• Evaluate the breastfeeding dyad to help a client understand whether the baby is effectively transferring milk from the breast
• Assist in utilizing breastfeeding and pumping supplies
• Explore the options available if they are experiencing breastfeeding problems
• Explain the symptoms for a range of breastfeeding problems
• Provide referrals for medical diagnosis or treatment

Where can a CBC, CLC, and IBCLC work?

• Maternity units in hospitals and birth centers
• Neonatal intensive care units
• Special care nurseries
• Outpatient lactation clinics
• WIC programs
• Visiting nurse programs
• Maternal and child health services
• Parenting centers
• Military family support centers
• Physician and midwife offices

While CBCs and CLCs have a very broad range of knowledge, they CAN NOT do the following:

• Give medical advice
• Give a medical diagnosis
• Prescribe medication
• Carry out treatment

Becoming a CBC, CLC, or IBCLC is possible for nurses who have an interest in lactating women and helping change the conversation regarding breastfeeding. According to the CDC Breastfeeding Report Card, 4 out of 5 (83.2%) started to breastfeed, over half (57.6%) were breastfeeding at 6 months, and over one-third (35.9%) were breastfeeding at 12 months in 2015. Compared to rates for infants born in 2014, rates for infants born in 2015 increased for breastfeeding at 6 and 12 months.

Breastfeeding has significant health benefits to both the newborn and the mother. CBCs, CLCs, and IBCLCs assist in improving the health of families through breastfeeding. To reach their breastfeeding goals, mothers need continuity of care, which is achieved by consistent, collaborative, and high-quality breastfeeding services and support.