The Landscape of Breastfeeding Support
A User’s Guide
When looking at the landscape of breastfeeding support, there are different certifications, training programs, and scope of practices. Here we have put together an outline to help describe what each may entail.
About this document
Breastfeeding is a public health imperative. While breastfeeding rates continue to increase, significant barriers still exist for many families in spite of efforts at local, state and federal levels to improve breastfeeding support. Many mothers are unable to breastfeed for as long as they wish because they lack access to appropriate support services. There are a number of types of lactation support providers, all of whom are necessary to improve breastfeeding initiation, duration, and exclusivity. However, differing education and training, multiple types of certifications, and confusing terminology may be bewildering to families, insurers, employers, policy makers, hospitals, and the general public. This table is designed to help the public navigate the many different lactation qualifications.
Certification programs versus certificate programs: There are several important differences between professional certification programs and educational certificate programs. Only the IBLCE program is a professional certification program in lactation consulting, granting the IBCLC certification. According to the Institute for Credentialing Excellence (also known as ICE and formerly known as NOCA), the leader in setting quality standards for credentialing organizations, there are a number of key differences between certification programs and certificate programs. The National Commission for Certifying Agencies (NCCA), part of ICE, is considered the gold standard in accreditation for any certification program. A certification program that is accredited by NCCA has measures in place to eliminate potential conflicts of interest, such as those described above. Its criteria are rigorous. NCCA’s precursor, was formed in 1977, in cooperation with the federal government, to develop standards of excellence for voluntary certification programs. NCCA accredits a broad range of certifying organizations.
According to ICE, professional certification is:
“a voluntary process by which a non-governmental body grants time-limited recognition and use of a credential to individuals who have demonstrated that they have met predetermined and standardized criteria for required knowledge, skills or competencies. To retain the credential, certificants must meet requirements for renewal. The credential awarded by the certifier denotes that the participant possesses particular knowledge, skill or competencies.”
(ICE 1100: 2010 (E)—Standard for Assessment-Based Certificate Programs, Institute for Credentialing Excellence, Washington, D.C., 2010.)
A Certificate program
• Provides education and training to an individual
• Is generally associated with a particular course or program
• Is not independent of any provider of classes, courses or programs
• Certificate holders “shall not say that they are ‘Certified in. . .” and “shall not use acronyms or letters after their names to reference the certificate they hold” or make “claims or imply that the certificate is a professional certification.”
A Certification program
• Assessment of knowledge or skills (which is completely separate from training)
• Individuals must meet predetermined criteria (education, professional experience, supervised clinical experience) to be eligible for exam
• Must pass a professionally developed exam
• Is time limited and requires periodic renewal
Generally speaking, lactation consultants are paid lactation professionals who help mothers and babies with a wide range of problems, including sick mothers and babies and are a valuable part of the health care team. These types of problems they evaluate might include excessive weight loss in a breastfed infant, questions about medications, and anatomic issues in the mother or baby that might interfere with breastfeeding, and other types of high acuity scenarios.
Counselors generally have less extensive training and they help troubleshoot basic problems, recognize when to refer mothers to other health professionals. They provide valuable emotional support, encouragement, and confidence building. Often they are volunteers serving in mother-to-mother support groups, or may work as WIC peer counselors.
Educators may teach breastfeeding classes to pregnant women.
Most of these organizations charge fees for the training and/or certification, and again for recertification, if they provide it. If the organization that provides the certification is also the same organization that provides the training, there may be a potential conflict of interest. Certification programs from NCCA take measures to ensure that there is no such conflict of interest.
The role of experience:
Some organizations require that an individual holding their certificate must have breastfed her own children. This is especially true for peer counselors offering mother-to-mother support. Be aware that experience breastfeeding one’s own children, by itself, is neither necessary nor sufficient to provide professional clinical advice, nor would it count as appropriate clinical experience to qualify one to sit for the exam to become an IBCLC.
While there may be other individuals who are as skilled and knowledgeable as IBCLCs but do not hold this qualification, without the IBCLC, a consumer has no guarantee of an individual’s minimum level of training, experience or knowledge. As with any profession, some who hold the qualification may be more skilled than others. Many of these qualifications, including the IBCLC, have a grievance process for removing those certified individuals who are later found to possess insufficient skills for the certification.
Finally, there is a role for individuals who have lesser qualifications than the IBCLC. It is important, however, that the consumer know which is the appropriate type of help or education they should seek.
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Lactation Consultants- Professional Certification |
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditationfrom NCCA* Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites(college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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International Board Certified Lactation Consultant (IBCLC) International Board of Lactation Consultant Examiners www.IBLCE.org |
90 hours |
300-1000 hours depending on chosen pathway 14 college-level health science courses |
Accreditation from National Commission for Certifying Agencies (NCCA) Independent |
Exam is given at an independenttesting center IBLCE and the exam areindependent of any course, person, business, organization, or group to assure that no conflicts of interest exist |
90 hours lactation-specific classroom education 14 college-level health science courses 300-1000 hours lactation specific clinical experience |
Must recertify every 5 yearswith 75 hours of continuing education or by exam |
Scope of Practice is independent of any courses or programs Certificants have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation https://iblce.org/wp-content/uploads/2018/12/scope-of-practice-2018.pdf Clinical Competencies inform the public of the field in which IBCLCs can provide safe, competent and evidence-based care. Certificants practice within 83 areas of clinical competency https://iblce.org/wp-content/uploads/2018/12/clinical-competencies-2018.pdf |
*National Commission for Certifying Agencies of the Institute for Credentialing Excellence
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Breastfeeding counselors, educators and educational programs. Some include certificates of completion |
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditationfrom NCCA Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites (college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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Certified Lactation Specialist (CLS) Lactation Education Consultants |
46 hours |
None |
No |
Exam given at end of course Proprietary |
None |
Every 5 years None if IBCLC or retake course or acquire 25 hours education or by take home exam |
Emphasis is placed on preparation for practice as an IBCLC |
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Certified Breastfeeding Specialist (CBS) Lactation Education Resources |
45 and 90 hour options |
None required for CBS Separate opportunities for 100 & 500 clinical placement hours and college courses |
No |
Exam given at end of course Proprietary |
None |
Every 5 years 20 education hours |
Scope of Practice created by course provider www.lactationtraining.com/ images/PDFs/Scope-of- Practice-CBS-revised.pdf Qualified to perform duties in uncomplicated breastfeeding situations |
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditation from NCCA Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites (college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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52 hours |
None |
Accreditation provided by Academy of Lactation Policy and Practice (ALPP), a part of the Healthy Children Project, Inc. American National Standards Institute (ANSI) certifies that ALPP meets ANSI’saccreditation program requirements |
Exam given at end of course Proprietary |
None |
Every 3 years 18 hours continuing education |
Scope of practice created by course provider https://www.alpp.org/pdf/CLC-Scope-of-Practice.pdf Course completion signifies the certificant has a firm grounding in information and counseling skills required to provide support to breastfeeding mothers and their children
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Certified Lactation Educator Counselor (CLEC) UC San Diego | Extension https://extension.ucsd.edu/courses-and-programs/lactation-and-perinatal-education |
45 hours onsite, 60 hours online |
None |
University-based program |
Periodic testing |
None |
None |
Lactation Educator Counselors are typically entry level practitioners and deal primarily with the normal process of lactation. Required prerequisite to the Lactation Consultant course
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditation from NCCA Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites (college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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Certified Lactation Educator (CLE) Childbirth and Postpartum Professional Association (CAPPA) |
20 hours |
No college level health science courses Observe 2 support meetings 4 hours observation with IBCLC |
None |
Proprietary |
None |
Every 3 years 15 hours Read 10 research studies from peer reviewed journals |
The CAPPA CLE® does not prescribe, treat, nor diagnose breastfeeding related conditions and is trained to refer clients facing circumstances that require this degree of intervention to a qualified professional, such as an IBCLC. The CAPPA 20 Hour Lactation Educator™ course is not an IBCLC exam prep course, nor does the CAPPA CLE® training prepare a student to become an IBCLC.
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Certified Breastfeeding Educator (CBE) Lactation Consultant Services |
23 hours |
None |
None |
Proprietary |
None |
Every 5 years 5 hours |
An educational offering that provides a comprehensive overview of breastfeeding promotion and assistance strategies is available for health care providers and breastfeeding advocates. Certified Breastfeeding Educators™ are not qualified to represent themselves as lactation consultants. |
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditation from NCCA Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites (college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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Certified Lactation Educator (CLE) Evergreen Perinatal Education |
45 hours |
None |
Proprietary |
Quizes on content |
None |
None |
This education is for any healthcare professional or individual who works with new families and their newborns, or as the beginning process for becoming an International Board Certified Lactation Consultant (IBCLC). |
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9 month online course |
None |
Proprietary |
Candidates are expected to complete at least one lesson (typically one textbook chapter plus some brief online activities) per month. |
Have to have breastfed an infant for 1 year |
Complete minimal continuing education within three years after accreditation |
Volunteer lay counselors. Their primary function is to offer evidence-based breastfeeding information and support to women through in-person meetings, by phone, or online as representatives of Breastfeeding USA. |
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Certified Clinical Lactationist (CCL) Breastfeeding Outlook https://breastfeedingoutlook.com |
90 hours |
None |
None |
Proprietary |
Complete 90 hour course; non-licensed providersmust completeHealth Sciences Continuing Education Package |
Every 3 years 30 hours continuing education
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Scope of practice created by course provider https://breastfeedingoutlook.com/documents/CCL/CCL_Terms_and_Conditions.pdf |
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Program title Sponsoring entity |
Hours of lactation- specific classroom education |
Hours of required clinical experience College-level health science courses |
Accreditation from NCCA Independent or proprietary |
Certification exam Independent or proprietary |
Prerequisites (college coursework, clinical experience, etc) |
Recertification process |
Scope of practice Independent or proprietary Comments |
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Self-paced study program |
Demonstrtesprogressively increasing helping skills with other mothers at LLL meetings |
Proprietary |
None |
Has breastfed infant for 1 year; has attended a series of LLL meetings |
Leaders are accountable to stay current on breastfeeding information and LLLI policies and procedures |
Volunteer lay counselors who give mother-to-mother support on behalf of the organization. The LLLI training program focuses on the normal course of breastfeeding from prenatal through weaning. Effective communication skills and group dynamics for leading support groups are also included. |
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WIC Peer Counselors US Department of Agriculture https://wicbreastfeeding.fns.usda.gov/become-wic-peer-counselor |
Typically 20 hours |
None |
None |
None |
Has breastfed a baby for 1 year; past or current WIC participant |
None Annual continuing education |
WIC peer counselors give basic breastfeeding information. WIC peer counselors refer moms to a WIC Designated Breastfeeding Expert for complex breastfeeding challenges. |
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NMC Counselor Nursing Mother’s Council Nursing Mother’s Counsel |
Workshops 21 hours |
Shadows on hospital rounds and home visits; counsels under supervision |
None |
Role play exam Proprietary |
Personal experience Breastfed for 6 months |
6 hours annually |
Volunteer lay counselors Volunteer lay counselors |
NOTE: The contents of this chart are subject to change. For the most up to date information on any given credential, please refer to that credential’s website or contact them directly.
Sources of information
All information, included quoted information, is taken from the organizations’ websites.
All information is subject to change.
Last revised: July 2019
© 2019 Massachusetts Breastfeeding Coalition
