Lactation Management Training: From Novice to Expert

Lactation Education Resources Blog

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So many people who are excited about working in the lactation field begin by earning a certification like Certified Lactation Educator, Certified Lactation Specialist, Certified Lactation Counselor, WIC Breastfeeding Peer Counselor, LER’s own Certified Breastfeeding Specialist, or one of the many other “mid-level”, shorter lactation trainings out there.
Many then use that training to help families through work or volunteer experience, getting hands-on time providing clinical lactation support. While they would love to take the next step by becoming an IBCLC, they know more education and training is involved, so it seems like a dream for “someday.”
Sound familiar? If the description above fits you, the IBCLC may actually be closer than you think!
To be eligible to take the IBCLC exam, you need to complete three components: clinical hours, general health science education, and 90 hours of lactation education.
Clinical Hours
If you are providing lactation support through your work, or if you’re a trained counselor for a peer support organization, you may already be earning Pathway 1 clinical hours without realizing it! And if you are seeking to earn your clinical hours through mentorship in Pathway 3, you may be interested in LER’s internship program. (Not familiar with the Pathways? Read more about the different options here.)
General Health Science Education
If you’re already a health care professional like a nurse, dietitian, physician, or midwife, you’ve automatically fulfilled the general health science education requirements with your prior training. Even if you’re not, the list includes many classes you may already have taken, like biology, nutrition, and statistics. (You can find a full list here, as well as links to LER partners offering courses you may still need to complete.)
90 Hours of Lactation Education
The final step is simply to complete your 90 hours of lactation education. Your current training has given you a good foundation in lactation support basics via 45-55 hours of didactic education - so you’re already at least halfway to the 90 hours! That’s where LER’s new Lactation Consultant Bridge Course comes in: you can complete your education hours, prepare for the IBCLC exam, and most importantly, prepare for the advanced practice knowledge and skills required for IBCLC professional practice.
To create the Bridge course, we took a deep dive into what was covered in the course for our basic credential, the Certified Breastfeeding Specialist. We considered the additional necessary topics to provide a truly well-rounded IBCLC education. When you walk into a room as an IBCLC, the expectation is that you have a comprehensive, in-depth education to be prepared for almost any question or scenario. We compiled our cutting-edge workshops and lectures into the Bridge course, with a focus on compelling topics that lactation consultants face in practice.
Bridge topics include working with multiples, premature infants, relactation and induced lactation, infant feeding response in disasters, and so much more. In total, the Bridge course offers 45 hours of amazing content to prepare you for a wide range of practice situations. We hope it will enable you to complete your lactation education and that once you’ve “crossed the bridge” to IBCLC, you’ll realize it really was closer than you thought!
Common questions about the Lactation Consultant Bridge Course:
Does the course confer a certification like Certified Breastfeeding Specialist?
No - the Bridge course doesn’t give you the foundational parts of your lactation education, but builds on a basic course you have already taken. To enroll in the Bridge course, you should have already completed a basic education course/certification l (often 45-55 hours long).
Don’t you need to go through a specific educational program to become an IBCLC?
You can source your 90 hours of lactation education from a variety of places! While you can “piece together” your education from different sources, IBLCE recommends that your education cover all the topics on the IBCLC Detailed Content Outline. The Bridge course is intended to fill in gaps in your education beyond your original training, and to help prepare you thoroughly for the exam and for practice.
Where can I complete the 5 hours of communication skills education that is now required by IBLCE?
We’ve got you covered! A communication and counseling skills course will also be available from LER for those who still need to complete that requirement. (It will be offered separately from the Bridge course.)
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A parent schedules a prenatal consult with you and explains, “I am expecting a baby via surrogate, and I’m interested in inducing lactation. But I’m not really interested in taking medication. Is it still possible?” Or a parent who is planning to adopt says, “I’d love to induce lactation. I could be matched with a baby tomorrow and bring them home next week… or I could be waiting for a year or more. How do I plan for that?” Alyssa Schnell, MS, IBCLC is an experienced lactation consultant and the author of the book “Breastfeeding Without Birthing.” Her new Lactation Education Resources course, “Individualized Approach to Lactation,” shares her extensive research and clinical experience - as well as her own personal experience - with induced lactation. Below, she shares some key points about the importance of understanding and customizing a plan for each family:
Moving beyond medical protocols
A medical protocol to induce lactation was developed years ago, and many people have used it successfully. It is often the default protocol recommended when someone is interested in inducing lactation. But as Schnell counseled more and more families, she realized the protocol wasn’t a good fit for everyone. She was discouraged when some interested patients felt that because they were unwilling or unable to follow that exact protocol, they wouldn’t be able to induce lactation after all. “I thought wait, wait, that can’t be right - there can’t be just one way that we induce lactation,” Schnell says. “I started doing a lot more research and discovered that there are other protocols out there for inducing lactation.” She’s combined her research, our fundamental understanding of how inducing lactation works, and her own extensive clinical experience to develop a three-step plan for inducing lactation that can be used by any parent wanting to induce. Each step is flexible and can be modified and customized - or even skipped - to fit the parent’s needs and circumstances.
There are alternatives to prescription medication
Some patients are unable to or unwilling to take prescription medications that are commonly used to induce lactation. At each step, there are non-medication approaches if medication is not right for that individual parent. Those same approaches can also augment protocols that call for medication. Herbs, alternative therapies like acupressure and acupuncture, and manual techniques like breast massage are all ways to support milk production. Each should be customized to the parent’s specific situation, goals, and health history.
It’s not just adoptive parents interested in inducing lactation
The most frequently discussed scenario for inducing lactation is that of an adoptive parent. But there are many other people who may contact an IBCLC for support with inducing lactation, including an intended parent (baby arriving via surrogacy); the partner of a gestational parent; a transfeminine parent; and more. “I want to walk attendees through each of these circumstances and help you understand what the different needs and nuances are for each of them,” Schnell says.
A parent does not need to induce lactation to nurse!
Schnell explains that while parents and lactation consultants can often become very focused on the goal of milk production, it is not necessary to induce lactation to establish a nursing relationship. Without making any particular effort to establish milk production, the parent may choose to comfort-nurse the baby (for example, nursing to sleep, nursing after the baby has had a bottle, and/or feeding the baby using a nursing supplementer at the breast/chest). “The intention is to have the benefits of the closeness and the physical components of baby feeding at the breast or chest, and not emphasize about getting the parent’s milk,” Schnell notes. While those approaches may encourage the body to make some milk, the focus is on the bonding and nurturing that come from the nursing relationship.
Both sharing her own story and the stories of the many patients she has worked with, Schnell illustrates the many different ways induced lactation can look, and provides specific tools and strategies for the IBCLC counseling any family interested in inducing lactation. And beyond induction, “I also hope that this information will help you with other situations as well,” Schnell says. “This information applies to relactation, insufficient glandular tissue, breast reduction surgery, and any other low milk production issue.”
And Schnell is offering two additional courses that will provide you with even more resources and skills to support patients who are building milk supply: “Tools for Supplementation,” and “The Proficient Pumper.” All three courses are included in her new online conference, now available at Lactation Education Resources.
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Looking for other resources on relactation?
Check out our free fact sheet
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IBLCE Exam Prep: Tips for Medication Questions
For those of us who are preparing for the IBLCE exam this September, especially those without a medical background, the medication questions can be particularly nerve-wracking. In this blog post, Angela Love-Zarenka, IBCLC, RLC shares tips for demystifying this part of the exam.
Start by understanding the categories of medications.
All medications can be organized into categories, such as antibiotics or anti-inflammatories. A good place to start - especially if you do not have a medical background - is to review an outline on those categories, known as classes. Learn which are the most commonly used during the time of pregnancy through weaning and familiarize yourself with those.
Identify the medications that are contraindicated for breastfeeding.
As you know from your lactation training, most medications are compatible with lactation, but some are absolutely contraindicated. Be sure you know which those are.
Learn the generics.
The exam will use generic names of medications. Be sure you are familiarizing yourself with, for example, sertraline (the generic name) and not Zoloft (the trade name).
Don’t forget vaccinations.
Learn which vaccinations are contraindicated in lactation and when. Remember, if a topic is on the exam blueprint, it may be on the exam!
Understand the why behind the guidelines.
When you are studying medication, try to not just memorize whether the medication is acceptable, but truly understand why. For example, if a mother is receiving heparin via IV, can she continue to breastfeed? The interesting thing about heparin is that it does not pass into breastmilk because the molecular weight is too big. (That is why she is receiving it via IV, not orally.) Knowing these nuances can help.
Feel Prepared to soar through your IBLCE Exam. LER offers two exam prep courses designed to help you study efficiently and effectively.
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Epigenetics is a hot topic these days and discussed more and more in the lactation world - but what IS it? Why is it relevant to the perinatal period? And as experts in lactation, how should we understand and explain the role human milk might play in “programming” the epigenome?
Laurel Wilson, IBCLC, RLC, BSc, CLE, CLD is an experienced lactation consultant and speaker on perinatal health topics. Her new Lactation Education Resources class shares leading-edge research discoveries in the exciting new field of epigenetics. These discoveries are changing how we think about human milk. Below, she shares some key points about epigenetics and infant feeding:
Our DNA is not destiny: it’s just a starting point.
Only a small percent of disease comes directly from genetic origin. Many people are born with a genetic predisposition to disease; common examples include diabetes, heart disease, and many types of cancer.
But not all people born with the genes placing them at higher risk for a disease will develop it. Why?
“Epigenetic” literally means “above the gene.” Epigenetic changes take place when cellular elements interact with our genes to “flip the switch:” turn genes on or off, or increase or decrease how active they are. Environmental factors like how we are fed as infants, what we eat later in life, what physical activity we do, and how much stress we experience can all flip the switch on genes that affect our health. These epigenetic changes can persist throughout life. In some circumstances they can even be inherited by following generations.
There are multiple ways that genes can be turned on or off.
One example of a way genes can be turned on or off is through the function of molecules called microRNAs. The primary role of these regulators is to turn genes off and on.
MicroRNAs can survive very difficult conditions: they can survive pasteurization and even boiling, freezing, and acidic environments - like say, a baby’s stomach.
There is a very high level of microRNAs in human milk for the first 6 months after birth - this is a stream of genetic instructions passing from parent to baby via milk. In fact, microRNAs in human milk is the only time outside of sexual reproduction that genetic material is transferred from one person to another!
Breast/chestfeeding does not just affect the epigenetics of a baby: it also affects the parent.
There are over 700 maternal genes expressed during the postpartum period! Many of the hormones and hormonal changes involved in lactation - including prolactin, oxytocin, estrogen, and progesterone - communicate to the brain that parenting is happening, and alter gene expression in the brain.
No surprise: “Many of these genes are linked to reward pathways, to promote bonding and connection between parent and child,” says Wilson.
It is vital for us to understand and communicate about this research accurately.
We are often called upon - by the families we serve, other health professionals, journalists, and others - to discuss the unique properties of human milk and breast/chestfeeding. Is it just food? Why work hard to promote and protect human milk feeding?
We all know that beyond nutrition, milk provides a multitude of immune factors, hormones, prebiotics, probiotics, and anti-microbials, many of which play a role in the numerous lifelong health effects of human milk feeding.
But we are now learning that factors in milk may be doing something more: changing the very genetic expression of both baby and parent in ways that may have lifelong health effects.
Wilson is skilled at translating research findings in a clear and accessible way, so you can easily understand and communicate this information yourself. And it’s important that more people understand the epigenetic implications of infant feeding. "The good news is that the epigenome is changeable,” she says, “and once we begin to make changes we can see positive changes for our future generations.”
Learn more about epigenetics, the infant microbiome, and more in “Activate: How Human Milk and Breast/Chestfeeding Activates Our Genes Through Epigenetics”, a new course at Lactation Education Resources.
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You get a call from a prenatal client who discloses that she is living with HIV. She asks you whether she can safely breastfeed her baby. Do you know how to answer?
On a new client history form, a mother includes antiretroviral therapy (ART) on her medication list. She tells you she is feeding her baby her milk but would like to also feed formula. Do you know whether this is a safe option?
An exclusively breastfeeding client asks for your help with sore and damaged nipples. She tells you she is HIV positive, and she’s worried that her damaged nipples may put her baby at risk for HIV transmission. Do you know how to counsel her?
Dayna Hall, BS, IBCLC, ICCE, ATC, a researcher with extensive experience working at a hospital in Africa in an area where one-third of the population was living with HIV and the instructor in a new Lactation Education Resource class shares some information and strategies with lactation consultants here.
What does U = U mean?
When a person undergoes antiretroviral therapy (ART) and effectively suppresses their viral load to the point that the virus cannot be detected, they can no longer transmit HIV to another person via sexual contact. In 2016, a campaign was launched that assigned the shorthand “U = U” to this concept (standing for “undetectable equals untransmittable.”) The term has been accepted by 800 groups, governments, and organizations in more than 100 countries.
“For people taking ART as prescribed and achieving and maintaining viral suppression, there is effectively no risk of transmitting HIV through sex,” Hall says.
Does U = U apply to breastfeeding?
Unfortunately, the answer is not an automatic yes—it’s more nuanced than that. “The U = U campaign, for the time being, is specific to sexual transmission,” Hall says. “People living with HIV, adhering to their ART, can safely conceive because the virus is suppressed. But ART is not a cure.”
What do major health organizations recommend?
At the moment, that depends on what organization you ask.
WHO and UNICEF recommend that parents living with HIV exclusively breastfeed their infants for six months and continue breastfeeding for at least 12 months or longer while being fully supported for ART adherence.
The CDC, however, recommends that parents with HIV in the United States not breastfeed their babies at all. National organizations in Britain, Australia, and Canada have similar policies.
Why the discrepancy?
Simply put, WHO has adjusted its recommendation based on ART, while others have not.
Recommendations by the CDC and others are still based on the concept that when safe formula feeding is possible, it is less risky than breastfeeding with HIV, regardless of ART treatment and viral suppression.
“This is in marked contrast to the WHO, which recognized that the demonstrated gains in the availability and use of ART in all resource settings warranted a change to their global recommendations for infant feeding,” Hall explains.
What is the bottom line?
With the availability and effectiveness of ART, the balance of risks and benefits of breastfeeding with HIV has dramatically changed, according to Hall, and lactation support provider’s recommendations need to reflect that new reality—while always considering the entire picture for each unique family and collaborating carefully with the family’s entire care team.
Says Hall: “It is ethically justifiable and frequently safer for providers to participate in a shared decision-making process to develop a feeding plan that may include exclusive breastfeeding for infants whose mother is living with HIV.”
Hall offers an in-depth look at the complex, ever-changing landscape of lactation and HIV and outlines the science and politics behind conflicting recommendations in “WHO Says What,” a new course at Lactation Education Resources. To learn more, register for the full class here.
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