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The International Board of Lactation Consultant Examiners (IBLCE) has announced their plans for a new lactation support credential. The IBLCE is the organization that currently offers the certification credential for lactation consultants, the gold standard in lactation credentials, the IBCLC. The new credential will provide;

  • a credential for those who do not wish to pursue the full requirements for IBCLC certification
  • a stepping stone for those who seek a credential they can use for employment until they qualify for the IBCLC certification

This new credential will hopefully consolidate the many lactation credentials that are currently being offered by various groups. The United States Lactation Consultant Association has compiled a current list: Who’s Who in Lactation.
http://uslca.org/wp-content/uploads/2017/07/2-page-Whos-Who-updated-July-2017-Watermark.pdf


This plethora of course credentials is confusing for those aspiring to this field, as well as employers. With training at various levels, it is impossible for national organizations and health ministries who would like to measure the efficacy of breastfeeding services offered by those with differing levels of education and clinical experience.


In 1985, the IBLCE 1) developed a criterion-referenced examination for lactation support providers around the globe based on practice analysis survey (also known as a role delineation study), 2) defined clinical competencies and a scope of practice and 3) administers an accountability system for maintaining quality care. A similar system will be set in place for the second credential. One uniform testing organization will allow the standardizing of content of the curriculum taught to match the skills necessary to be a lactation support provider at both levels, current and proposed. The evidence demonstrates that integrated lactation care, provided by the appropriate provider, will help families meet their goals. The evidence also shows that skilled care provided at the time it is needed will improve national goals for initiation, exclusivity and duration.


There are situations and practice settings where access to an IBCLC is limited. Community health workers, peer support counselors, prenatal lactation educators, hospital bedside care providers all play a role in breastfeeding support. ALL lactation support providers deserve recognition of their education and competence to provide a standard of care which will support breastfeeding families. A global exam and credential created and managed by an organization which has done this for the past 30 years, is a benefit to those who want to provide service at a level below that of the IBCLC.


There are many for whom the IBCLC is out of reach due to the un-availability of training, cost of the college courses and lack of mentors available for clinical training. A entry-level credential will likely meet the needs of many world-wide.


Some are concerned and confused by the new credential. It was reassuring to see IBLCE listening to concerns at the ILCA conference and promising they will continue to dialogue with all stakeholders including IBCLCs, training organizations, government agencies, and health ministries. The creation of a new credential is a process and will not happen overnight. LER supports the IBLCE in their efforts to follow the process to bring a new credential to the landscape of lactation support providers.

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Katie Hinde is studying breast milk’s status as the first superfood, providing babies with invaluable microbes custom-tailored to their individual needs, via an incredible and unlikely dialogue between the mother’s enzymes and the baby’s saliva.  And in studying the marvels of human breast milk she strongly advocates for a society and health care system that will support the breastfeeding goals of all women.

Katie Hinde Associate Professor, Director of the Comparative Lactation Lab in the Center for Evolution and Medicine and the School of Human Evolution and Social Change at Arizona State University. Click the link below to view her TED Talk.

https://www.ted.com/talks/katie_hinde_what_we_don_t_know_about_mother_s_milk

Maybe her March Mammal Madness can be your inspiration for your next World Breastfeeding Week event!  http://mammalssuck.blogspot.com/

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Lactation Education Resources has exciting plans for enhancing our Lactation Consultant Training Course beginning in January 2017. We will add micro-learning sessions – short 5-15 minute classes on a focused topic available live as well as archived for viewing later. Another welcome addition will be Virtual Teaching Assistants. VTAs will be available to students to discuss topics and answer questions about the lessons or give career advice.


There will be a tuition increase beginning January 2017. The 90-hour Lactation Consultant Training Program will increase to $975 and the other courses will increase proportionately. We have not had an increase in tuition for over 5 years. If you, or a friend, were planning on taking the Enriched Lactation Consultant Course, you might want to sign-up before the price increase. Just a head’s up. ;-)

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We, along with breastfeeding supporters around the world, mourn the passing of Miriam Labbok MD, MPH, IBCLC. Miriam was a friend and supporter at the inception of our Lactation Consultant Training Course at Georgetown University Hospital in 1990.  Those of us who had the good fortune to have worked closely with her in those early years, know of her influence on the breastfeeding world. Those who come to this work in the future will not know her personally, but will also be strengthened by her tireless work in support of breastfeeding.

Dr Labbok had a distinguished career beginning at the University of Pennsylvania and Tulane Medical School. She served as Director of the World Health Organization Collaborating Center of Breastfeeding, and was the Chief of Nutrition and Maternal Health, Division of the Agency of International Development (USAID). She was UNICEF’s Senior Advisor on Infant and Young Child Feeding and Care.

Most recently she was the founder and a professor at the University of North Carolina Gillings School of Global Public Health and Director of the Carolina Global Breastfeeding Institute. She was a favorite speaker at hundreds of breastfeeding conferences and won many achievement awards related to breastfeeding promotion throughout her career.

Dr Labbok’s vision and commitment to protect, support, and promote breastfeeding has had worldwide influence on the health of mothers and infants!

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We have taken, as gospel, the guideline of weight loss of greater than 5-7% (7-10% in many circles) as dangerous for newborns and requires supplementation – for years.  Is this an arbitrary line in the sand, or serious research?


What do you mean that the research upon which this guideline is based might be flawed?  That data was incompletely gathered, sample sizes were too small, formula supplemented infants were not excluded or the supplementation was not recorded.  Was the weight loss effect of maternal IV fluids during labor considered?  The recent article in the Journal of Human Lactation Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full Term Breastfed Infants questions the foundation of these guidelines.  And this is not the first time the data supporting the weight loss guidelines has been challenged.  Noel-Weiss did so in 2008.


The consequences of over-diagnosing excessive weight loss are many.  The mother’s own breastmilk could be expressed and used as a supplement but often that is not considered, and the handy bottle of formula is offered.  Volumes are often excessive.  That formula bottle contains virtually unlimited amounts of supplement, compared to the volumes the baby would be consuming at the breast, if breastfeeding was going well. 

 
Then there is the disruption to the gut flora.  And the sensitization to cow’s milk through the porous newborn gut wall.  Even one bottle can make a difference.


The possible physical sequela are a concern, but the most serious problem with incorrectly identifying an infant as losing too much weight is the damage done to the mother’s breastfeeding intention.  “Well, from the start, I didn’t get this right”.  So, what does it matter if I offer a bottle when the baby cries and I am tired, or I when I go for my OB check-up, and then one when my home is full of guests and I might be embarrassed, and then when I go out for a while with friends, and then, and then….  It starts a slippery slope.   When a mother hears that her baby is losing too much weight she not only questions the adequacy of her breastmilk but of her mothering capacity.   

So, who will do the research, the right way, and get reliable guidelines?  We then can prevent the serious complications of hypernatremic dehydration in a few infants and preserve the breastfeeding relationship during the dip in weight before the mother’s milk comes in, in many infants.  Research methods have improved, more researchers are looking at these issues and we owe it to our breastfeeding babies and mothers to get this right.

Thulier D.  Weighing the Facts: A Systematic Review of Expected Patterns of Weight Loss in Full-Term, Breastfed Infants.  J Hum Lact. 2016 Feb;32(1):28-34.

Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review.  Open Med. 2008;2(4):e99-e110.

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