Clinical Experience for the IBCLC Candidate

Creating a culture of effective lactation professionals from a population with a wide range of backgrounds, levels of education, and, frequently, other healthcare credentials, is a tremendous task.  The process of preparing individuals for the International Board-Certified Lactation Consultant (IBCLC) exam is extremely challenging because it encompasses far more than straightforward classroom learning.  The clinical experience component is crucial to the learner’s ability to apply the information, and the counseling skills gleaned from shadowing a practicing IBCLC are incomparable.  Observing breastfeeding dyads at various points along the entire spectrum of infant and early childhood development places breastfeeding in its proper perspective for lifelong health.  Improving the system of providing opportunities for clinical shadowing was a focus of the working group session of lactation educators at this summer’s International Lactation Consultant Association (ILCA) Conference.  This increased emphasis on the clinical experience component of the preparation process is warranted because no part of the education process does more to prepare the exam candidate for actual work in the field.

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Working with breastfeeding families requires a level of counseling and communication skills which can be vastly different from providing other types of care.  New parents need information and techniques presented to them at a level which they can understand and with compassion and sensitivity to their specific needs.  These skills are not easily taught in a classroom setting, much less in an online format.  While classroom and online provision of lactation education are excellent ways to inform and pass along vital, evidence-based information about how human lactation works, these teaching styles do not lend themselves easily to the nuance and subtlety observed by the learner when shadowing a working IBCLC.  This is the primary reason that exam candidates are required to accomplish 3 main types of preparation before applying to sit for the exam: 90 hours of didactic learning, college- or university-level courses in a specific set of basic health sciences, and a number of clinical experience hours which is determined based on the background of the candidate (e.g., currently-practicing healthcare providers and certain volunteer lactation providers require fewer clinical hours than individuals without a similar background.) (You can see a list of specific requirements at www.iblce.org)  The current system of gaining clinical hours is flexible and accommodating, and this is appropriate because of the very diverse range of backgrounds from which potential candidates emerge.  However, IBCLC candidates  must take responsibility for obtaining clinical experience which reflects the true variety to settings in which the IBCLC is expected to be able to practice.

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As IBCLCs practice in a multitude of healthcare and community settings, it is critical that the candidate create a plan for shadowing IBCLCs in many places to gain the required knowledge and experience to eventually be capable of providing a high level of quality lactation care anywhere.  As the candidate accumulates didactic knowledge, he or she finds ways to apply it during their shadowing experience. It is of the utmost importance that the IBCLC candidate have documented clinical shadowing with an IBCLC in the following settings: assisting healthy newborns in the hospital or birth center; assisting premature and/or sick babies in the hospital setting; facilitating a robust breastfeeding support group with members who attend regularly as their babies grow and develop; consulting with breastfeeding dyads in a pediatric or other physician’s office; providing prenatal education about breastfeeding; observing breastfeeding dyads in a WIC or other clinic-type setting; and shadowing an IBCLC who provides private consultation in her home, the breastfeeding family’s home, or in an office or clinic.  This range of settings ensures that the candidate will have seen breastfeeding mothers and babies across all the chronological ages and stages of infant development which are mandated on the IBCLC Exam blueprint.  The development of clinical judgment in lactation occurs when the candidate is observing closely the interaction between an IBCLC and his or her client during a consultation.  

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There is no substitute for the experience a candidate gains by moving out of his or her comfort zone.  If a hospital RN is preparing for the IBCLC exam, he or she should be accumulating hours outside of the setting where they normally work.  If the candidate only sees newborns breastfeeding during the period of accumulating clinical experience, he or she may not have the skills to sensitively and effectively counsel the mother of a healthy 4-month old whose mother is considering early weaning because her baby is teething.  If a peer counselor with years of experience in breastfeeding support groups is preparing for the exam, he or she needs to spend time in a hospital or birth center observing an IBCLC assisting brand-new babies and their postpartum mothers who are recovering from labor and childbirth.  If a pediatrician is preparing for the IBCLC exam, he or she should be visiting the NICU with an IBCLC to gain experience talking to mothers who are exclusively pumping and learning to breastfeed an immature, very small baby and shadowing a private-practice IBCLC to learn how best to provide hands-on breastfeeding skills to mothers and babies of all ages.  Even if the candidate plans to continue practicing in their current setting once they have earned the credential “IBCLC,” the Clinical Competencies of the IBCLC require that any current IBCLC should have the capacity to practice anywhere.  An IBCLC is an independent practitioner and is expected to be able to assist breastfeeding dyads of all ages and at all stages of growth and development in any setting.  Additionally, an IBCLC is expected to be able to provide evidence-based lactation education to othe healthcare professionals in many settings, communicating effectively, appropriately, and in a culturally-sensitive manner with a variety of audiences.  

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Professional lactation educators who have been training candidates know very well that a fundamental piece of the preparation process occurs when the candidate begins to re-examine her own personal experience of breastfeeding or, in the case of the candidate who has not ever breastfed, his or her own experiences culturally, socially, and within their own family.  Just as students of the mental health professions are engaged in a process of examining their own mental health and issues prior to beginning a practice, the IBCLC must have spent time analyzing their own breastfeeding experiences, as well as addressing any lingering emotions surrounding it so that he or she can bring a neutral and supportive counseling presence to their clients.  The experience of breastfeeding one's own children does not, by itself, constitute lactation education; rather, through obtaining evidence-based lactation education and then following through with an objective analysis, one can see their personal breastfeeding experience as informing their body of knowledge and practice.  This examination and analysis frequently happens organically during the process of clinical mentorship, and candidates often uncover previously unrealized truths and unrecognized successes from their personal history with the help of their mentor.  These revelations can cement the bond between mentor and candidate, creating a professional relationship which can later be leveraged to benefit the greater community.  

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As discussed at the ILCA Conference working group session, many potential candidates have reported to their lactation instructors that they are finding practicing IBCLCs to be somewhat reluctant to take on students/interns.  In a field where 45% of respondents to ILCA’s recent survey replied that they plan to retire within the next 10 years, this is absolutely unacceptable.  The founding generation of IBCLCs has begun to exit gracefully - we must retain their wisdom and knowledge through clinical mentoring and internships.  What the very first IBCLCs learned through trial and error in a brand-new profession is priceless information.  Many of them have written the very books that this younger generation are studying in preparation for the exam.  We in the middle, sandwiched between the highly experienced and the newest of the new, must commit to and assimilate clinical mentoring as a part of our practice, regardless of setting and regardless of where we are in our lactation careers.  If you have something to offer, hang up a sign (real or virtual) to recruit aspiring IBCLCs to shadow you, gather a group of lactation interns and have them help you do that research you’ve been wanting to do, write an article or maybe even that book you’ve always wanted to write!  Becoming a mentor and taking on interns can be an excellent antidote to the caregiver fatigue which IBCLCs periodically experience.  Teaching, discussing, and debriefing cases with interns or students is empowering and allows for thorough examination of what works and what needs to be changed in a practice. Frequently, interns and students bring the latest research from their classroom and help the current IBCLC update practices and knowledge as well.  Similarly, taking on interns who have a completely different background can be enlightening for the IBCLC - imagine what a seasoned pediatrician might observe during a consult which the non-physician IBCLC might not have ever noticed, or what the RN who is present during a breastfeeding support group can offer to a worried mother concerned about a sudden rash which is out of the IBCLC's scope of knowledge or practice.  Building these relationships as candidates prepare for the exam is the ideal way to establish interconnected groups of professionals and build a breastfeeding-supportive community. The pediatrician who knows from her experience shadowing the IBCLC who runs the local Baby Cafe drop-in that it is an excellent support source for her patients will definitely be referring patients there regularly, and the IBCLC who learned from her intern who is an RN in the Labor & Delivery unit knows better how to care for her immediate postpartum clients.  

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There are disparities in the amount of opportunities available to IBCLC exam candidates depending on the geographic area in which they live, the number of practicing IBCLCs in their community, and the timetable they are following to complete their preparation process.  These recommendations are for optimal clinical experience prior to applying to sit for the exam.  IBCLC exam candidates should strive to obtain as many as possible during their preparation.  The composition of an IBCLC exam candidate’s experience will always be highly variable.  It is the nature of what we do as lactation professionals that this vast array of backgrounds brings unique and useful perspective to our work.  We need everyone at the table - those originally trained as attorneys or dentists, former/current La Leche League Leaders or peer counselors with 15 years of experience, hospital-based IBCLCs, RNs who have worked in NICUs and Pediatrics or Labor wards, midwives who have delivered babies at home and in hospitals, doctors with research capabilities, policy and grant writers, former elementary schoolteachers-turned-passionate-breastfeeeding-mothers, people married or related to politicians with legislative and community influence - so that our work can always be fresh and continue moving forward.  We must  remain collaborative, cooperative, and creative to ensure the next generation of IBCLCs are well-rounded and thoroughly capable at practicing the art and science of lactation support.  

Christine Staricka, BS, IBCLC, CCE

November 2, 2014