Frequently Asked Questions
USLCA welcomes questions related to the association, the lactation consultant profession, and guidelines for clinical practice. You may submit your questions to us at firstname.lastname@example.org. The questions answered on this page do not address specific clinical topics. The association does not endorse individual techniques and procedures. For answers to those questions, please refer to current textbooks and manufacturers' instructions.
- USLCA/ILCA Membership - including login loop to Sage's JHL
- ILCA Bookstore
- Scope of Practice
- Ethical & Legal
- Clinical Guidelines
- Breastfeeding Promotion & Statistics
Question: How do I know if my membership is active?
Answer: Log into Members Only, choose Member Profile and then choose Check Order Status to see if your membership is active. If you are unable to log into Members Only contact email@example.com .
Question: I would like to renew my USLCA/ILCA membership for 2 years, but it shows one year when I go to renew. How do I change it to 2 years?
Answer: We cannot process 2-year applications online at this time. Please contact the ILCA office at firstname.lastname@example.org to set up a 2-year invoice in your member record. When that is completed, you will receive an email telling you it is all set.
Question: Does the cost of membership include back issues of Clinical Lactation and JHL since January?
Answer: The journals are published quarterly. You will receive any issues you missed during the calendar year as of the date of your renewal. The back issues of the JHL come directly from the publisher, so please allow 8-10 weeks for delivery. All past and current issues of the JHL can be viewed on the Members Only portion of the website. Back issues of Clinical Lactation can be viewed at www.clinicallactation.org.
Question: Does membership cost include membership from January to January no matter when you join? Do USLCA and ILCA pro-rate dues?
Answer: USLCA and ILCA’s membership year runs Jan 1 through Dec 31, regardless of when you join. Dues are not pro-rated because no matter when you join you receive all issues of the two journals for that membership year. You will also have access to both journals online, to all eGlobes and eNews published, and everything else that has occurred during the year through the website.
Question: What is the cost of a 2 year membership?
Answer: Visit this link Join Online on the ILCA website and enter your country to see the prices.
Question: Do I keep my old ILCA membership number when I renew?
Answer: Yes. Your number and password will remain the same.
Question: Is it possible to join USLCA without also joining ILCA?
Answer: USLCA membership is available only as a joint membership with ILCA.
Question: How do I change my address, contact information or other demographic information in my member profile?
Answer: Go to the Member Login page and enter your Member ID# and your password. You can then edit your profile. If you’re an IBCLC, remember to notify IBLCE of address changes so you will receive notices of recertification, and other certification information.
Question: How do I update my name in the member information?
Answer: Name changes must be done by emailing the ILCA office at email@example.com or by calling 919.861.5577 or toll free in U.S. and Canada at 888.452.2478 (ILCA-IS-U). Don’t forget to send IBLCE documentation of your name change by emailing IBLCE office in your region. See firstname.lastname@example.org for all regions.
Question: How do I get listed on the FALC (Find A Lactation Consultant) Directory? How do I update my info there?
Answer: The Find A Lactation Consultant Directory is updated every two weeks and lists IBCLC members throughout the world. This is a free service to all ILCA members who hold the IBCLC credential. Before anyone is added to the listing, the ILCA office must first verify your credential with IBLCE, so adding your IBLCE certification number to your application is helpful. If you need to update your contact information, go to the Member Login page and enter your Member ID# and your password. You can then edit your profile.
Question: I want my mail to go to my home, but I want to show my work address on the FALC Directory. How do I do this?
Answer: Unfortunately, at this point, it is not possible. We hope to have the capability of showing a different address on the FALC listing than your mail address sometime in the near future, and will notify members when that change takes place.
Question: When accessing the Journal of Human Lactation, I am caught up in a loop that continuously asks to log in as an ILCA member. What should I do?
Answer: If you are caught up in a loop that continuously asks you to log in as an ILCA member, it is because your security settings on your computer are set too high. Please contact your IT support person and ask them to set your security to allow access to the Sage Publications page without the extra login. Please click here for instructions on how to bypass the security. If you continue to have difficulties gaining access to the Journal, please contact email@example.com.
Question: How can I find a Lactation Consultant in my area?
Answer: On ILCA’s home page at www.ilca.org, go to the right of the screen to find the dark blue box labeled Find A Lactation Consultant.
Question: How long will it take to receive my order?
Answer: If your order is being shipped within the United States, it will usually arrive within 10-14 business days from when ILCA receives the order. ILCA’s office is on the east coast of the United States, so orders shipped to the west coast may take closer to 14 business days. Allow 3-4 weeks for orders shipped outside the United States, though it is possible for them to take longer if they are delayed going through customs. Note: During certain times of the year when the ILCA office is closed for the Conference or holidays, orders will be delayed, so please allow longer for delivery.
Question: If I place my order over the phone, can I get it faster?
Answer: The fastest way to receive an order is through the online bookstore on our website. Orders placed there do not have to go through our accounting department first, so we are able to ship them sooner than orders placed by phone, fax or mail.
Question: If I need my order quickly, can I pay extra for expedited shipping?
Answer: Yes. Contact our office and we will do our best to work with you.
Question: Do you accept purchase orders?
Answer: Yes, we will gladly accept purchase orders for bookstore items, but not for conference registration or membership. Send a printed copy of the purchase order by fax or mail and include contact information for the organization’s purchasing department and accounts payable department.
Question: I would like to become a lactation consultant. What do I need to do?
Answer: You will need a combination of college courses, a lactation course, and clinical practice hours as described below. Also see Resources for Becoming a Lactation Consultant for other suggestions.
College Prerequisites: As a first step, you will want to visit the International Board of Lactation Consultant Examiners' website (see below) to learn about requirements for certification. To qualify to take the certification exam you will need to have taken post secondary courses in anatomy and physiology, sociology, psychology or counseling, child development, and nutrition. You may have taken courses in college that will satisfy some of these requirements. If there are some you need to take, you can begin that while you are putting the rest of your requirements in place.
Lactation Management Course: Your second step will be to acquire instruction in lactation management. The instruction must have been taken within 3 years of sitting for the exam, so you will want to plan this carefully. The Accreditation and Approval Review Committee on Education in Human Lactation and Breastfeeding (AARC) has a list of AARC Approved Courses.
Also see ILCA’s Directory of Course Providers for courses that have not sought AARC Approval (which is voluntary). The Guide to Selecting a Lactation Course will help you in your selection process. Check with IBLCE regarding current requirements when you are ready to complete a lactation program. In 2012, the requirement increases from 45 hours to 90 hours.
Clinical Experience: The third step involves hands-on clinical experience with breastfeeding mothers and babies. The number of clinical hours you will be required to have will depend on your background. Depending on the certification track you use, some of the hours may need to be acquired under clinical supervision. You can review information on the IBLCE website and call them if you have questions. To locate a site for acquiring clinical practice, visit ILCA’s Clinical Instruction Directory or locate IBCLCs in your area at ILCA’s Find A Lactation Consultant Directory.
Continuing Education: Attending conferences and other forms of self study are other important means of preparing for the profession and staying current with research and clinical practice. Conferences are a valuable opportunity to network with lactation consultants from around the world. Visit the Conference page on the ILCA website to learn about ILCA's annual conference. Also visit the Worldwide Education Calendar for other offerings in your area. Check ILCA’S Independent Study Modules for other opportunities for self study.
International Board of Lactation Consultant Examiners (IBLCE), E-mail firstname.lastname@example.org, Website www.iblce.org, Phone 703.560.7330
International Lactation Consultant Association (ILCA), Email email@example.com, Website www.ilca.org, Phone 919.861.5577 or 888.452.2478 (ILCA-IS-U) toll free in U.S. and Canada
Question: Do I need a college degree to become a lactation consultant?
Answer: At present, there is no requirement that a lactation consultant hold a college degree. The courses IBLCE requires can be completed without obtaining a degree. Those courses are anatomy and physiology, sociology, psychology or counseling, child development, and nutrition. These requirements will change for first-time candidates who take the exam in 2012. Contact IBLCE for more information.
If you are a high school graduate considering a profession as a lactation consultant, it is recommended that you continue with postsecondary schooling and receive a minimum of an associate’s degree. To receive a credential in lactation consulting, you must complete a college course in areas identified by the certification board. There are many other college courses that will also help to prepare you for practicing as a lactation consultant. You may want to consider a degree in the healthcare arena. While it is not required that you obtain a license in the medical field (such as nursing, dietetics, physician, midwife) such a license will help to open doors to you for potential employment as a lactation consultant.
In addition to your college preparation, you will need to complete specialized education in lactation consulting. This includes both classroom instruction and supervised clinical experience under the mentorship of an experienced lactation consultant. The educational requirements for qualifying to take the certification exam are evolving and you will need to check with the certification board at the time you are ready to begin your lactation training to learn the current requirements.
The Accreditation and Approval Review Committee on Education in Human Lactation and Breastfeeding (AARC) is a review committee for the Commission on Accreditation of Allied Health Education Programs (CAAHEP), the largest programmatic accreditor in the health sciences field. Resources are available on the AARC website for post-secondary academic programs in lactation to apply for accreditation. Accreditation services begin in September, 2011. This opens the door for accredited programs to be offered in colleges and universities throughout the world. The Standards and Guidelines on the AARC website contain the general education and lactation content required for a comprehensive academic program in lactation consulting.
Question: Do I need to be licensed in another area of the health care profession to become a lactation consultant?
Answer: There is no requirement that a lactation consultant be licensed in another profession such as nurse, physician, midwife, or dietitian. Lactation consulting is a stand-alone profession with its own unique curriculum and scope of practice. The majority of lactation consultants, however, do have such licensure. It may open more employment opportunities since the primary job settings for lactation consultants are in hospitals and health clinics where such licensure will be attractive to employers.
Question: What kind of lactation course do I need to take to become a lactation consultant?
Answer: See ILCA's Guide to Selecting a Lactation Management Course for suggestions to help you in your selection process. The course must have been taken within 5 years of sitting for the exam, so you will want to plan this carefully. Also see ILCA’s Directory of Course Providers. Visit IBLCE at www.iblce.org to locate the IBLCE office in your region and learn about requirements in your region. The Regional Director or Country Coordinator for your region can provide more local information on education.
Question: What kind of clinical experience do I need and how can I get it?
Answer: The IBLCE Clinical Competencies for IBCLC Practice identifies the clinical situations in which a lactation consultant intern must demonstrate competence. Competence for many of the experiences will require more than one exposure. The number of clinical hours you will be required to have for certification will depend on your background. You can review information for your region on the IBLCE website www.iblce.org and call them if you have questions. The Regional Director or Country Coordinator for your region can provide more local information on clinical experience opportunities. To locate a site for acquiring clinical practice, visit ILCA’s Clinical Instruction Directory or locate IBCLCs in your area at ILCA’s Find A Lactation Consultant Directory.
Question: How can lactation consultant interns in the United States obtain professional liability insurance to cover the clinical work during their internship?
Answer: USLCA, in partnership with the insurance carrier CM&F Group, makes affordable professional liability coverage available to USLCA members. The program is limited to Board Certified lactation consultants (IBCLCs) or those training specifically to become IBCLCs. To qualify, the intern must be enrolled in and under the supervision of an accredited or licensed training program. IBLCE’s Pathway 3 is recognized by USLCA and IBLCE as an approved program that culminates in certification through IBLCE as an IBCLC. Therefore, those enrolled in Pathway 3 would be covered as a Student Lactation Consultant Intern and qualify for this collaborative liability program offered through USLCA and CM&F. Contact USLCA for information about the program.
Question: What continuing education is available for staying current as an IBCLC?
Answer: Attending conferences can help you prepare for the profession and to stay current with research and clinical practice. It is also a valuable opportunity to network with lactation consultants from around the world. Visit the ILCA Conference page on the ILCA website to learn about annual conferences. Visit the Worldwide Education Calendar for other offerings in your area. Independent study modules are another way to obtain continuing education. Visit ILCA’s Continuing Education site for a catalog of all available modules. Also visit IBLCE at www.iblce.org to locate the IBLCE office in your region and learn about requirements in your region. The Regional Director or Country Coordinator for your region can provide more local information on continuing education opportunities.
Question: Can I send my study module in the mail instead of completing it online?
Answer: Yes, ILCA will still accept study modules at the office but you will need to allow up to 3-4 weeks for processing. Completing it online will be much faster as you will get your certificate within minutes of submitting your answers.
Question: Can I take a lactation management course simultaneously with the required clinical experience?
Answer: We recommend that you take a lactation management course before you begin clinical experience so you will have a good knowledge base before you begin to see mothers and babies.
Question: Would someone be able to assist me in obtaining experience hours?
Answer: Availability of experienced IBCLCs to mentor new IBCLCs varies depending on where you live. In some areas of the world, experienced lactation consultants are offering supervised clinical experience for interns. You can check your local hospitals, clinics and private practice lactation consultants to see if there are any near you.
To locate a site for acquiring clinical practice, visit ILCA’s Clinical Instruction Directory or locate IBCLCs in your area at ILCA’s Find A Lactation Consultant Directory.
They must have been an IBCLC for at least 5 years. In most cases, you will need to pay for these services. Again, this differs throughout the world.
Question: How much can an intern expect to pay a clinical instructor for mentoring her in acquiring clinical practice hours?
Answer: This will vary depending on where you live. The Clinical Competencies for IBCLC Practice identifies the clinical situations in which a lactation consultant intern must demonstrate competence. Competence for many of the experiences will require more than one exposure. The amount to be paid to the clinical instructor may depend upon how many hours it takes for the intern to demonstrate competency in all areas. In the U.S., the fee for a clinical instructor to mentor a lactation intern could range from $3500 to $6000 depending on how much mentoring the intern needs. Working with an intern generally increases an IBCLC's consultation time by 50 to 100%. If a consultation would normally be 20 minutes, with an intern it would probably be 30 to 40 minutes. The extra time includes time spent before and after the consultation, as well as lengthening the duration of the consultation itself if the instructor dialogues with the intern while working with the mother. The duration of a consultation will vary depending on the purpose and whether it is an outpatient visit with a private practice IBCLC or a postpartum visit in the hospital. If the internship takes place in the hospital, the instructor's time may be covered by hospital wages. The price for the intern might then be negotiated with the hospital. Some interns have contracted to work for the hospital for at least 500 hours after they become certified in exchange for the mentoring they receive.
Question: Does ILCA endorse or recommend instructional materials for in-services?
Answer: ILCA does not endorse or recommend products. There are many resources available to members throughout the ILCA website, including reviews of books and other publications. There are also user reviews of products at online bookstores such as www.Amazon.com and www.BarnesandNoble.com.
Question: Can I start helping mothers after I complete a 5-day lactation course?
Answer: Lactation courses are designed to give prospective IBCLC candidates an academic background in lactation. They are intended to be coupled with clinical experience so the candidate may meet the requirements of taking the IBLCE examination. Your next step is to establish a plan for certification with the IBLCE and arrange for a clinical instructor to supervise your acquisition of clinical practice hours.
Question: I am seeking to gets hands-on or at least "eyes-on" experience with more complicated cases, so I am hoping to shadow a more experienced IBCLC. I have contacted an IBCLC near my town who has such experience. I need resources that will support my venture, such as confidentiality forms, etc. Also, how can this be presented to the hospital?
Answer: Forms for clinical instruction can be found on the ILCA website under the Education tab at Student Resources. ILCA members may also post questions on ILCA’s Discussion Board under the topic Clinical Mentoring to ask how others have approached their hospitals.
Scope of Practice
Question: Can I see patients in the hospital or other health care settings if I am not an IBCLC? Can I call myself a lactation consultant?
Answer: Employers are urged to hire IBCLCs for helping patients with breastfeeding. Being credentialed by IBLCE is essential for protecting the breastfeeding client and for maintaining the professional respect for the lactation consultant who has worked to earn that IBCLC credential. IBLCE requires on-going re-certification and maintains a mechanism for disciplining malpractice and ethics violations. Calling yourself a lactation consultant without having the IBCLC credential can be confusing and potentially misleading to clients. ILCA discourages the use of any title other than IBCLC. In some regions of the world and in some health care systems, the IBCLC credential is required. If you reside in an area that allows you to see patients, it is important to define your role with the patients. They need to understand that they are not being seen by a professional lactation consultant who is a credentialed IBCLC. See theScope of Practice for IBCLCs.
Question: Does an IBCLC need to be a licensed health professional to see patients?
Answer: The Scope of Practice for IBCLCs is medically oriented with core competencies and assessment skills as described in the Clinical Competencies for IBCLC Practice, also available as a free download at www.iblce.org. Other health professions that teach and utilize assessment skills include occupational therapists, dietitians, respiratory therapists, and speech pathologists. The lactation consultancy profession has followed the model of the registered nurse and other complementary professions, in developing detailed assessment and skills checklists. IBLCE does not require the candidate to hold another license to be eligible to become a lactation consultant. It is important that employers recognize that the IBCLC certification is the criterion for employing someone in such a position, and that it is not a subspecialty of another health professional license (such as RN). Nonetheless, IBCLC licensure is being sought in some states and countries, because reimbursement for the services provided is often tied to existence of a license (even though the IBCLC certification demonstrates competence to see clients/patients)
Question: I am supervising an IBCLC candidate in obtaining her practice hours. Our nurse manager is concerned that the intern is not an RN. Do IBCLCs need to apply for practice privileges?
Answer: The experience and credentials required for working in a hospital will depend on where you live. In some countries, most hospitals and communities who employ an IBCLC require that the IBCLC be a midwife or RN. Each facility defines the role of students and preceptors within that facility. A student typically works with patients/clients under the supervision of a preceptor as part of the process of mastering the skills necessary for the profession. This is a graduated process that defines the levels of responsibility as the skills are acquired and mastered, similar to schools of nursing. Each facility will typically define the scope of privileges granted to certified health professionals. An IBCLC is employed by the facility and therefore does not need to apply for practice privileges. See the Scope of Practice for IBCLCs
Ethical and Legal
Question: If an IBCLC working in a hospital advises all new moms to give formula to their babies as a "just in case" measure, what is the ethical process for addressing this malpractice?
Answer: It would be hoped that you can first address this issue locally and support this IBCLC to improve her clinical practice. If all local strategies don’t work, the International Board of Lactation Consultant Examiners (IBLCE) has a process for filing a complaint or concern regarding breaches of the Code of Ethics for IBCLCs and concerns with violations of the International Code of Marketing of Breast-milk Substitutes. You may report alleged violations to IBLCE. A complaint form for this process is available at www.iblce.org. Complaints cannot be anonymous; IBLCE requires that the person bringing the complaint identify themselves. Additionally, complaints of violations of the Code of Ethics must be based on first-hand knowledge. Complaints based on hearsay will not be reviewed. The Code of Ethics for IBCLCs is available at www.iblce.org.
Question: What are the new HIPAA standards for patient confidentiality and where can we get information on these standards?
Answer: The U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) is designed to protect families with pre-existing medical conditions, and help guarantee privacy and confidentiality of patient medical records. IBCLCs who practice in accordance with the Standards of Practice for IBCLCs, Code and Ethics for IBCLCs, and Scope of Practice for IBCLCs will already be conforming to the privacy protections envisioned by HIPAA. However, HIPAA does require some simple paperwork for USA-only-based IBCLCs. ILCA's Reimbursement Tool Kit for Lactation Consultants lists all the state HIPAA contacts. It can be obtained in the ILCA Bookstore.
Question: Where can I find laws regarding breastfeeding in individual states or countries?
Answer: Several states in the U.S. have adopted laws pertaining to breastfeeding. Some of these laws address the right to breastfeed in public and others address accommodation laws for working breastfeeding mothers. La Leche League International has frequently-updated pages discussing Breastfeeding and the Law both worldwide, and state-by-state in the USA.
Question: A mother asked me to testify at a custody hearing. What resources are available?
Answer: There is a chapter devoted to legal issues in ILCA’s Core Curriculum for Lactation Consultant Practice, 2nd ed (available through ILCA’s Bookstore). The Professional Liaison Department of LLLI at www.lalecheleague.com handles general legal concerns for mothers and families about breastfeeding (including rights of the breastfeeding dyad, and facts about the effects of human milk on infant and child health). The IBCLC’s role in a court hearing will differ, depending on whether the IBCLC consulted the mother, or is being called as an outside expert on lactation issues. Seek specific guidance from the attorney representing the mother.
Question: I plan to provide a lactation education class in my community. Do I need to purchase malpractice insurance?
Answer: You will need to check with an Insurance authority of the country to which you are working what insurance is required. You typically would not need professional liability insurance to teach a class. But if it involves working with mothers and babies at all, you would need coverage. Most hospitals will require any health care provider having clinical contact with patients to carry some form of professional liability (malpractice) insurance. And, most insurers will only cover those who carry a credential (like IBCLC) or a license (like MD or RN). For ILCA members who live in the USA, their automatic membership in the United States Lactation Consultant Association provides the benefit of professional liability insurance for the IBCLC at a substantial group savings. See http://www.uslcaonline.org/clinicalprac.html.
Question: How can I find out what the standards of practice are for lactation consultants?
Answer: ILCA’s Standards of Practice for IBCLCs are available on the ILCA website in English, French and German.
Question: Do lactation consultants have formal guidelines for clinical practice?
Answer: Yes, ILCA collaborated with the International Board of Lactation Consultant Examiners to develop Clinical Competencies for IBCLC Practice available at www.iblce.org.
Question: Where can I find position statements published by ILCA?
Answer: ILCA position statements and many other documents to help guide clinical practice are available for download on the Publications page under the Resources tab on the ILCA website.
Question: What is ILCA's position on loaning a breast pump to a friend?
Answer: ILCA defers to individual pump companies regarding recommendations about the use of their pumps. There is often confusion over single person pumps and rental pumps. Rental pumps can be used with multiple users because the equipment that touches the individual client is purchased by the client and is used only by that individual. Contact your local government agency for guidelines in your country. While a pump may be designed to be a single user pump, the US Food and Drug Administration (FDA) only regulates sales over state borders and has no jurisdiction over handing down pumps to friends. The FDA currently has approved only two vapor barrier systems, so the mother needs to contact the pump manufacturer to see if the pump she is considering is approved for use by more than one person.
Question: Are there standardized "lactation rating tables" identifying risks of drugs on breastmilk?
Answer: Dr. Tom Hale created Lactation Risk Categories for his book, Medications and Mothers' Milk. The categories L1 to L5 are modeled after the obstetrical pregnancy risk categories for use of medications and drugs in pregnant women. The National Institutes of Health also has a TOXNET database at: http://toxnet.nlm.nih.gov. The Lactation Risk Categories are used internationally and are listed below.
• L1 SAFEST: Drugs which have been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote, or the product is not orally available in an infant.
• L2 SAFER: Drugs which have been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; and/or the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
• L3 MODERATELY SAFE: There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
• L4 POSSIBLY HAZARDOUS: There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
• L5 CONTRAINDICATED: Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience; or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
Question: Where can I find guidelines on handling breastmilk for patients in the NICU?
Answer: Contact the Human Milk Bank of North America at www.hmbana.org. The Academy of Breastfeeding Medicine has a Protocol for Human Milk Storage (in English and German) for home use for the full-term baby.
Question: Is there a standard job description or checklist for lactation consultants?
Answer: Facilities create their individual job descriptions. Several sample job descriptions are posted on the Members Only side of the ILCA website. A checklist for “Seeking Employment as an IBCLC” is available on the same page. In addition, the checklist in Clinical Competencies for IBCLC Practice available on the IBLCE website can be useful in developing a job description. Also see the Scope of Practice for IBCLCs.
Question: What should the salary be for an IBCLC employed by a hospital?
Answer: An IBCLC employed by a hospital is usually paid on a similar pay scale as a clinical nurse specialist.
Question: How is the general availability of jobs for lactation consultants?
Answer: Availability of jobs for lactation consultants depends largely on where you live. You can contact local hospitals and physician offices to find out if they have lactation consultants and if so, how many. You can go to Find A Lactation Consultant on the ILCA website to find lactation consultants in your area and talk with them. ILCA members also have access to job listings in the "Career Mart" on the Members Only side of the ILCA website. Your national ILCA affiliate may also have resources on job placement of lactation consultants.
Question: How do lactation centers usually charge for their services?
Answer: This can vary considerably depending on where you live. In some countries the mother will be charged for the length of the consultation if the IBCLC is in private practice. If seen by an IBCLC working for the government the service could be free. In the U.S., most lactation centers charge a fee similar to patient visits in other areas of health care, with the patient paying at the time of service. Insurers in some states in the U.S. give billing privileges to facilities that employ an IBCLC or to individual IBCLCs. Some insurers pay for visits under the standardized lactation billing code, S9443 (lactation classes, non-physician provider, per session). Many add the code to their covered services when billed repeatedly. Lactation services can be bundled into a diagnosis-related group (DRG) for first-year pediatric care or OB/childbirth services and billed to the provider, who receives the per capita base rate. The patient's co-pay is usually a percentage of the full fee or a percentage of what the real cost of the service is minus what the insurer will pay. The additional fee is billed to the insurer or provider.
Question: How can I acquire financial support for a lactation center?
Answer: Many lactation centers in the U.S. seek grants from community service organizations or hospital foundations to subsidize the cost of doing business. Medically underserved populations in the U.S. may be eligible for state and federal money through a number of programs offered by the Department of Health and Human Services (DHHS) such as community health centers or Medicaid funding. You may want to attend a medical billing class at a local community college. Also, check with each of your state's insurers to learn what they pay for and how they want their forms coded and submitted. Make the case for the cost savings associated with use of breastfeeding and breastmilk on long-term health care and associated costs. There are several well referenced web sites that address the "cost of not breastfeeding."
Question: How is a lactation center usually structured?
Answer: In the U.S., most lactation centers are attached to a hospital and on-going care after hospital discharge can be sought at the hospital where a DRG can be used for the hospital to receive payment. This hospital-based assistance may only be available for a set time post-birth (e.g., ten days). After that, the family would need to access a private lactation consultant and pay the fees.
Question: Can patients seen at a lactation center have the fee covered by insurance?
Answer: Some US states have coverage for outpatients. In these states coverage may depend on the health professional background of the IBCLC. For example, the family may be able to claim for the visit if the IBCLC is also a speech pathologist or nurse practitioner. Coverage also varies from policy to policy. In Oklahoma, Medicaid coverage was recently approved for outpatient lactation consult visits with the IBCLC who is also a licensed health care provider, such as an RN. In the past twelve months, there has been a move in Australia for IBCLC's to work in general practice and pediatric physician practices. The doctor sees the patient for a short consult; then the IBCLC takes over, and the billing is handled as a doctor visit. For more information, see ILCA's Reimbursement Tool Kit for Lactation Consultants in the ILCA Store.
Question: Is there a recommended minimum malpractice insurance coverage amount for lactation consultants?
Answer: The typical malpractice insurance requirement for individuals in a U.S. or Canadian hospital or outpatient facility is $1 million and an additional $3 million of personal malpractice liability insurance. The best place to check on malpractice coverage is with the insurance companies in the category of "personal liability insurance." You may want to use an internet search engine and search for "Professional Malpractice Insurance" to find these companies. Most hospitals and/or facilities that accommodate students will require the student to obtain individual malpractice insurance. The IBCLC may be under the category of allied health professional. See http://www.uslcaonline.org/clinicalprac.html.
Question: What are the staffing guidelines for hospital-based IBCLCs?
Answer: Level of care for patients and level of acuity of the patients are important factors in determining staffing ratios. Will every mother and baby be seen or only those for whom a consultation is requested? Are the mothers/babies referred there for high-risk situations or is it a community hospital? When will lactation services be available - evenings, nights, weekends, holidays? What other units in the hospital will be able to utilize the services - intensive care units, pediatrics, emergency department, clinics? What percentage of mothers need intervention in hospital and post discharge? Answers to these
Questions will help determine the necessary staffing ratio. Resources include:
• Mannel and Mannel, Staffing for Hospital Lactation Programs: Recommendations from a tertiary care teaching hospital, Journal of Human Lactation, 11 2006; vol. 22: pp. 409 - 417.
• Riordan, Breastfeeding and Human Lactation 3rd edition, Jones and Bartlett Publishers; 2004, pp 41: Suggests a minimal staffing ratio of one IBCLC per 1000 births, citing three bedside visits per day per couplet.
• Chapman, Randomized Trial Evaluating a Unique Lactation Consultant Intervention, Journal of Human Lactation, 8 2006; vol. 22: pp. 362-363.
Question: How does a private practice IBCLC start her own business and start charging for her services?
Answer: There are several textbooks that address setting up and charging for a clinical practice: Breastfeeding and Human Lactation, Jan Riordan, Jones and Bartlett; Counseling the Nursing Mother, Judith Lauwers and Anna Swisher, Jones and Bartlett; The Lactation Consultant in Private Practice: The ABC's of Getting Started, Linda J. Smith, Jones and Bartlett. In addition, you can check ILCA's Visit ILCA’s Worldwide Education Calendar for workshops on setting up a private practice.
Question: How can I start a human milk bank at my hospital or facility?
Answer: In Canada, Mexico and the U.S., you can contact the Human Milk Banking Association of North America at www.hmbana.org to purchase a copy of their guidelines for establishing a donor human milk bank.
Question: Where can I purchase Superbills specific to Lactation Consultants?
Answer: Please refer to the Reimbursement Tool Kit for Lactation Consultants available through the ILCA Bookstore.
Question: I am the Business Office Director for an OB-GYN practice. Can we bill for the services provided by a lactation consultant?
Answer: Reimbursement depends on coverage provided by your state's insurers and whether the lactation consultant is a nurse, an advanced practice nurse or a non-nurse. Check the Reimbursement Tool Kit for Lactation Consultants for answers to billing questions. Your billing service may want to contact all of the insurers that your patients use and determine what codes they require for the service. Billing for lactation services should always be done as this establishes the need for the IBCLC and documents outcomes of the services. The AAP has guidelines, Supporting Breastfeeding and Lactation: The Primary Care Pediatrician’s Guide to Getting Paid, available at http://www.aap.org/breastfeeding/CODING.pdf.
Breastfeeding Promotion and Statistics
Question: Where can I get the support data to convince hospital administrators and clinicians to commit to becoming a baby-friendly facility?
Answer: The following resources are available:
• Baby Friendly International: www.unicef.org
• Baby Friendly USA: www.babyfriendlyusa.org
• See the ILCA Conference page for information on ordering tapes from past ILCA conferences. There have been several speakers on the subject of becoming Baby Friendly.
• Philipp BL, Merewood A, Miller LW, et al. Baby-Friendly Hospital Initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics 2001; 108:677-681.
• Merewood A, Philipp BL. Implementing change: Becoming Baby-Friendly in an inner city hospital. Birth 2001; 28:36-40.
• Merewood A, Philipp BL. Becoming Baby-Friendly: Overcoming the issue of accepting free formula. J Hum Lact 2000; 16:272-282.
Question: Where can I get some hard evidence-based data to change habits and practices in our hospital?
Answer: There are several well-referenced sources for "Best Practice" standards:
• ILCA's 2005 edition of Clinical Guidelines for the Establishment of Exclusive Breastfeeding available in the ILCA Bookstore
• Model Hospital Policies available from Wellstart International
• The Academy of Breastfeeding Medicine Protocols available at http://www.bfmed.org/
• American Academy of Pediatrics February 2005 Breastfeeding Policy statement
• Colorado study published in Birth in September 2007
Question: Do you have any current data which shows the percentage of women who breastfeed exclusively after three months?
Answer: Resources for current breastfeeding rates include:
Breastfeeding in the United Kingdom at www.babyfriendly.org.uk
Global Data Bank on Breastfeeding at http://www.who.int/topics/breastfeeding/en/
Question: Where can I find the CPT codes?
Answer: The latest CPT codes are from 2009. You can view them here. The document from the AAP