Did you know that doulas, lactation counselors, placenta encapsulators, etc. are not licensed or regulated in the United States! This means that anyone without training, experience, or certification can call themselves a doula, placenta encapsulator, or lactation counselor without even having training. I feel that it is very important before you hire anyone to ask them about where they trained and certified, and what specifically are they trained to be. I’m not saying that anyone without certification is not trained to perform the duties that they are performing, but there does need to be some standards in place.
Becoming certified means that you have taken a training program and “passed”, thereby you have received your certification to practice. Certifying means that you are regulated and held accountable by your certifying agency. Your certifying agency provides you with a scope of practice that you should abide by; these are your standards. Most certifying agencies also require you to meet continuing education requirements and submit for recertification every so often. Certification means that we have the education, skills, ethics to abide by, and a scope of practice to not go beyond. If you are hiring a non certified doula or breastfeeding counselor, please ask what agency they are trained with, and what their potential credentials would be if they were to become certified.
Many people providing lactation and birth support have no scope of practice to answer to, because they chose not to certify. They are self regulated. This is scary to me. It can, and has had serious consequences. To add to all this mess, there are many different certifying agencies in the United States, and each one has their own rules and regulations.
I’ll try to give some examples for lactation.
There are a few trainings who offer the role of a Breastfeeding Counselor; many of them are through agencies that offer doula certification. A breastfeeding counselor can very well counsel you; they can help educate you on what to expect, what is going to be normal. They can show you how to get a basic good latch, how to hold your baby. They can be an amazing peer support! What they cannot do is assess and solve problems; they should not being trying to help you with supply issues, or a continued painful latch. If the dyad is having any problems they need to refer out to an IBCLC (International Board Certified Lactation Consultant), this is beyond their scope.
I am trained as a CLC (Certified Lactation Counselor) through the ALPP, there are no other organizations who offer the title of a “lactation counselor”. A CLC takes a 40 hour training, and an exam. They are trained to counsel the needs of the dyad, conduct comprehensive assessment, and identify and address problems the mother may be having. If a CLC notices something like your infant possibly having a tongue tie, we can point out the difficulties we see you are having and refer you to an IBCLC and a clinical healthcare provider, because telling someone their infant has a tongue tie is a medical diagnosis. We are not there to diagnose or treat anything. We are not there to clinically help you through extensive and/or long lasting difficulties, but we will still be there to emotionally and physically support you through this time while you are working with a specialist.
An IBCLC is the specialist in the field of lactation, and the IBLCE is the only certifying body to award this credential. Sometimes women simply call them “lactation consultants”, but they should be the only ones who are referred to as this. A CLC is not a “lactation consultant” (IBCLC), just as someone trained in basic breastfeeding support is not a “lactation counselor” (CLC). There’s a lot of confusion on this, and it can cause a lot of issues! An IBCLC is required to have college education, comprehensive lactation training (90 hours), and up to 1000 hours of clinical experience before they can even sit for their board exam! I know these women pour their hearts into it, because I am working my way to be able to sit for this exam. Saying that, you should see why they have a large scope of practice, and why we should always refer the dyad to them for anything beyond our scope.
Each individual who provides breastfeeding support is wonderful, and we all need to work together to take appropriate steps to maintaining our scope of practice. We all make mistakes to get experience, but when someone who is not an IBCLC makes the mistake of not referring women who are having difficulty breastfeeding, health issues, or by trying to solve problems that we shouldn’t be solving we are providing a disservice to these women, and the impact of those errors can cause a lot of pain and trouble for the dyad.
I trained with Childbirth International and am a Certified Labor Doula, they also offer childbirth education and a breastfeeding counselor program. They have one main scope I’d like to point out for all of their professionals: “Does not provide clinical care, medical assessment, diagnosis, or advice”; “do not provide prescriptions, advice, or recommendations including regarding use of “natural” remedies or “alternative” therapies”.