Dear Mary Kay and others,

The issue of credentials boils down to public protection and predictability.
Professional regulation, including licensure, certification, and title
protection registry is very complex and holds many legal implications. (I've
been studying this in relation to LCs for over 10 years).  Licensure is
mandated by a governmental body and is the most restrictive - only those with
the license can practice the profession, and right-to-work laws apply.
 Certification is a voluntary verification of skills and knowledge in a
particular body of knowledge; anyone can practice, but only those meeting
certification criteria can use the title.  Registration is least restrictive
- individuals must register with a governmental body to practice the
profession. RN is a professional license, BSN is a college degree.  People
don't pass the BSN exam in any state - they must take the state RN licensing
exam even if they have a BSN degree.

There is legal basis for why these exist, and it hinges on predictability
over a wide geographic area. National certifications are considered more
valid than state-specific ones. State-wide credentials are more valid than
those issueed at the end of a course. Who gets to say the minimum performance
needed to get the credential is very important, and lawsuits won and lost
over how the cut score for credentialing exams is established.

The IBCLC exam is the only international criterion-referenced lactation
credential available. (Criterion-referenced means candidates are tested
against a standard which is set according to psychometric principles and
legally-valid protocols. Norm-referenced is the other kind of exam - scoring
candidates on a curve and against each other rather than against a set
standard. An end-of-course test measures what students learned in a course.)
 Course-specific titles are statements of completion of a particular course,
period - regardless of the respectability of the institution designing the
course. Passing a course is not the same as passing a state, national or
international board examination.  Both have value; they are not the same
thing.  At least one US state government has established the principle that
only passing a criterion-referenced exam verifies that the candidate has
indeed mastered the material. All courses and degrees are education - useful
in preparing for a board exam.

Holding the IBCLC certificate means you passed the international exam.
 Holding a course-specific title like CLE means you successfully completed a
course. Not everyone who takes the exam has taken a course.  Not everyone who
takes a lactation course takes the certification exam.  In June 1994, the
range of lactation course lengths was 18 to 300 hours - obviously people
think differently about what's needed in a course! Not everyone who is very
knowledgable about lactation has taken a course, or in fact, has taken the
exam.  Trouble is - how do you tell objectively?  That's why board exams
exist.

I often list my academic degree BSE, which actually has only partial
relevance to my LC work, and my certification IBCLC. Your RN is your license
to practice nursing, CLE is your verification of completing a lactation
educational program (more in the category of my BSE, not the same length but
far more relevant), and IBCLC is your LC professional certification. The
IBCLC certificate is our common pathway to practicing as an LC.

Linda Smith, BSE (Bachelor of Science in Education), FACCE (ASPO-certified
childbirth educator), IBCLC - childbirth educator and lactation consultant in
private practice
Dayton, OH