The Scope of Practice for IBCLCs states: 

"IBCLCs have the duty to uphold the standards of the IBCLC profession by: 
- working within the framework defined by the IBLCE Code of Ethics, the
Clinical Competencies for IBCLC Practice, and the International Lactation
Consultant Association (ILCA) Standards of Practice for IBCLCs
- integrating knowledge and evidence when providing care for breastfeeding
families from the disciplines defined in the IBLCE Exam blueprint"

There are numerous points in the list of Clinical Competencies that relate
to the psychological, social and cultural aspects of breastfeeding. For example:

"The student will:
- assess mother's psychological state and provide information appropriate to
her situation

The student will:
- reinforce to mother and family the importance of:
     -keeping the mother and baby together
     -feeding the baby on cue - but at least 8 times in each 24 hour period

The student will be able to assist mothers with the following challenges:
- cultural beliefs that are not evidence-based and may interfere with
breastfeeding, (i.e., discarding colostrum, rigidly scheduled feedings,
necessity of formula after every breastfeeding etc.)
- postpartum psychological issues including transient sadness ("baby blues")
and postpartum depression

From the IBLCE Exam Blueprint:

"G. PSYCHOLOGY, SOCIOLOGY, and
ANTHROPOLOGY (10-16 questions)
• counseling and adult education skills
• grief, postnatal depression and psychosis
• effect of socio-economic, lifestyle, and
employment issues on breastfeeding
• maternal-infant relationship
• maternal role adaptation
• parenting skills
• sleep patterns
• cultural beliefs and practices
• family
• support systems
• domestic violence
• mothers with special needs, e.g.
adolescents, migrants"

Standard 4.3 of the Standards of Practice for IBCLCs from ILCA states:

"Provide anticipatory guidance (teaching) to:
- promote optimal breastfeeding practices
- minimize the potential for breastfeeding problems or complications".

There is plenty of evidence to indicate that scheduled feedings, separation
of mom and baby etc are likely to cause breastfeeding problems!

I've only posted a few examples from the various documents, but all of these
things are built into the Standards of Practice, Exam Blueprint etc. because
they have such a direct impact on breastfeeding. It's impossible to separate
the mechanics of breastfeeding from the psychological and social aspects of it. 

Warmly,
Fleur Bickford BSc., RN, LLLL
Ontario, Canada

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