For the sake of those wishing to become IBCLCs who are not RNs, I still think LLL is the best starting-off point. OTOH, I dislike the idea of "using" LLL to become an IBCLC, so there is an issue to consider there. If you are already an LLLL, then great, but I have seen women become LLLL's so that they could use it to improve their doula practices by claiming to have breastfeeding experience, never giving back anything to LLL once they had been accredited. . 

I was an LLLL for 5 years before I applied to sit for my exam. That gave me 2500 hours, but I do not honestly think all Leaders are qualified based upon this. Certainly, an active Leader spends quite a bit of time with moms, both at meetings and on the phone, but many Leaders have little skill outside of the ever-narrowing range of normal in our culture. When I was a new Leader, most of the problems I saw were engorgement, plugged ducts and sore nipples, primarily caused by hospital policies that separated moms and babies and uneducated hospital staff. I do think that the time I spent in a counseling capacity, teaching and supporting was the best skill I ever acquired as an IBCLC, though. LLL's philosophy that the mother is the expert on her own baby has been the best guiding principle that I could have ever asked for. Because I did a lot of home visits, I also had a much broader experience (and more hours) than most Leaders. I also volunteered for WIC, so that added quite a lot to my knowledge base and skill set.

Even so, by the time I sat for my exam, I had spent an additional 2 years working between 40-60 hours per week running a hospital clinic-based peer counseling program. This is where I learned to work in the NICU and with women from dozens of cultures/countries and with hundreds of teen moms I claimed very few of the hours I accrued b/c I didn't need them, but most of my hours were spent with mothers. 

The same year, I watched a
dozen nurses claim the hours they simply spent on the post-partum
floor, little of which was spent actually helping mothers bf and even less doing so with any efficacy. I can
tell you that in the almost 4 years that we were in hospital, the peer counselors helped
almost all of the mothers and the nurses did very little hands-on bf
care as compared to prior years. And, as another person noted, even if those nurses had spent all of their hours helping women, very few of them were actually helpful--they just kept teaching the same wrong things over and over. I agree that it is beyond absurd that nurses can qualify for the exam using hours they spent BEFORE they received any valid breastfeeding education. At least Leaders have to become Leaders BEFORE their hours can qualify.

While I had twice as many CEUs as needed by the time I sat for my exam--the nurses had been literally spoon-fed 30 hours, which they gathered, all at once, a few of months before the test. 

I know that there are fantastic nurses working in all settings who are phenomenal IBCLCs, but they have self-selected through their own desire to be excellent practitioners. You could say the same is true of LLLLs as well, but becoming a Leader is inherently self-selecting. 
In other words, the process is far from workable and makes it more and more difficult for anyone to be really capable of practicing before they are certified. 

So, if you want to become an IBCLC, I suggest you take it upon yourself to find your own path to becoming competent and hopefully to excelling, b/c following the paths laid out will ensure no such thing. Be creative. Be persistent. I mentored an LLLL who passed her test last year and I can assure you that she was ready! 

And, please, let's really raise our voices to compel the IBLCE to work with us to create a more worthwhile process for certifying IBCLCs. This is not about us vs them--that is a useless argument, b/c if you are the "them" then you need more education or supervision anyway and I would think you'd like an opportunity to get it. If you are competent, then you are not an "us"--you are simply a good practitioner who wants to be proud to be part of a good profession. IMO, we need to find a way to assure that the IBCLCs already practicing are competent, before we push more into the fold. Testing will never do that, b/c we have seen that almost anyone with a medical background can pass the test. What we need is a better evaluation tool BEFORE we get to the test. And, Barbara Ash is right--we need to be creative if we are going to solve that problem across the continents. 



Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC

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