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Thursday, April 20, 2017

Licensure for Lactation Consultants in Oregon

The state of Oregon is one of many states working to write and pass a bill that would license lactation consultants in the state. Rhode Island and Georgia have already passed bills creating licensure for IBCLCs and at least 36 states are working on it. See here for a map. To see the bill Oregon is working on and its progress, please visit the Oregon State Legislature Oregon Legislative Information page.

Why do IBCLCs need to be licensed?

Many professions require licensure in order to practice. Some of the most obvious and familiar include physicians, physician assistants, nurses and nurse practitioners, midwives, speech pathologists, physical therapists, occupational therapists, lawyers, dentists, teachers, accountants, veterinarians, pharmacists, psychologists, engineers and architects. Licensure is intended to ensure the public that a person is competent to practice in that profession. An individual who is licensed is known to have a certain minimum level of education and experience, and must satisfy ongoing requirements including continuing education to assure knowledge and skills. The goal of licensure for any profession, and in particular for lactation consultants, is to provide public safety. Many studies (see here) have shown improved breastfeeding outcomes with the use of IBCLCs as an intervention.

According to the United States Lactation Consultant Association (USLCA) USLCA’s Issue Paper on Need for Licensure of Lactation Consultants,”The U.S. Surgeon General’s Call to Action to Support Breastfeeding recognizes International Board Certified Lactation Consultants® (IBCLC®) as the only health care professionals certified in lactation care and recommends their licensure. An IBCLC is an allied healthcare provider and a member of the maternal-child healthcare team with specialized skills in clinical lactation care and management. The IBCLC credential is the preeminent certification for the provision of clinical lactation care and services. While many training courses provide a certificate of completion, only the IBCLC credential denotes certification in lactation consultation. The IBCLC works in a variety of settings including hospitals, clinics, physician’s offices, public health, human milk banks, and private practice. Research has documented improved breastfeeding outcomes when mothers and infants receive the services of an IBCLC.”

How does licensure ensure public safety?

Licensure protects consumers because it prevents unqualified individuals from practicing and helps patients distinguish from among the variety of different levels of lactation support. Many people receive training and offer breastfeeding support. There are La Leche League leaders, breastfeeding peer counselors, and a variety of individuals who have taken breastfeeding support courses at different levels and may be called certified lactation educators (CLE), certified lactation counselors (CLC), advanced lactation counselors (ALC) and others depending on the course and the organization offering the course. These breastfeeding supporters provide extremely valuable education, support, mentorship and  breastfeeding problem solving with mothers and babies.

At the highest level are International Board Certified Lactation Consultants (IBCLCs) who require the most education, supervised hours, and most comprehensive exam for certification. Many breastfeeding supporters offer wonderful advice and support for basic breastfeeding questions and common concerns, but for more difficult or complicated breastfeeding problems or situations, an IBCLC is the best choice. For a comparison of the education and background required for many of the different lactation supporters, please see this document: https://massbreastfeeding.org/landscape/

At the moment there is no protection of the name “lactation consultant” and anyone may legally refer to themselves as a lactation consultant, whether they are an IBCLC, one of the other qualifications mentioned, or even someone with no training at all in breastfeeding. Most breastfeeding supporters at various levels are open with parents about their background and ability, but there are some who dishonestly call themselves lactation consultants, or lead parents to believe they have a qualification or background that they don’t have.

Health insurance companies generally only reimburse for services rendered by licensed providers. This provides a level of protection for both the patients and the insurance companies. Patients can assume that if their insurance covers a certain provider, that the provider is competent to practice and will provide high quality care. The insurance company knows that the licensed provider will be practicing in an evidence based and up-to-date way and will be working efficiently.

Aren’t many lactation consultants licensed as nurses or dieticians? Why do they need additional licensure?

Many lactation consultants are licensed as nurses or other health care providers including physicians, midwives, registered dieticians, occupational therapists and speech language pathologists. According to a recent survey by USLCA, 49% of lactation consultants are nurses. Among the 51% who are not are some professionals licensed in another way, but many are not. These IBCLCs are currently unable to bill insurance and because of this either work in settings where insurance is not billed (such as WIC) or work in private practice and parents must pay out-of-pocket for their services.

Some states (including Oregon) are proposing licensure bills that would exempt other licensed providers from IBCLC licensure on the basis that the additional cost and additional education requirements for licensure in the state would be a hardship to these lactation consultants and to their employers. However, many lactation consultants who are already licensed as nurses and other providers will likely choose to become licensed anyways to support their chosen profession and because they want to show themselves as accountable to the public.

If lactation consultants are licensed, they can bill insurance for each contact and mothers are more likely to seek lactation support for their breastfeeding problems if it is covered by their insurance. Lactation consultants are likely to be able to see more mothers as a result, increasing access for all families to lactation care.

Some lactation consultants, particularly those who work for WIC, cannot bill for their services because of how WIC is funded, even if they become licensed. Some states (Rhode Island, Georgia and Oregon’s proposed bill) are allowing exemptions to licensure for these lactation consultants because they believe the cost of licensure may be a hardship for these lactation consultants, but as with nurses, many of them will choose to become licensed anyways because they believe, along with the USLCA that: “the small economic sacrifice does not change the ethical duty of health care providers to be answerable to the public.”

What next?

All families deserve skilled, appropriate breastfeeding support, no matter where they live, or how young or old their baby. Each state needs to work to create licensure for IBCLCs for public safety reasons, to make lactation care more accessible and equitable, and to put the lactation consultant profession on par with other healthcare professions. Lactation consultants can and should be held to the same ethical and professional standards as other healthcare providers. Lactation consultants help improve breastfeeding outcomes, and breastfeeding duration is directly linked with improved health outcomes for infants and mothers. Creating licensure for IBCLCs is the next step in the movement to improve access to equitable lactation care throughout the United States, and to help each mother reach her breastfeeding goals.

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