Two Midwife Model Supporting Perinatal Services Celebrated in Haida Gwaii

Mar 8, 2016

Authors: Kayla Serrato & Nicole Gibbons

Partners from the communities of Skidegate and Old Massett, First Nations Health Authority, Northern Health, the local Medical Advisory Committee, the Midwives Association of BC and midwives Celina Laursen and Shannon Greenwood celebrated the launch of a two midwife model to practice and support pregnancies and birth for all women on Haida Gwaii in February 2016.

The journey of bringing birth closer to home and into the hands of women has resulted in a two midwife model of care supporting perinatal services in Haida Gwaii. On February 18, 2016 at Haida House in Tlell, partners celebrated the ceremonial signing of two alternative payment plan contracts allowing two midwives to practice and support pregnancies and birth in a rural and remote environment, enhancing maternal and child health programs and services for all women on Haida Gwaii. These midwives are linked to local physicians, nurses, doulas and community program staff and have the ability to support labor and delivery at the homes of women or at the Queen Charlotte Island General Hospital. The realization of this model was a result of collaboration between the communities of Skidegate and Old Massett, First Nations Health Authority, Northern Health, the local Medical Advisory Committee, the Midwives Association of BC and midwives Celina Laursen and Shannon Greenwood.

The vision and perseverance of Skidegate and Old Massett made this Community-Driven, Nation-Based model a reality. In this model, both midwives offer regular midwifery care to all women on Haida Gwaii who choose this service, while also supporting maternal child health programming offered in community, on-reserve. One midwife primarily supports the north island and works with Old Massett and one midwife primarily supports the south island and works with Skidegate. Having a midwife present and available in community to connect with women thinking about having a baby, pregnant women, new parents and infants is intended to improve access to care and enhance services received.

During the ceremonial signing, the group was grateful to have Elders present from both Skidegate and Old Massett, who shared kind words to open and close the day.  The history of giving birth on Haida Gwaii was talked about and the work of previous midwives and physicians over the years was honoured.  All partners involved had an opportunity to share their reflections about the importance of this work. Many acknowledged the discussions and negotiations involved in finalizing this model were emotional and challenging but emphasized the common passion and personal and professional growth that resulted.  Personal birth stories, traditional birth practices and a Haida song were shared. Celina and Shannon both shared their journeys in deciding to become a registered midwife. The strength and meaning of being able to have family present to play an active part of a baby’s welcoming, on traditional territory was celebrated. Following local protocol, after the ceremonial signing of certificates gifts were shared with witnesses.

Midwifery care and maternal child health are areas of work that link closely with FNHA’s vision of Healthy, Self-Determining and Vibrant BC First Nations Children, Families and Communities. A big congratulations goes out to the communities and all partners involved in making this two midwife model on Haida Gwaii possible. It is hoped that this work will inspire other First Nations communities, regional health authority partners and primary care providers to consider new ways to provide maternal child health care that better meets the needs of communities and continues to move forward the priority of bringing birth closer to home.

For more information about midwives:

For more information about considerations in developing a collaborative maternity care model:

Read more on FNHA Maternal, Child and Family Health here:


A midwife crisis

By Celina Ip

Tree de la Vie opened in Nov. 2015 and is currently the only midwives clinic within the region north-east of Edmonton. The clinic has clientele from 10 different communities including 20 per cent from Cold Lake and Bonnyville.

Lack of midwifery funding from Alberta Health Services has placed the Lakeland region’s only midwife centre at risk of closure.

In September, the Alberta government increased funding for midwifery services by $1.8 million to enable 400 more midwife-supported births for the fiscal year. Currently, there are already more than 1,800 women on waiting lists for midwife care in the province. While further funding is needed to support the rising waitlist, AHS recently announced that they will be maintaining the same amount of funding for the 2016/2017.

Alberta Association of Midwives (AAM) has been passionately rallying for the cause by pushing the Alberta government to increase funding in order to support the staggering number of women hoping to receive midwife care.

“The increase in the number of courses of care by 17- 18 per cent last year is not an increase in pay for midwives, it is an increase in the number of Albertans who can receive midwifery care. Even with this increase our midwives are not utilized to their full capacity,” wrote AAM in a statement on their website.

“We also continue to ask that the number of courses of care be immediately increased to allow midwives to work at their full capacity to accommodate as many of the 1,800 pregnant Albertans who are currently waiting for care as possible. Many of Alberta’s midwives are only working part-time, or even less, With the dozen students graduating this spring, our midwives can serve 3,800 pregnant Albertans who are having babies and want access to midwifery care in this fiscal year.”

The lack of funding is also putting many of the province’s midwives at risk of having to close their practices as they may not receive enough funding to support their services for the entire year. The clinics that are most at-risk are ones located in rural areas whose waitlists are not as long as the clinics located in the metropolitan cities like Edmonton and Calgary.

The St. Albert Community midwives clinic had to recently close their doors and now Lac La Biche’s Tree de la Vie clinic fears they may eventually face the same fate.

Tree de la Vie opened their doors four months ago, in Nov. 2015. The clinic is located in Plamondon and they have hospital privileges in Lac La Biche.

As the first midwives’ clinic to serve communities north-east of Edmonton, their clientele has been rapidly increasing with women coming from 10 different communities.

The clinic is run by two registered midwives, Marianne King and Chantal Gauthier-Vaillancourt.

“We get clients from Lloydminster, Vermillion, Fort McMurray, Athabasca, Cold lake, Bonnyville, St. Paul and all over the area. About 20 per cent of our clientele right now are from the Cold Lake and Bonnyville area,” said Gauthier-Vaillancourt.

Along with being passionate about their profession, King and Gauthier-Vaillancourt opened up their midwives clinic to make the service accessible and available to women in the aforementioned communities.

“Both of us know there’s definitely a need and we both are just passionate about offering that care to women in rural areas and in our home communities,” said Gauthier-Vaillancourt.

“To us it’s about making women feel most comfortable and safe during their pregnancy. Some women feel comfortable with doctors but other women would rather take a different route – that’s why we feel so passionate about being able to offer that alternative.”

Marla Haring is a Tree de la Vie client from Cold Lake who was originally going to see a doctor but eventually opted for a midwife-assisted birth. Haring was pleased by the services she received from King and Gauthier-Vaillancourt and expressed her hope that the clinic remain open to continue to serve women in the area.

“Women should have options with how they want to have their babies and seeing a typical doctor doesn’t necessarily work for everybody. I just find you get a lot more support from a midwife – with them, if I had any questions during my pregnancy I could just send them a text or call them and I would have an answer right away,” said Haring.

Prior to Tree de la Vie’s opening, many women would be traveling as far as Edmonton or Calgary to receive midwifery services.

“A lot of our out-of-town clients would be traveling regardless. If you look at Athabasca and Boyle which are about 40 minutes from us, neither of those communities has obstetrical care at all.

“Even if they wanted to have their baby at the hospital in their community, they don’t have that choice. They’d have to go to Edmonton or come to us,” said Gauthier-Vaillancourt.

Despite having just opened four months ago and experiencing notable success, Gauthier-Vaillancourt fears that the government’s lack of funding will put them at risk of closing their doors by the end of the year.

“It’s been quite stressful and overwhelming because we’ve only been around for four months and we’re just getting going. But now we’re not sure if we have funding past October,” said Gauthier-Vaillancourt.

“So even the women that are calling us with due dates that are beginning of November, we’ve kind of put those on hold because we don’t want to be in this predicament where we’re taking them into our care and then telling them I’m sorry but we can’t.

“We definitely don’t want to be committing to care if we’re not going to be in a position to do so.”

Not Your Idea: Cultural Appropriation in the Birthing Community

Ever wonder why babies don’t sleep through the night?

The Sleep Cycle

Breastfeeding is a “gut feeling” thing…It’s something you know by instinct and not something you can calculate, or think through. Some say, you need to use your right brain that regulates emotions and not your left one, the one that analyses. Breastfeeding is something you feel, it is not a logical thing. You cannot control when your baby will wake up, how hungry he will be and how long he will breastfeed. In fact, once you have a baby, there is no way you can ever control anything again… No, this is only a joke…Well there is a little truth to it.

In the beginning, babies’ respond to stimuli with reflexes. They cannot control their movements and their bodily functions. They react to things with their primitive brain, the first brain fully developed at the birth of a human being. The other parts of our brain, the…

View original post 943 more words

A Healing Ritual for Abortion

I mentioned earlier today that I’m working with a couple who need to terminate a pregnancy, and that we’re designing a series of ceremonies to help everyone involved get through the process with love and grace. In the few hours since I posted that, I’ve had an outpouring of private messages about this story, so I’d like to tell you a bit more about it, with great gratitude to the couple for their willingness to share their experiences.
There’s nothing easy about the decision to abort a pregnancy, or the process required to complete it, but those challenges are made much more difficult by the deep societal taboos around silence and shame. Our goal is not only to change the experience for this child, this couple, and those who care about and support them, but also to help build some new healing patterns in the cultural field around this experience.
At our first healing session, this morning, we talked a lot about what is happening, spiritually and energetically speaking: for this spirit who has begun the journey in, and also for those here who would welcome it. I see the journeys of birth and death as voyages across a great sacred river, between the Land of the Living, and the Land of the Dead (which is also the Land of the Not-Yet-Born). In my imagination, there is a great wheel superimposed on the river, overlapping on each shore. Each of us travel around the wheel; at birth, we enter this world, and at death we return to the other one. The Wheel of Life holds and guides both those processes.
My work is usually about helping people travel from this world to the other, but in the case of pregnancy loss, the soul has not fully made its way here yet. There’s a kind of compression of the wheel, where coming in and going out overlap. It can be painful and confusing, for everyone involved. A big part of healing requires unwinding these two processes, so each can have the attention it deserves.
The Mom is very clear that this tiny being inside her is a boy, and they have named him already. Before his parents and his community are able to say goodbye to this little one, they need to fully say hello to him. Naming is powerful; it makes him real. We did a beautiful ritual today to let him know that his people on this side of the river see him, they love him, and they claim him as one of their own. And we let him know, with great tenderness, that this is not the right time for him to come. For many good reasons, he’s not going to be able to finish his journey to this side of the river. The image was of a lighthouse beacon, flashing a loving message to him out in the water, letting him know that he should prepare to turn around.
I believe that each soul that comes into this world does so with an idea of what it wants to learn or experience. Some of us have big tasks, and it can take us decades to fulfill the goals we set for this lifetime. Others need only a very short time to receive what this world has to offer them, and when they get that, they can return to the far shore of the river.
This child’s time here will be short, and so at this ritual, his Mom committed to giving him the fullest experience of love and beauty she can before he goes. Likewise, her time being pregnant is short, and because mothers in this situation are so rarely able to publicly claim their mothering experience, she is going to claim her own experience of pregnancy fully in the next few days too. This includes going to a pre-natal yoga class, and really connecting to and loving this tiny spirit, while knowing that their time together is short.
We’ve set another ritual for the end of the week, which is 2 days before the appointment for the abortion. That ceremony will involve Mom, Dad, and friends and family members who support both of them. At this point, we’ll shift the energetic pattern from welcoming and loving this soul while he’s here, to grieving his leaving, and helping him start his journey back across the river. We’ll ask him to pull his energy out of the tiny physical form that it’s beginning to coalesce in, and to turn his attention back to those on the far shore, knowing that he’ll be leaving us and joining them soon. With this loving preparation, our intention is that his spirit is aware and able to accept what is happening.
This is a journey in progress, and I appreciate your interest in it. I’ll post another update after the next ritual.
May this healing work bring love and light to all who are touched by it.
Sarah Ritual Healing for Death Midwives and Celebrants: A Practical Skills Training Begins April 15th, 2106

The Alphabet Soup of Breastfeeding Support

Because breastfeeding can have a positive lifelong effect on your baby’s health and development as well as your own health, its importance is widely recognized in the health-care field. However, many mothers find themselves unsure where to turn for help or information when problems related to breastfeeding arise. New mothers may be especially overwhelmed by the volume of information that is shared with them or confused by conflicting advice given by different caregivers. This article presents a guide to the different types of breastfeeding support specialists you may seek out or encounter as you begin your breastfeeding journey.

Your family, friends, and community may influence your decision to breastfeed and will be an important source of support after your baby arrives. Sometimes you simply need a little encouragement, a nutritious meal (that you didn’t have to prepare), or the company of a friend to keep you going through breastfeeding challenges. Your partner, mother, grandmother, auntie, friend, or even a stranger on the internet can help you find information you need or offer “been there, done that” advice. If you need more specialized information, help, or connection to the social support of a breastfeeding group in your community, trained breastfeeding specialists are available to fill the need.

There are many different training programs available to the aspiring breastfeeding support specialist or volunteer. The resulting “alphabet soup” of initials can be downright confusing, even for people who work with breastfeeding moms! Understanding what the initials stand for, as well as what training, education, and experience is required to earn them, may help you choose whom to call if you need breastfeeding help and support.


Professional Fellowship and Certification

Professional fellowship and certification requires post high school education, including health education that provides an understanding of whole body systems and how they affect lactation. Professionals perform clinical evaluations of breastfeeding and create and oversee a plan of care, which may involve more than one type of health-care provider. One factor that sets professionals apart is the requirement to follow an ethical code of conduct overseen by the organization that provides the fellowship or certification.

Breastfeeding Medicine Specialist (Fellow of the Academy of Breastfeeding Medicine–FABM)

Breastfeeding Medicine Specialists are Medical Doctors (MD or DO) who have completed additional training in breastfeeding and human lactation and specialize in this field. They are able to treat complicated breastfeeding issues that require evaluation by a physician such as failure to thrive (a baby not gaining weight, not growing as expected), tongue tie, breast abscess, low milk production that is not resolved by more frequent nursing/expressing, and breast or nipple infections. They are also able to assist with common and ordinary breastfeeding problems as well as concerns that relate to the normal course of breastfeeding.

Breastfeeding Medicine Specialists often work in either private or group physician practices. They may work entirely in the field of breastfeeding medicine or use their breastfeeding expertise while working in another medical speciality such as obstetrics, pediatrics, or family medicine. Most often, mothers are referred to FABMs by an IBCLC or another physician who recognized an issue that required their expertise. As with most physicians, however, mothers may self-refer.

Education and experience:

An applicant must have completed the required education and training to become a physician, additional education in lactation science and management, as well as the required clinical experience hours working directly with breastfeeding mother-baby pairs.

Breastfeeding Medicine Specialists are recognized by the Academy of Breastfeeding Medicine to have “demonstrated evidence of advanced knowledge and skills in the fields of breastfeeding and human lactation. FABM denotes that the physician has ongoing specialized professional activities related to clinical expertise, research or teaching experience, and/or significant advocacy efforts in the field of breastfeeding medicine.” See the full reference here. Breastfeeding Medicine Specialists must apply to maintain their fellowship every 10 years.

Breastfeeding Medicine Specialists can:

  • make a medical diagnosis
  • prescribe medication
  • order and perform medical testing
  • perform medical procedures

Find a Breastfeeding Medicine Specialist:

Currently, a publicly accessible database is not available. You may call the Academy of Breastfeeding Medicine and ask how to contact the closest Breastfeeding Medicine Specialist to you.

Contact information: Academy of Breastfeeding Medicine

International Board Certified Lactation Consultant (IBCLC)

Certification by the International Board of Lactation Consultant Examiners (IBLCE) is recognized as the gold standard credential for professionals who work with breastfeeding mothers.

IBCLCs are allied health professionals who have completed extensive, comprehensive education in breastfeeding and human lactation, education in health sciences and related subjects, and the required hours of supervised clinical experience. By passing the IBLCE exam, they have demonstrated they are qualified to work with breastfeeding mother and baby pairs as clinicians. IBCLCs can help mothers overcome common breastfeeding difficulties such as sore nipples, mastitis, and milk production concerns. They can also provide assistance with more complex issues, such as breastfeeding with illness or disability, low weight gain, and tongue tie. IBCLCs also help with concerns related to the normal course of breastfeeding (sleep, returning to work or school, etc.).

IBCLCs may work in private practice, group practices, hospitals, birth centers, health clinics, parenting centers, WIC clinics, physician practices, midwives practices, chiropractic practices, or multi-faceted practices such as perinatal clinics. They are part of the maternal-child health team and coordinate care with physicians and other health-care professionals. Additionally, IBCLCs may work in research, advocacy (including policy-making), non-profit management, or as volunteers. IBCLC is a stand alone credential, though many practicing IBCLCs are also licensed professionals such as physicians, registered nurses, or registered dietitians.

Education and experience*:

At least 90 hours of education specific to breastfeeding and human lactation

At least 1000 hours of supervised clinical experience working with mother and baby pairs, or 300-500 hours of directly supervised clinical experience with a mentor

A degree in one of the health sciences OR completion of the following courses:

  • Biology
  •  Nutrition
  • Human Anatomy
  • Psychology or Counseling or Communication Skills
  • Human Physiology
  • Introduction to Research or Statistics
  • Infant and Child Growth and Development
  • Sociology or Cultural Sensitivity or Cultural Anthropology
  • Basic life support
  • Medical terminology
  • Medical documentation
  • Occupational safety and security for health professionals
  • Professional ethics for health professionals
  • Universal safety precautions and infection control

(*Source: International Board of Lactation Consultant Examiners Candidate Information Guide 2013)

The eligibility requirements above were implemented in 2012. Please note that these requirements have changed several times since the exam was first administered in 1985.  See this presentation from IBLCE for full details. Depending on which year an IBCLC took the exam, and which pathway was taken, the candidate was required to acquire between 1000-8000 supervised clinical experience hours or 300-500 clinical experience hours that were directly supervised by an IBCLC mentor before applying for the exam. It is also of note that many candidates have more lactation-specific education hours than required at the time of application not only because they attend conferences and webinars earning Continuing Education Recognition Points (CERPs) while working towards eligibility, but also because it takes many hours to cover all the topics in the exam blueprint. For example, one of the most popular comprehensive education programs available to IBCLC hopefuls is the 120-hour Health e-Learning BreastEd course.

The IBLCE exam contains 175  multiple choice questions of which 100 include clinical photos. The exam covers all aspects of breastfeeding and human lactation as well as related topics such as child development, pharmacology, nutrition, anatomy and physiology, and ethics.  All IBCLCs must recertify every five years by CERPs (a total of 75 hours) and at least every 10 years by exam.

IBLCE is the only certification program in lactation accredited by the National Commission for Certifying Agencies.  The NCAA is a regulatory body that provides volunteer oversight for allied health professions.

IBCLCs  can:

  • take a complete lactation history including evaluating breast anatomy and function and assessing factors related to breastfeeding such as maternal condition, social support, and potential challenges
  • assess the baby’s facial and oral structure and evaluate neurological responses and reflexes
  • assess for developmental milestones and normal infant behavior
  • perform a comprehensive, clinical evaluation of breastfeeding efficiency and effectiveness including assessing latch/attachment, milk transfer, and milk intake
  • assist the mother to find comfortable and effective positions for breastfeeding
  • assess the mother’s milk production and provide education  and assistance regarding  adjusting milk volume if necessary
  • use the appropriate World Health Organization growth chart to assess the breastfeeding child’s weight and growth patterns
  • evaluate and demonstrate the use of breastfeeding techniques and devices and provide evidence-based information to mothers about their use
  • write a comprehensive evaluation of a mother’s lactation history and breastfeeding assessment and work with the mother to develop and implement an appropriate and achievable breastfeeding plan
  • assess and provide strategies for initiation and continuation of breastfeeding in challenging circumstances such as a medical condition in mother or baby, compromised lactation, or emergency situation
  • provide information and strategies for overcoming breastfeeding challenges such as painful nipples, mastitis, and engorgement
  • empower mothers and families with information, support, and appropriate referrals to help them cope with peripartum mood disorders
  • educate mothers and families about normal baby behavior including signs of hunger and expected feeding and sleep patterns
  • provide current, unbiased, evidence-based information to assist the mother in decision making
  • obtain the mother’s consent to gather and disclose information and written assessments to pertinent health care providers

 Find an IBCLC:

  • ILCA: Find a Lactation Consultant Directory-IBCLCs who are also members of the International Lactation Consultant Association may choose to have their contact information listed on this page. Due to that limitation, it may not be a comprehensive listing of all IBCLCs in your area.

  • Department of Public Health or WIC breastfeeding resource directory-Search your state Health Department or WIC website for this valuable listing of breastfeeding support resources in your community. It is usually updated annually.

  • Search-Most IBCLCs in private or group practice have a website and/or a Facebook page that is searchable using a web search engine such as Google or Bing. Searching for IBCLCs in a specific city or geographic region may help you narrow down the results. (For example “IBCLC New York, NY” or “IBCLC Bay Area CA.”)

  • Word of mouth and referrals-If you need the services of an IBCLC, you can ask your physician, nurse, or nutritionist for a referral. Your insurance company may have a referral list of  IBCLCs that are covered under your plan. You may also find recommendations from from other women through parenting groups, breastfeeding support groups or meet-ups, and online groups.

  • More info:

    Clinical Competencies for the Practice of International Board Certified Lactation Consultants (IBCLCs)

    Scope of Practice for International Board Certified Lactation Consultants

    Position Paper on the Role and Impact of the IBCLC


    Mother-to-Mother Support

    Experienced mothers are trained in basic breastfeeding management, modeling optimal breastfeeding practices, and sharing (or facilitating the sharing of) information and experiences with pregnant and breastfeeding women individually and in group settings.  Mother-to-mother support gives mothers the opportunity to talk with other women about their concerns in a way that might not otherwise be possible in today’s world. Women are empowered to explore options that are the foundation of a personally satisfying breastfeeding experience. Mothers often find it easier to share their concerns with other mothers; this mutual sharing of experiences and information builds trust and respect. Mother-to-mother support has the following benefits:

    • It is community-based and easy to access.
    • It provides an essential complement to existing health care and social services systems.
    • It counters incorrect or misleading breastfeeding information with accurate, evidence-based information.
    • It enables and empowers mothers to make informed choices about breastfeeding and parenting.
    • It provides a social outlet for mothers (group meetings).

    WIC Breastfeeding Peer Counselor (WIC BFPC or WIC PC)

    Through the federal Women, Infants, and Children program, WIC Breastfeeding Peer Counselors provide mothers with breastfeeding information and support from pregnancy through weaning. During pregnancy, they visit with mothers by phone and in person to provide them with basic breastfeeding information, answer questions, and offer anticipatory guidance to help make breastfeeding easier. After a mother’s baby is born, her BFPC will continue to make regular contact with her, answer her questions, and offer practical suggestions to help her reach her breastfeeding goals. Depending on the policies of her state or tribal program, BFPCs may also facilitate support groups, teach breastfeeding classes, dispense breastpumps, certify participants for the WIC program, and make home or hospital visits.

    Personal experience:

    Breastfed for at least 6 months, WIC participant

    Education and training:

    20-hour on-site training  that covers all aspects of the normal course of breastfeeding and human lactation as well as communication skills. Training activities include role play and demonstration of necessary skills including assisting moms with using common breastfeeding tools and equipment (such as breastpumps).

    Continuing Education:

    1 hour per month minimum; additional requirements vary by state

    More info:

    Who are Breastfeeding Peer Counselors, and what do they do?

    Volunteer Breastfeeding Counselors

    The following volunteer organizations offer one-to-one breastfeeding counseling (which may include online or text communication and home visits), group meetings, and online resources. Counselors are educated and mentored within the organization before beginning to work with mothers. They may be supported by a network of professionals in the field of lactation that works as a sounding board for complicated situations.

    La Leche League Leader (LLLL)

    Personal experience:

    Breastfed for at least 9 months at time of application; Please see additional requirements here.

    Education and training:

    Applicants must complete required reading, writing exercises, and role play which covers all aspects of the normal course of breastfeeding and human lactation, as well as communication skills.  For full details, please see here.

    Continuing Education:

    Leaders are expected to keep up-to-date and are strongly encouraged to continue their education. Proof of completion is not required. To fill the need for continuing education, Chapters, Area Networks, and Regions regularly provide education opportunities such as seminars, conferences, lunch and learns, as well as informative publications such as Leaven and newsletters.

    More info:

    How can I become a LLL Leader?

    About La Leche League

    Breastfeeding USA Counselor (BfUSA Counselor)


    Breastfed for at least 1 year at time of application.

    Education and Training:

    Training varies based on experience. Includes reading, online training activities, and role playing.

    Continuing Education:

    Minimal number of credits every 3 years

    More info:

    Becoming a Breastfeeding Counselor

     Nursing Mothers Counsel Counselor (NMC Counselor)

    Requirements vary by chapter.  Please see the chapter website for specific information.

    Nursing Mothers Counsel (California)

    BACE: Nursing Mothers’ Council

    Nursing Mothers Counsel (Oregon)

    Certificate Programs

    The following programs offer similar preparation to individuals who may provide mothers with information about the normal course of breastfeeding and basic breastfeeding support. After completion, they will be prepared to:

    • answer questions about common breastfeeding concerns such as prevention of sore nipples, preparing for return to work or school, and milk production issues
    • offer practical tips for helping mothers fit breastfeeding into their lifestyle
    • provide anticipatory guidance about common breastfeeding situations and problems
    • provide education to help mothers prepare to breastfeed or return to work or school
    • recognize when breastfeeding is going well and when more help is needed
    • recognize when a breastfeeding issue is beyond their scope of practice and refer to the appropriate professionals.Many certificate program graduates use their education in their occupations as nurses, nutritionists, midwives, labor doulas, postpartum doulas, baby boutique and pump rental station employees, or WIC Breastfeeding Peer Counselors. Some work as part of a group practice, usually with an IBCLC as the lead, while others start businesses to support women in their communities directly.

    Certification vs. Certificate Programmes:  What’s the Difference? 
    Practice Analyses

    Certified Lactation Counselor (CLC)


    Healthy Children’s Project, Inc

    Exam, certificate, and renewal administered by Academy of Lactation Policy and Practice, a division of Healthy Children’s Project, Inc. The ALPP certificate is accredited by the American National Standards Institute.  ANSI accreditation means that the testing process of the certificate program has been found to be fair, valid, and reliable.


    5 day on-site breastfeeding education (45 credit hours), role play, competency check (example: watch a short video and describe what action the CLC would take) and pass a 100 question exam with 75% or better immediately after program; Program information

    Renewal: Every 3 years with 18 hours of breastfeeding education, plus required fee

    Advanced Lactation Consultant (ALC) and Advanced Nurse Lactation Consultant (ANLC)


    Healthy Children’s Project, Inc (please see CLC listing above)


    45 hour course; Program information

    Prerequisites: RN license and CLC or IBCLC 

    Prerequisite: CLC or IBCLC 

     Certified Lactation Specialist (CLS)


    Lactation Education Consultants


    5 day on-site education and training (45 credit hours), complete assigned homework and readings, and pass final exam immediately after program; Program information



    Certified Breastfeeding Counselor (CBC)


    Childbirth International


    Mentored online training, required reading and exercises, create portfolio of local breastfeeding resources, provide 30 hours of breastfeeding support, and complete final open book exam; Program information



    Breastfeeding Counselor (BC)


    Breastfeeding Support Consultants Center for Lactation


    Distance learning course (95 hours), read required text, complete study questions and role plays, and pass final exam; Program information



    The following certificate programs prepare candidates to provide breastfeeding education rather than support. Please see the program requirements and accompanying documents for more details, including the scope of practice of the certificated educators for each program.

    Certified Lactation Educator (CLE) 


    Childbirth and Postpartum Professional Association (CAPPA)


    Complete all assignments and read all required texts/books, write one-page essay, attend 20-hour training (a distance track is also available), attend 2 breastfeeding support group meetings, attend 1 breastfeeding class,  submit 2 letters of recommendation, develop breastfeeding class outlines and handouts, create local breastfeeding resource list for families, complete part 1 of HUG your baby training, and pass final online exam with 85% or better; Program information


    Every 3 years with 15 hours of breastfeeding education, required evaluations, reports, reviews, and fee. Details

    Lactation Educator (LE)


    Evergreen Perinatal Education


    5 day on-site education and training (45 hours), written breastfeeding project (homework), write study guide on breast anatomy and physiology, participate in quizzes, case studies and role plays, evaluate program; Program information



    Lactation Educator Counselor (LEC)


    University of California at San Diego Extension: Breastfeeding Education by Gini Baker, RN, MPH, IBCLC


    5 day on-site education and training (45 hours) or online (60 hours). Complete assignments including internet resource, nutrition, clinical, and counseling problems, review 4 research studies, observe a breastfeeding class, develop breastfeeding class curriculum, read required text, satisfactorily complete periodic testing; Program information



    For more information about, and a comparison of, the various breastfeeding support specialists in the USA please see The Landscape of Breastfeeding Support by the Massachusetts Breastfeeding Coalition.

    Finger Lakes-  Ganondagan’s Native American Dance and Music Festival - Ontario

    Because of the immense importance of breastfeeding to both individuals and public health, it is imperative that our communities support and empower mothers both to initiate breastfeeding after birth and to continue breastfeeding as long as desired, ideally through the first year and beyond.

    While it is helpful for mothers and community members to be aware of the diversity in breastfeeding specialists, these practitioners only represent one part of the larger picture of essential support for mothering. Breastfeeding specialists, community advocates, and health-care providers must work together with families in order to ensure that women have access to the accurate, evidence-based information and support they need to develop and meet their own breastfeeding goals.

    Thank you to all the colleagues and friends who shared information to make this resource as comprehensive as possible. Special thanks to Adrienne Uphoff, IBCLC for her time and patience while editing and updating this article, as well as for the generous gift of her wordsmithing wizardry.

    © Jolie Black Bear, IBCLC 2012– All Rights Reserved