Clinical Competencies for IBCLC Practice

Clinical Competencies for IBCLC Practice

Much of the clinical practice of the International Board Certified Lactation Consultant (IBCLC) consists of systematic problem solving in collaboration with breastfeeding mothers and other members of the health care team. This checklist includes most of the clinical/practical skills that an entry level IBCLC needs in order to be satisfactorily proficient to provide safe and effective care for breastfeeding mothers and babies. The list is designed to encompass common breastfeeding situations and the challenges which are encountered most frequently by lactation consultants. Clinical instructors will be able to use this checklist as an appropriate guide in providing individualized education. A list of possible sites for obtaining clinical/practical experience appears at the end of the list of competencies.

Students are encouraged to become familiar with other documents that address the role of the IBCLC. The knowledge, skills and attitude inherent in the role of an IBCLC are summarized in a list of sixteen Competency Statements contained in the International Board of Lactation Consultant Examiners Candidate Information Guide.  A more detailed description of the role is provided in the Standards of Practice for IBCLC Lactation Consultants published by the International Lactation Consultant Association (ILCA). Optimal breastfeeding care is clearly presented with rationales and references in the 2005 Clinical Guidelines for the Establishment of Exclusive Breastfeeding, also published by ILCA.

The following clinical competencies for IBCLC Practice were collaboratively developed by representatives from IBLCE and ILCA and most recently updated in 2003.

Communication And Counseling Skills

In all interactions with mothers, families, health care professionals and peers, the student will demonstrate effective communication skills to maintain collaborative and supportive relationships.

The student will:

» Identify factors that might affect communication (i.e., age, cultural/language differences, deafness, blindness, mental ability, etc.)

» Demonstrate appropriate body language (i.e., position in relation to the other person, comfortable eye contact, appropriate tone of voice for the setting, etc.)

» Demonstrate knowledge of and sensitivity to cultural differences

Elicit information using effective counseling techniques (i.e., asking open-ended questions, summarizing the discussion, and providing emotional support)

» Make appropriate referrals to other health care professionals and community resources

The student will provide individualized breastfeeding care with an emphasis on the mother’s ability to make informed decisions.

The student will:

» Assess mother’s psychological state and provide information appropriate to her situation

» Include those family members or friends the mother identifies as significant to her

» Obtain the mother’s permission for providing care to her or her baby

» Ascertain mother's knowledge about and goals for breastfeeding

» Use adult education principles to provide instruction to the mother that will meet her needs

» Select appropriate written information and other teaching aides

History Taking And Assessment Skills

The student will be able to:

» Obtain a pertinent history

» Perform a breast evaluation related to lactation

» Develop a breastfeeding risk assessment

» Assess and evaluate the infant relative to his ability to breastfeed

» Assess effective milk transfer

Documentation And Communication Skills With Health Professionals

The student will:

» Communicate effectively with other members of the health care team, using written documents appropriate to the geopolitical region, facility and culture in which the student is being trained, such as: consent forms, care plans, charting forms/clinical notes, pathways/care maps, and feeding assessment forms

» Use appropriate resources for research to provide information to the health care team on conditions, modalities, and medications that affect breastfeeding and lactation

» Write referrals and follow-up documentation/ letters to referring and/or primary health care providers that illustrate the student’s ability to identify:

» The mother’s concerns or problems, planned interventions, evaluation of outcomes and follow-up

» Situations in which immediate verbal communication with the health care provider is necessary, such as serious illness in the infant, child, or mother

» Report instances of child abuse or neglect to specific agencies as mandated or appropriate

Skills for First Two Hours After Birth

The student will:

» Identify events that occurred during the labor and birth process that may negatively impact breastfeeding

» Identify and discourage practices that may interfere with breastfeeding

» Promote continuous skin-to-skin contact of the term newborn and mother through the first feeding

» Assist the mother and family to identify newborn feeding cues

» Help the mother and infant to find a comfortable position for latching-on/attachment during the initial feeding after birth

» Identify correct latch-on (attachment)

» 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

Postpartum Skills

Prior to discharge from care, the student will observe a feeding and effectively instruct the mother about:

» Assessment of adequate milk intake by the baby

» Normal infant sucking patterns

» How milk is produced and supply maintained, including discussion of growth/appetite spurts

» Normal newborn behavior, including why, when and how to wake a sleepy newborn

» Avoidance of early use of a pacifier and bottle nipple

» Importance of exclusive breast milk feeds and possible consequences of mixed feedings with cow milk or soy

» Prevention and treatment of sore nipples

» Prevention and treatment of engorgement

» SIDS prevention behaviors

» Family planning methods and their relationship to breastfeeding

» Education regarding drugs (such as nicotine, alcohol, caffeine and illicit drugs) and folk remedies (such as herbal teas)

» Plans for follow-up care for breastfeeding questions, infant’s medical and mother’s postpartum examinations

» Community resources for assistance with breastfeeding

Problem-Solving Skills

The student will be able to:

» Identify problems

» Assess contributing factors and etiology

» Develop an appropriate breastfeeding plan of care in concert with the mother

» Assist the mother to implement the plan

» Evaluate effectiveness of the plan

Skills for Maternal Breastfeeding Challenges

The student will be able to assist mothers with the following challenges:    

» Cesarean birth

» Flat/inverted nipples

» Yeast infections of breast, nipple, areola, and milk ducts

» Continuation of breastfeeding when mother is separated from her baby

» Milk expression techniques

» Maintaining milk production

» Collection, storage and transportation of milk

» 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.)

» Medical conditions that impact breastfeeding

» Adolescent mothers

» Strategies for returning to school

» Maintaining milk production

» Nipple pain and damage

» Engorgement

» Plugged duct or blocked nipple pore

» Mastitis

» Breast surgery/trauma

» Overproduction of milk

» Postpartum psychological issues including transient sadness (“baby blues”) and postpartum depression

» Appropriate referrals

» Medications compatible with breastfeeding

» Insufficient milk supply, differentiating between perceived and real

» Weaning issues

» Safe formula preparation and feeding techniques

» Care of breasts

Skills for Infant Breastfeeding Challenges

The student will be able to assist mothers who have infants with the following challenges:

» Traumatic birth

» 35-38 weeks gestation

» Small for gestational age (SGA) or large for gestational age (LGA)

» Multiples/plural births

» Preterm birth, including the benefits of kangaroo care

» High risk for hypoglycemia

» Sleepy infant

» Excessive weight loss, slow/poor weight gain

» Hyperbilirubinemia (jaundice)

» Ankyloglossia (short frenulum)

» Yeast infection

» Colic/fussiness

» Gastric reflux

» Lactose overload

» Food intolerances

» Neurodevelopmental problems

» Teething and biting

» Nursing strike/early baby led weaning

» Toddler nursing

» Nursing through pregnancy

» Tandem nursing

Management Skills

The student will demonstrate the ability to:

» Perform a comprehensive breastfeeding assessment

» Assess milk transfer with:

» AC/PC weights, using an electronic digital scale

» Use of balance scale for daily weights

» Calculate an infant’s caloric and volume requirements

» Increase milk production

Skills for Use of Technology and Devices

The student will have up-to-date knowledge about breastfeeding-related equipment and demonstrate appropriate use and understanding of potential disadvantages or risks of the following:

» A device to evert nipples

» Nipple creams/ointments

» Breast shells

» Breast pumps

» Alternative feeding techniques

» Tube feeding at the breast

» Cup feeding

» Spoon feeding

» Eyedropper feeding

» Finger feeding

» Bottles and artificial nipples

» Nipple shields

» Pacifiers

» Infant scales

» Use of herbal supplements for mother and/or infant

Skills for Breastfeeding Challenges Which Are Encountered Infrequently

The following issues are encountered relatively infrequently, and may not be seen during the student’s training. The entry-level lactation would not be expected to be proficient in these situations. The student will need to use basic skills to assist the mother and infant while seeking guidance from a more experienced IBCLC.

Infant:

» Infant with tonic bite/ineffective/dysfunctional suck

» Cranial-facial abnormalities, such as micrognathia (receding lower jaw) and cleft lip and/or palate

» Down Syndrome

» Cardiac problems

» Chronic medical conditions, such as cystic fibrosis, PKU, etc.

Mother:

» Induced lactation and relactation

» Coping with the death of an infant

» Chronic medical conditions, such as MS, lupus, seizures, etc.

» Disabilities which may limit mother’s ability to handle the baby easily, such as, rheumatoid arthritis, carpal tunnel syndrome, cerebral palsy, etc.

» HIV/AIDS: understanding of current recommendations based on the mother’s access to safe replacement feeding

Skills For Meeting Professional Responsibilities

The student will demonstrate the following professional responsibilities:

» Conduct herself or himself in a professional manner, by complying with the IBLCE Code of Ethics for International Board Certified Lactation Consultants and the ILCA Standards of Practice; and by adhering to the International Code of Marketing of Breastmilk Substitutes and its subsequent World Health Assembly resolutions.

» Practice within the laws of the setting in which s/he works, showing respect for confidentiality and privacy.

» Utilize current research findings to provide a strong evidence base for clinical practice, and obtain continuing education to enhance skills and obtain/maintain IBCLC certification.

» Advocate for breastfeeding families, mothers, infants and children in the workplace, community and within the health care system.

» Use breastfeeding equipment appropriately and provide information about risks as well as benefits of products, maintaining an awareness of conflict of interest if profiting from the rental or sale of breastfeeding equipment.

Sites For Acquisition Of Skills

The student may acquire clinical/practical skills in the following settings:

» Private practice IBCLC office

»Private practice OB, pediatric, family practice or midwifery office

» Public health department; Women, Infants and Children (WIC) Program (in the US)

» Hospital

» Lactation services

» Birthing center

» Postpartum unit

» Mother-Baby unit

» Level II and Level III nurseries: Special Care Nursery, Neonatal Intensive Care Nursery

» Pediatric unit

» Home health services

» Out-patient follow-up breastfeeding clinics

» Breastfeeding hotlines and warm-lines

» Prenatal and postpartum breastfeeding classes

» Home births (if legally permitted)

» Volunteer community support group meetings