House Bill 3976 Authored by Representative Farrar
Licensure of International Board Certified
Lactation Consultants (IBCLCs)
The public is best protected when health professionals are licensed as competent to practice safely. Currently, anyone can call him or herself a Lactation Consultant and provide services for a fee to women and infants during the vulnerable perinatal period, with no requirement to provide initial or ongoing competency as a lactation expert. IBCLCs are required to have extensive educational and clinical experience before they sit for the certification exam. Once certified, they are required to have continuing education and must retake the exam every ten years.
Former US Surgeon General Dr. Regina Benjamin issued a Call to Action to recognize IBCLCs as the experts in lactation care. The report states that licensure of IBCLCs will increase access to help for mothers. Licensure will improve breastfeeding rates and create jobs.
Problem: Mothers frequently have breastfeeding difficulties that require lactation-specific expertise to solve, but access to IBCLCs is limited.
Causes of Limitations:
- Medicaid, which covers 48% of all births in Texas, only reimburses care rendered by licensed healthcare providers.
- Insurance companies, though required to cover lactation support, do not know whom to cover.
- Mothers do not know whom to call with serious concerns.
Benefits of Licensure:
- Facilitates insurance reimbursement (improving access to care)
- Requires background checks
- Demands ethical standards
- Eliminates confusion with other professionals
- Puts more LCs in pediatricians’ offices (increasing jobs and access)
- Creates jobs by establishing a career path for peer counselors and breastfeeding educators, and by attracting a new generation of care providers
Others who provide breastfeeding assistance have significantly less lactation-specific training, from pediatricians and ob-gyns to La Leche League leaders and WIC breastfeeding peer counselors, etc. The only restriction placed on them by licensure is that they cannot call themselves Lactation Consultants unless they are IBCLCs. Therefore, no current sources of support for breastfeeding would be restricted.
Licensing IBCLCs will help to ensure all nursing mothers get the
qualified help they need.
Research Supporting the Need to Improve Access to IBCLCs through Licensure
Breastfeeding mothers require access to health professionals with appropriate educational preparation, clinical skills, and availability to initiate and maintain lactation under a variety of normal and adverse health conditions. Lactation consulting is a highly specialized skill requiring extensive specialized training whose utilization demonstrates significant positive health outcomes.
Medicaid moms who work with an IBCLC in the hospital are four times more likely to continue breastfeeding after they leave the hospital.
Castrucci B, Hoover K, Lim S, et al. A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants. Journal of Public Health Management and Practice, 2006; 12(6):578-585
53% of moms who saw an IBCLC after they left the hospital were still breastfeeding at 4-6 months, compared with only 23% of moms who didn’t see an IBCLC.
Lukac M, et al. How to integrate a lactation consultant in an outpatient clinic environment. Journal of Human Lactation, 2006; 22:99-103.
“An additional barrier for many women, regardless of payment status, is not knowing how to get help with breastfeeding from an IBCLC…relatively few health professionals are adequately trained and experienced in providing breastfeeding support.”
Shealy K, et al. CDC Guide to Breastfeeding Interventions, US Dept. Health & Human Services, 2005; pg. 25.
Lay and professional support together extended duration of any breastfeeding significantly.
Britton C, McCormick F, Renfrew M, et al. Support for Breastfeeding Mothers. Cochrane Database of Systematic Reviews, 2007; Issue 1. Art. No.: CD001141.DOI: 10.1002/14651858.CD001141.pub3.nnnn
A Pew Health Professions Commission study states that consumers would be better protected from unqualified health practitioners if health care professionals were held to credentialing and regulation standards that include state requirements for professionals to demonstrate competence at regular intervals.
Moore D: A higher standard. Modern Healthcare, 1998; pg.14.
Lactation Consultants facilitate better breastfeeding outcomes.
Pediatrics 2006 Jan;117(1):e67-75.
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