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Clinical Competencies

International Board Certified Lactation Consultants (IBCLCs) demonstrate specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).
 
The Clinical Competencies encompass the responsibilities/activities that are part of the IBCLC’s practice. The aim of these Clinical Competencies is to inform the public of the field in which IBCLCs can provide safe, competent and evidence-based care. The Clinical Competencies are applicable in any country or setting where IBCLCs practice. It is understood that the IBCLC will practice within the boundaries of her/his training, expertise, culture and setting.

1. The IBCLC has the duty to uphold the standards of the profession and will:
  • conduct her/himself in a professional manner, practicing within the framework defined by the IBLCE Code of Professional Conduct for IBCLCs, the IBLCE Scope of Practice for the IBCLC, and the IBLCE Clinical Competencies for the Practice of IBCLCs
  • critique, evaluate and incorporate evidence-informed findings into practice within the laws of the setting in which s/he works
  • obtain continuing education to enhance skills and maintain IBCLC certification
2. The IBCLC has the duty to protect, promote and support breastfeeding and will:
  • provide evidence-informed education through various means including development of client information fact sheets, counseling, curriculum development, and multimedia campaigns to women, families, health professionals and the community about breastfeeding and human lactation
  • participate in the development of policies at global, national, and local levels which protect, promote and support breastfeeding or breastmilk intake in all situations including emergencies
  • advocate for breastfeeding women, children and families in all settings and promote breastfeeding as the child-feeding norm globally
  • support practices which promote breastfeeding and discourage practices which interfere with breastfeeding and will:
    • promote the principles of the Baby Friendly Hospital Initiative
    • carefully choose a method of feeding when supplementation is unavoidable and use strategies to maintain breastfeeding to meet the mother’s goal
    • promote the principles of the World Health Organization Global Strategy for Infant and Young Child Feeding
3. The IBCLC has the duty to provide competent services for mothers and families and will     perform comprehensive maternal, child and feeding assessment related to lactation, such as:
 
History Taking and Assessment Skills
  • obtain the mother’s permission to provide care to her and her child
  • ascertain the mother’s goals for breastfeeding
  • utilize appropriate counseling skills and techniques
  • respect a mother’s race, creed, religion, sexual orientation, age, and national origin
  • obtain a lactation history
  • identify events that occurred antenatally, during the pregnancy, labor and birth process that may adversely affect breastfeeding
  • assess the breasts to determine if changes are consistent with adequate function/lactation
  • assess maternal physical, mental and psychological states
  • assess social supports and possible challenges
Skills to Assist Breastfeeding Dyad
  • promote continuous skin-to-skin contact of the newborn and mother
  • provide education to assist the mother and family to identify newborn feeding cues and behavioral states 
  • assess oral anatomy and normal neurological responses and reflexes
  • assist the mother and child to find comfortable positions for breastfeeding
  • identify correct latch/attachment
  • assess effective milk transfer
  • assess for adequate milk intake of the child
  • assess for normal infant behavior and developmental milestones
  • provide suggestions as to when and how to stimulate a sleepy baby to feed
  • provide evidence-informed information to assist the mother to make informed decisions regarding breastfeeding
  • provide education for the mother and her family regarding the use of pacifiers/dummies including the possible risks to lactation
  • provide appropriate education for the mother and her family regarding the importance of exclusive breastfeeding to the health of the mother and child and the risk of using breastmilk substitutes (formula) 
  • provide information and demonstrate to the mother how to perform manual expression of breastmilk 
  • provide information and strategies to prevent and resolve painful damaged nipples
  • provide information and strategies to prevent and resolve engorgement, blocked ducts and mastitis 
  • provide information and strategies to minimize the risk of Sudden Infant Death Syndrome (SIDS)
  • provide information regarding family planning methods including Lactation Amenorrhea Method (LAM) and their impact on lactation
  • assist and support the mother and family to identify strategies to cope with peripartum mood disorders (prenatal depression, “baby blues”, postpartum depression, anxiety and psychosis) and access community resources
  • provide information regarding introduction to appropriate family foods
  • provide information regarding weaning from the breast when appropriate, including care of mother’s breasts and preparation and use of breastmilk substitutes according to World Health Organization Guidelines for Safe Preparation, Storage and Handling of Powdered Infant Formula
    • calculate an infant’s caloric/Kilojoule and volume requirements
    • assess the mother’s milk supply and provide information regarding increasing or decreasing milk volume as needed
    • assess the breastfeeding child’s growth using World Health Organization adapted growth charts
    • provide education to the mother related to normal child behaviors; signs of readiness to feed, and expected feeding patterns
General Problem-solving Skills
  • evaluate potential or existing challenges and factors that may impact on a mother to meether breastfeeding goals
  • assist and support the mother to develop, implement and evaluate an appropriate, acceptable and achievable breastfeeding plan utilizing all resources available
  • facilitate breastfeeding for the medically fragile and physically compromised child
  • evaluate how each breastfeeding dyad and situation is unique, and their affect on breastfeeding
  • provide anticipatory guidance to reduce potential risks to the breastfeeding mother or her child
  • assess and provide strategies to initiate and continue breastfeeding when challenging situations exist/occur
Use of Techniques and Devices
  • critique and evaluate indications, contraindications and use of techniques, appliances and devices which support breastfeeding or may be harmful to continued breastfeeding including alternative feeding methods 
  • evaluate, critique and demonstrate the use of techniques and devices which support breastfeeding, understand that some devices may be marketed without evidence to support their usefulness and may be harmful to the continuation of breastfeeding
  • evaluate and critique how techniques and devices may be used to ensure initiation and/or continuation of breastfeeding in certain circumstances
  • provide evidence-informed information to the mother regarding the use of techniques and devices
Develop, Implement and Evaluate an Individualized Feeding Plan in Consultation with the Mother 
  • use adult education principles
  • select appropriate teaching aids
  • provide information on community resources for breastfeeding assistance
  • provide evidence-informed information regarding a lactating mother’s use of medications (over-the-counter and prescription), alcohol, tobacco and street drugs, including their potential impact on milk production and child safety
  • provide evidence-informed information regarding complementary therapies during lactation and their impact on a mother’s milk production and the effect on her child
  • integrate cultural, psychosocial and nutritional aspects related to breastfeeding
  • provide support and encouragement to enable mothers to successfully meet their breastfeeding goals
  • use effective counseling and communication skills when interacting with clients and other health care providers
    • use the principles of family-centered care while maintaining a collaborative, supportive relationship with clients
    • support the mother to make evidence-informed decisions for her child and herself
    • provide education and information at a level which the mother can easily understand
    • evaluate the mother’s understanding of all information and education provided
4.  The IBCLC has the duty to report truthfully and fully to the mother and/or child’s primary health care provider and to the health care system and will:
  • obtain the mother’s consent for obtaining and disclosing of information as needed or as specified by local jurisdiction
  • provide written assessments as required
  • maintain documentation of all client contacts, assessments, feeding plans, recommendations and evaluations of care
  • retain records for the time specified by the local jurisdiction
5. The IBCLC has the duty to preserve client confidence and will:
  • respect the privacy, dignity and confidentiality of mothers and families except where the reporting of a danger to a mother or child is specifically required by law
6. The IBCLC has the duty to act with reasonable diligence and will:
  • assist families with decisions regarding feeding their children by providing evidence- informed information that is free of any conflicts of interest
  • provide follow-up services as required and requested
  • make appropriate referrals to other health care providers and community support resources in a timely manner depending on the urgency of the situation
  • work collaboratively with the health care team to provide coordinated services to families
  • report immediately to IBLCE if found guilty of any offence under the criminal code of the IBCLC’s country or jurisdiction in which they work or if sanctioned by another profession
  • report immediately to IBLCE any IBCLC who is functioning outside the IBLCE Scope of Practice for IBCLCs and/or not maintaining a practice which meets with the IBLCE Code of Professional Conduct for IBCLCs or the IBLCE Clinical Competencies for the Practice of IBCLCs
Sites for acquisition of skills
Skills may be acquired in various settings including hospitals, public health units, community agencies or locations and private practice facilities.

 www.iblce.org/upload/downloads/ClinicalCompetencies.pdf

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