What Is a Lactation Professional?

In Chicago at ILCA’s annual conference, the professionalization of lactation practice was a theme running across many sessions. Discussions ranged from how we differentiate levels of lactation practice to how effective lactation education programs are. These are excellent and timely questions having international relevance and little outcome data to inform us of appropriate next steps. I am reminded of how when we look ahead to continue building professionalism within the lactation field, it may also be useful to look at the past.

The profession of lactation consulting is in its infancy and experiencing growing pains, as we move toward licensure (in the US) and continue to define roles and responsibilities with the lactation specialty. Having a nursing background that spans decades, I remember when nursing was struggling to make the leap from “hand maiden” to professional. It was a long road that needed many forward thinking clinicians, educators, and administrators working toward the same goal. Many of the leaders within the lactation community have been doing similar work. Parallels exist between where lactation specialists are currently and where nursing was in the 1970s. Throughout nursing’s decades-long professionalization process, there were those who did not want the nursing role to be professionalized; they thought that requiring a baccalaureate degree was unnecessary and they were comfortable in a dependent role, instead of an interprofessional one. Many thought that a nurse is a nurse, is a nurse—despite the wide differences in didactic and clinical education preparation. Of course, this was not true in nursing and it is not true in lactation practice.

In thinking about what it means to be a lactation professional, we need to make several distinctions. First, we have to define what it means to be a professional and match that against what currently exists in the lactation field. Second, we must define levels of lactation practice within the current existing array in the field. Of course, those with a specialty in lactation who have licensure in 1 of the health professions already consider themselves and are considered by society as professionals, because these professions are well established. The question of professionalizing lactation as a specialty practice within health care is really more relevant for those who are not members of an established profession (eg, physicians, nurses, registered dietitians, midwives, and other licensed health care professionals). What do lactation specialists need to do to establish themselves as professionals in the eyes of the other health professions, third-party payers, breastfeeding families, and broader society?

A consensus concerning the definition across many professions has been well established.^1,2 One of the essential aspects of a profession versus any other service-oriented endeavor is that a profession holds itself to a higher altruistic standard that “obliges them to place the good of those they serve above their own self-interest.” ² Also inherent in this orientation is a notion of social justice that has an equity and inclusionary lens. ³ All of the following criteria must be operationalized within a profession^1-3:

In reviewing the characteristics of professional practice, we can identify that most of these criteria have been met for International Board Certified Lactation Consultants (IBCLCs) (ie, Code of Conduct, ⁴ Scope of Practice, ⁵ Standards of Practice, ⁶ and formal qualifications for practice). Evidence is accumulating concerning the IBCLCs’ clinical effectiveness ⁷ as well; however, as Dr Grummer-Strawn mentioned in his keynote address at the ILCA conference, we must have better outcome data about what works, under what conditions, and by whom to truly reach our goal of providing efficient and cost-effective care to all breastfeeding families.

Although there is still work to be done on some of the criteria of a profession, it is clear, based on the evidence above, that the IBCLC is the lactation professional.^1,8 The criteria differentiate in critical ways the IBCLC from other lactation support providers, who have less didactic education and/or fewer clinical mentorship hours. ⁹ A related issue is that the nursing profession had to grapple with the question: Are there both professional and nonprofessional nurses? The answer was yes—based on education and responsibilities. In lactation, just as in nursing, we have professional and paraprofessional providers. This diversity brings needed multiple perspectives, particularly in communities where opportunities to become IBCLCs are limited. In most communities, there is not enough professional lactation support to meet the needs of all breastfeeding families; we need multiple levels of practice to address the different levels of need. ¹⁰ The field of lactation is struggling with questions about defining these levels of practice along with articulating distinctions between professional and nonprofessional lactation care. ¹¹ It is essential to build a consensus about levels of lactation practice, while taking into consideration our international context and wide variety of health care systems globally. If we in the field are confused about our roles and responsibilities, surely those we serve will be even more confused and appropriate care will be more difficult to realize.

We have much to learn about our lactation specialty and the effectiveness of the care we provide, which must be grounded in the understanding that 1 approach to providing lactation care does not fit all. While I was in Germany this summer visiting family, I was able to meet with some IBCLCs. I was made aware that in Germany, one is not able to become an IBCLC without having another professional degree, because it is not possible to get the required college course work without being accepted into a professional degree program. This effectively changes the nature of lactation practice in that country. Although this is quite different from in the United States, this situation may be quite common globally. This is the type of issue that needs to be explored through research. It also highlights the need for research on the differences between IBCLCs who are licensed to practice in another health field and those who are not. A few of the many other questions raised are: (1) what other levels of lactation support providers are assisting families in various countries, (2) how is lactation support affected by health care systems in which there is universal coverage, and (3) how does the health care system in a country affect the lactation outcomes?

All of these issues have prompted our editorial team to consider how JHL might facilitate expanding this dialog within the lactation community. Of course, the journal significantly contributes to building the profession’s evidence base; however, is this enough? I think not. Over the next year, we will be implementing several new features in the hope that they will contribute to broader discussions within the health care field. (1) To contribute to a better understanding of the professional issues related to provider education and levels of practice, we recently put out a call for submission of manuscripts for a 2017 special issue, Education, Roles, and Licensure in Lactation Practice (manuscripts due by April 14, 2017). We are seeking research and program evaluation manuscripts with outcome data about (but not limited to) various types of lactation education programs, differentiation of roles according to levels of practice, and ways that lactation providers and health care systems deliver lactation care. We are particularly interested in sharing international perspectives on these issues. (2) We will be including at least 1 research article in each issue that has a commentary immediately following it, discussing ways in which the research article contributes to our knowledge base and ways in which it is applicable to lactation practice. This issue has the first such commentary written by Dr Sara Gill. (3) Beginning in the February 2017 issue, we will have several columns in each issue written by experts in the field. These will be similar to blog posts, in that the topics will be focused on current “hot topics,” with the purpose of sharing pertinent information with our readers. One column will be focused on explaining common issues in lactation research for nonresearchers or novice researchers. The second one will focus on relevant information to guide and expand breastfeeding advocacy efforts at the local, regional, national, and/or global levels. There are many advocacy efforts occurring internationally that are unknown to most of us because they occur locally or within a specific context different from our own. By sharing some of these, we hope to facilitate better networking and coalition building. If you find these columns useful, we will add a couple more later in the year focused on global lactation perspectives and effective community-based lactation programs.

During the conference at the “Meet the Editors” booth, I had the pleasure of meeting many JHL readers, who shared their ideas with me. Our team is always open to new ideas about how to meet the needs of our readers and the families they serve, so please continue to share your ideas with us.