Monday, May 21, 2012

Certified Lactation Counselor Training

A couple weeks ago I did my training to become a Certified Lactation Counselor. I knew probably about 80% of it already (since I am a voracious reader of birth/breastfeeding blogs and academic studies on evidence-based practices, and I have worked with breastfeeding moms), but I also learned a lot, too.

Some of the new and awesome things that I learned in CLC training:

1. Babies can detect breast cancer (WTF): There is something called Goldsmith's sign, which is when a baby might be detecting undiagnosed breast cancer. The baby refuses to nurse on one breast. If other reasons such as ear infection, teething, birth trauma, etc are ruled out, breast cancer might be a possibility! And cancer may be diagnosed as late as 5 years after this sign from baby.

2. Breastfeeding provides protection for LIFE: When mothers who breastfed their baby donated a kidney to their adult child later in life, the adult child had less organ transplant rejection (compared to mother-child pairs that had not breastfed). The same protection was afforded when there was a sibling --> sibling organ or tissue transplant, if they had breastfed.

3. Powdered formula is not a sterile substance:  It must be prepared at a temperature of at least 158 degrees F (and then cooled) before being fed to an infant, and you should not prepare a large amount ahead of time. A powder cannot be sterilized, and formula has been found to contain harmful microorganisms from time to time.

4. Colic = crying for more than 3 hours/day for more than 3 days/week, for greater than 3 weeks. I didn't know that definition!

5. Great resource! How to Safely Co-Sleep: The UNICEF UK Baby Friendly Initiative have a helpful pamphlet on how to safely sleep or co-bed with your baby. This is more than the U.S. provides, as they just say "don't do it," but people do it anyway, and do it unsafely.

Of course I learned a lot of other things, too, but less new and less awesome (and thus not worth sharing here). But in case you're interested in what the training covered...

On the first day we covered: International and national breastfeeding policy context, evidence-based practice, lactation credentials, examination of factors influencing success at breastfeeding, national perspectives on breastfeeding rates, anatomy and physiology of lactation, hormones of lactation, composition of human milk, gastrointestinal hormones of lactation, distinct weight gain patterns of breastfed babies, and myths about milk supply.
On the second day we covered: The effect of substances and objects on milk supply, the effect on milk supply of hypoglycemia, jaundice, latch-on, engorgement, implants, effect of milk supply of discrepant breast size, breast surgery, inverted nipples and others, counseling women with fears about milk supply, approaches to use in patient education with different types of learners, health outcomes associated with infant feeding choice, safer use of infant formula, and donor milk banking.
On the third day we covered: Application of social psychology theory to lactation counseling, influencing the infant feeding decision, men's concerns about breastfeeding, enhanced effectiveness through lactation counseling skills, supporting the mother's desire to breastfeed exclusively, the impact of maternity care practices on breastfeeding outcomes, parameters of feeding assessment, and strategies that have been found to be effective in assessing breastfeeding.
On the fourth day we covered: Strategies for dealing with the challenge of breast problems, milk expression, milk storage and handling, supplemental feeding methods for the breastfed baby, working women and breastfeeding, strategies for building or maintaining a milk supply under challenging conditions, galactogogues, strategies found effective for assisting babies with special challenges, effect of breastfeeding on amenorrhea and fertility, the effect of foods in the mother's diet on the infant, the effect of alcohol, caffeine, and environmental contaminants on mother's milk, the impact of medications on the infant, and contraindications to breastfeeding.
On the fifth day we covered: Early support in the "zone of professional unavailability," common concerns after the early weeks - ages and stages, vitamin supplementation, complementary feeding, weaning, nursing older babies, nursing strikes, ethical issues in lactation care, and the Baby-Friendly Hospital Initiative

A lot of people in my course were new to working with breastfeeding moms - many people from the community, some people in public health, a few from Healthy Start-type positions, a handful of doulas, but only one nurse. I have realized this is not the normal audience for this type of class, which is generally mostly people from medical backgrounds. Elita at Blacktating writes about her course, which had a different audience, but was structured similarly to mine.

The organization that runs the course, The Center for Breastfeeding, has claimed that the CLC certification is equal to the IBCLC training in that both are "entry level." You can read more about their opinion here: Position Paper on the Comparative Roles and Training of the IBCLC and CLC. Basically they believe that since the CLC course has not only an exam that must be passed, but also several competencies, that it is just as good a training as the IBCLC, where "anyone can take the exam" and there are no competencies. I beg to differ. The IBCLC certification requires over 1000 clinical hours, in addition to certain pre-requisite education on anatomy/physiology, etc, and the CLC training does not require any. I imagine this is all part of a political rivalry between the two certifying organizations.

I'm glad to have added this training to my skill set, and anxiously await the results of my exam!


  1. i just have to say, you are very inspirational. i love reading your blog. i am sure you did GREAT on your exam.
    who did you go thru? do they have on-line stuff you can do?

  2. Aw, thanks! I think the Center for Breastfeeding is in-person training only. But apparently Childbirth International offers a CBC online-training!

  3. Hi Emily,

    I love reading your blog posts and following you on FB/Twitter. I really like how you listed some things you learned and was fascinated by #3. "Powdered formula... must be prepared at a temperature of at least 158 degrees F (and then cooled) before being fed to an infant..."

    I've recently seen friends prepare powdered formula from room temperature store-bought distilled water and feed baby after a few shakes. These are friends who read tons, follow Dr.'s orders, etc. so I'm just wondering how they might have missed information on preparing the formula with water at 158 F and if there is any documentation that I might send their way, so it doesn't seem like I'm butting in too much. I imagine this should be continued for as long as the infant is drinking formula?

  4. Hi Sarah! Thanks for following!

    What we learned came from the WHO recommendations. You can find them a user-friendly version here:

    Or a longer version with explanations here:

    Yes, since powdered formula can not be sterilized, a child should always receive formula that has been prepared with boiling water. :)

  5. I just happened across this day's blog. Did you pass the test and was it hard?

  6. Hi Julie!
    Yes I passed the test, and no it wasn't hard. But not everyone in my course passed.

  7. How was the LAT portion of the test that Elita mentioned on Blacktating? I am taking the CLC in Harlem next month with no medical background to speak of. thanks!! - Lolo

  8. Lolo,
    The LAT portion was challenging. The videos of babies nursing would only be about 20 seconds long, so you had to notice a lot very quickly. They only repeated it 2 times. You basically guess on your assessment and hope for the best. I didn't feel 100% confident on my responses, but you just have to get certain sections right to pass (which they determine), so even if you couldn't identify every category, you could be ok. This might not make sense without looking at the Lactation Assessment Tool...

    I have heard of people not passing only the LAT portion and having to re-take it again at a later date.

    I don't think you need a medical background for the LAT as much as for some of the other modules you're tested on. For the LAT you just have to practice watching babies nurse and know all of the elements of latching and sucking. I think it is a skill that lactation consultants grow over time, too.


  9. Some of my friends were looking to get in such training for becoming a certified counselor and that's why if I will provide this information to them then they will highly benefited. Thanks

  10. Just a heads up - your link to Elita at Blacktating redirects to a porn site. Apparently is the blog... is porn. Not your intent, I'm sure! ;)

  11. For more information on Breast implant and Breast implant Delhi he recommends you to visit

  12. Cool!Some of my friends were looking to get in such training for becoming a certified counselor and that's why if I will provide this information to them then they will highly benefited. Thanks - Birth Trauma Counselling

  13. Hi Emily, recently discovered your Blog and Love it!!
    I will be taking the CLC class in 2 weeks in Chicago and was wondering if you might recommend any resources to study prior to taking the class and Exam. I have ordered the Pocket Guide to Lactation Management and have the (LaLeche) Womanly Art of BF. Any other books videos or demo toys you use or recommend? I am looking at the Atlas of Breast feeding but not sure about it..? Thanks for any advice you have. Keep the Faith!! Janice

  14. Hi Janice,
    Good luck on your class and exam! Those are 2 fantastic resource. The hardest part of the exam is visually assessing a baby's latch, so I recommend you watch a LOT of babies and/or video on the elements of a proper latch.
    Best wishes!

  15. Hi Emily, I hope you're still following these comments. I was wondering if you can miss any T/F questions on the LAT portion to pass? Thanks!

    1. Hi Kaylyn, I took the test too many years ago to remember :) Good luck!


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