How do I become an IBCLC if I’m already a physician or advanced practice nurse?

It’s a question we see often: “I’m a physician/NP/CNM and would like to become an IBCLC. Where do I start?”

As IBCLCs, we understand the experience of getting fired up to support families who need lactation support. Sometimes it takes just a single encounter with the field. Sometimes it’s a passion that develops over years. But either way, if you landed here because you’re excited about becoming a lactation consultant – we get it! And we get how confusing the route to becoming an IBCLC can feel.

Many physicians and mid-level providers become interested in becoming IBCLCs, either through their professional experience working with families, personal experiences with their own children, or both! Based on your professional credentials, IBLCE considers you a “recognized health care professional”, which affects a few things about the options available to you on your pathway to IBCLC. So we’ve put together this guide to IBCLC especially for you! Let’s get started:

Understanding the IBCLC Pathways

Many health care professions usually have a single clear pathway: take required prerequisite courses, enroll in an accredited academic program, graduate, and pass an exam.

So you likely completed prerequisites, enrolled in a degree program, completed your classes and clinical rotations, and graduated. You then studied and took your boards, and when you had passed, you were cleared to begin practice.

However, lactation consultants can choose from three possible pathways – and Pathway 1 is actually split into two different categories!

Feeling overwhelmed? We’re here to help break it down, and think about which Pathways will make the most sense for you as a physician, NP, or CNM.

Please note that your final word should always be the website of the International Board of Lactation Consultant Examiners (IBLCE). They set the standards and policies for IBCLC training, examination, and certification. Here is a flowsheet from IBLCE to help people navigate through the Pathways to certification.

So how to navigate the pathways to become an IBCLC given your background?

Common components of ALL Pathways

In each IBCLC Pathway, you must complete the following 4 components:

1. Health Sciences Education: Either be an recognized health professional OR complete 14 prerequisite health science courses
2. Lactation Education: Complete 90 hours of lactation-specific education, and 5 additional hours of communication skills specific to lactation
3. Clinical Hours: Gain clinical experience in lactation care (number of hours varies based on the pathway)
4. Exam: Take and pass the IBCLC exam (offered twice each year)

For 1, Health Sciences Education, you are considered to have fulfilled that requirement with your prior education. Your current professional credentials will satisfy that requirement per IBLCE.

Given that, you just have to figure out how and where you will complete your lactation education and clinical hours. Below, we’ll go through all the Pathways and how they might look for you:

Pathway 1 for health care professionals

In Pathway 1, just like all the other Pathways, you must complete your Lactation Education (see above) – our online course is an excellent fit for those completing Pathway 1. You then need to complete your clinical hours, which because you are a recognized health care professional, you may do as part of your work.

How many hours you need: For clinical hours, you must obtain at least 1000 hours of lactation-specific clinical experience in a supervised role. These hours must take place in the 5 years before you apply to take the exam.

Where you can earn your hours: You may already be working in a position where you can earn your hours. If you work in obstetric, family practice, or pediatric settings, you may regularly be providing hands-on and/or phone or virtual support to families. For example, a pediatrician or pediatric nurse practitioner may spend time at most newborn visits counseling families about feeding and offering support. A nurse-midwife may be providing education at prenatal visits, and then seeing patients for support postpartum.

A special consideration for providers is whether your current role will allow you to earn 1000 hours in 5 years. Providers have many demands on the limited time they are allotted for patient care, and lactation support is often very time-consuming. If your current role does not include lactation support, or does not include enough to get 1000 hours in 5 years, you may consider whether you can change jobs or alter your current role to provide more opportunities for working with families.

Note that unlike Pathway 3, in this Pathway your hours do not need to be mentored/supervised by a practicing IBCLC. Additionally, as your current license enables you to practice independently (or fairly independently, depending on the state in which you practice as an NP/CNM), you do not require supervision of any kind when earning your hours.

Keep in mind that simply providing lactation care as part of your job is adequate to qualify to sit the exam, but is often not adequate to feel prepared to practice independently. Think back to the training for your current role as a physician, NP, or CNM. How much did you learn from the mentorship of your instructors, clinical mentors, and early co-workers that informs how you practice today? While it is possible to become an IBCLC without ever even meeting another IBCLC, we advise against it! Reach out to local IBCLCs and ask to shadow them, even if just for a few days. As you’ve probably told your own students, “you don’t know what you don’t know. Shadowing a practicing IBCLC will help you identify areas for growth in your lactation consultant education, so that you can best serve your patients and help them achieve their feeding goals.

How you count your hours: Very few physicians, NPs, or CNMs who are not already IBCLCs are spending 100% of their time on lactation-related care! But if lactation care is part of your current role, IBLCE allows you to provide a good faith estimate of the amount of time you spend providing lactation care. They suggest keeping a weekly time log for several weeks. This will help you determine how much of your time you spend on average in lactation-related care. For example, a nurse-midwife who rounds on patients postpartum may find about 1 hour of every 12 hour shift is spent on lactation support. You may then use this calculator from IBLCE (downloads an Excel spreadsheet) to calculate your hours and determine how long it will take you to reach 1000. Make sure you can reach 1000 hours in 5 years’ time! (A job where you provide 1 hour of lactation support a week won’t be enough.)

Click here to learn even more about Pathway 1 for recognized health professionals.

Advantages with this Pathway:

• You can complete your hours while you are working, as part of the job you already do.
• You may be able to complete your hours fairly quickly if you are providing a lot of lactation support.

Why this Pathway might not be for you:

• If your current job does not provide enough lactation hours, or you’ll take longer than you’d like to earn them, and you can’t find a way to increase that amount.
• If you would prefer to learn from an IBCLC mentor (Pathways 2 or 3) vs. complete the clinical hours on your own (Pathway 1).

Pathway 1 for peer supporters

Pathway 1 for peer supporters is very similar to Pathway 1 for health care professionals. Again you must complete your Lactation Education (see above). But instead of earning your hours through your work, you earn them as a volunteer counselor for an IBLCE-recognized peer counseling organization.

How many hours you need: You must obtain at least 1000 hours of lactation-specific clinical experience as a peer counselor. These hours must take place in the 5 years before you apply to take the exam.

Where you can earn your hours: A full list of recognized organizations is here. Examples include, but are not limited to, La Leche League Leader, Breastfeeding USA counselor, or Dr Milk peer supporter.

How you count your hours: Currently, you are able to count these hours as a “flat rate”: 250 hours per year if you provide only telephone/online counseling, or 500 hours per year if you provide face-to-face support. (This will change on Jan 1st, 2022; from that point forward, you will be required to count your time on an hour-by-hour basis. More information from IBLCE here.) All of your hours must be completed in the 5 years immediately prior to the date you apply to take the exam.

Click here to learn even more about Pathway 1 for peer supporters 

Advantages with this Pathway:

• Volunteer training is generally very low-cost or free.
• You can earn your hours on your own time.
• This role may open up opportunities for you to learn and interact with others in your peer support organization.
• You will likely get to work with families with babies/children with a wide range of ages.

Why this Pathway might not be for you:

• If you have never breastfed/chestfed/pumped for your own children, many organizations will not work with you as a peer counselor.
• You may find the volunteer time commitment challenging.
• And again, if you would prefer to learn from an IBCLC mentor, vs. complete the clinical hours on your own, you are better off doing Pathway 2 or Pathway 3.

Pathway 2

Pathway 2 programs are comprehensive academic programs – much more like the other formal health professions education we discussed at the beginning. Your Lactation Education (see above) and Clinical Hours (see above) should be provided as a package from your Pathway 2 program.

Some Pathway 2 programs are available via distance education; in others, you are required to be on-campus for education. You will also obtain at least 300 hours of lactation-specific clinical experience through mentorship with one or more practicing IBCLCs. Always verify before enrolling where and how the program will find and contract clinical mentors/sites for you. Please ensure that you will be able to obtain the clinical hours necessary in order to complete the program.

At NCSU, we are not a Pathway 2 program currently; you may find a list of Pathway 2 programs here. 

After you complete all of your requirements, you will be eligible to apply to take the IBCLC exam.

Advantages with Pathway 2:

• This Pathway is often the fastest route to completion: many programs move students from start to finish in about a year.
• It can be very helpful to have your program arrange all of your education and clinicals.
• You receive direct mentorship from experienced IBCLCs, vs. trying to “figure it out as you go” in Pathway 1.

Why this Pathway might not be for you:

• You may have difficulty finding a program that is available in your area and/or offers clinical rotations that work with your location and schedule.
• Pathway 2 programs tend to be the most expensive route to IBCLC certification, which can present a financial barrier (some programs offer scholarships and/or financial aid, and your current employer may offer tuition assistance).

Pathway 3

In Pathway 3, just like all the other Pathways, you must complete your Lactation Education (see above) – our online course is an excellent fit for those completing Pathway 3. For clinical hours, you obtain hours through mentorship with one or more practicing IBCLCs.

How many hours you need: You must obtain at least 500 hours of mentored lactation clinical hours with an IBCLC mentor. These hours must take place in the 5 years before you apply to take the exam.

Where you can earn your hours: You may earn hours with any currently certified IBCLC. You may receive your training in any clinical setting (e.g. an IBCLC who solely runs a milk bank or only does research would not be a potential mentor). This may include hospitals, outpatient clinics, private practice, WIC nutrition programs, facilitation of support groups, and more. If you work alongside IBCLCs in your current setting, you may be able to arrange for mentorship with them.

How you count your hours: There are three phases to the clinical hours. In Phase 1, the mentee is on “observation-only” mode. In Phase 1 you become familiar with clinical IBCLC practice (but this does not count towards the 500 hours). You then become increasingly involved, hands-on, with clinical care (Phases 2 and 3). The mentee must accumulate 500 hours of practice time in Phase 2 and/or 3. All of your hours must be completed in the 5 years immediately prior to the date you apply to take the exam.

We have more details on Pathway 3 in this post. If you are planning to do Pathway 3, we advise you to wait to enroll in our course or any lactation education course until you feel confident you can find, or have found, mentorship. Please be sure you can complete your clinical hours as planned.

Advantages with Pathway 3:

• Like Pathway 2, you receive direct mentorship from experienced IBCLCs, vs. trying to “figure it out as you go” in Pathway 1. Just like when you began your work in your current profession, you are able to learn from experienced clinicians.
• Depending on how busy your mentor(s) is/are, you may be able to earn your hours fairly quickly.

Why this Pathway might not be for you:

• In some areas, it can be difficult to find a Pathway 3 mentor.
• Many mentors charge a fee for mentorship, which can be a financial barrier.
• It may be difficult to arrange the schedule for mentored hours around your own, which may make earning hours go more slowly.

Please note that we offer Pathway 3 mentorship opportunities through NCSU, but students applying to that program must complete the on-campus, classroom-based courses first; those completing the online-only courses are not eligible to apply to our mentorship program at this time. For more information about our on-campus Pathway 3 program, contact us.

Taking the exam

Finally, with all the Pathways, you must take and pass the IBCLC exam.

The exam is offered in April and October of each year. You must apply to take the exam 6-8 months in advance of the exam date; the IBLCE website has upcoming deadlines. All of your education and clinical hours must be complete before you apply to sit the exam.

Once you’ve passed, congratulations! Welcome to the community of IBCLCs worldwide. There’s a lot to do, and we can’t wait for you to get started!

Have more questions?

Still not sure which IBCLC Pathway is right for you as a physician, NP, or CNM?

Still not sure how to become an IBCLC? Join check out our free live and recorded webinars on Pathways to IBCLC.

Ready to get started? Take a look at our 90-hour lactation education course – low-cost and self-paced, with personal attention from our expert instructors.

The world needs more IBCLCs, and we’re excited to help you along your way!