Lactation Support Providers

Team-based lactation consultant/primary care provider visits increase access to breastfeeding support. Our work studied the integration of an International Board Certified Lactation Consultant (IBCLC) into the primary care setting. Yet many communities have limited IBCLC availability. If you are in a community with limited availability, or you do not already have an IBCLC on staff, translating our team-based model into your practice setting raises questions about what type of lactation support to provide.

What are the different types of lactation support?

The United States Breastfeeding Committee provides a Lactation Support Providers Descriptor Table outlining the difference in training between lactation consultants, breastfeeding counselors, breastfeeding peer counselors, and lactation educators. Check out their video for a great summary of what each group offers. Similarly, The United States Lactation Consultant Association published a “Who’s Who in Lactation” table to help explain the different training options ranging from International Board Certified Lactation Counselor (IBCLC) to Certified Lactation Counselors (CLC) to Certified Breastfeeding Educators (CBE) and peer counselors.

Lactation support training requirements vary

Training varies from the supervised 300-1000 clinical experience and 95 hours of lactation specific education of an IBCLC to 20-50 hrs of lactation specific education and training for breastfeeding counselors, educators and/or peer counselors. Studies have identified improved breastfeeding outcomes with the different lactation support providers: IBCLC, breastfeeding counselors, and peer support.  Additional studies show the importance of having culturally and community appropriate support.  Depending on the knowledge and support of the other health care providers, experience, clinical lactation support needs, and level of  communication there are lots of options. While IBCLC support works well for our clinic setting, your practice will need to identify their breastfeeding support needs, resources, and goals.

How does insurance reimbursement fit in?

Creating a financially sustainable program is a reality for many clinics when looking to expand services. If this is a focus for your clinic, see our blog on billing for services.  The ability to directly bill for a lactation support provider’s service varies significantly by insurance and state. The range is from no direct LSP reimbursement, to reimbursing IBCLC but not non-IBCLC providers, or requiring a license (such as MD, RN, or RD) to qualify for reimbursement. Because of the variability, each clinic will need to research the insurance plans for their clinic. The Women’s Preventive Health Services Initiative (WPSI) document outlines options for coding lactation preventive benefits as a maternal benefit at no cost-sharing and is a helpful resource when talking to the insurance companies. If insurance reimbursement is challenging, consider indirectly covering the cost of LSP by calculating the time “freed-up” for  your medical provider to see (and bill) for another patient, or starting with grant funding. 

What does your practice need?

Breastfeeding support improves outcomes especially when provided over the continuum of care from prenatal to postnatal, inpatient and outpatient, family and community.  There are a number of ways to provide support.  In primary care clinics we need to start at the very basic level with health care providers being knowledgeable and supportive.  Once we have that foundation we can determine our next steps of collaboration.  As you explore the possibilities perhaps ask your patients and practice what you need from your lactation support provider:

Does your clinic need…. 

• An interested staff member to be trained to provide breastfeeding education support to families during clinic appointments?
• Insurance reimbursement to enable a breastfeeding knowledgeable health care provider to provide more time intensive support to families having breastfeeding difficulties?
• To enable a nurse IBCLC on staff to switch responsibility from their current non-breastfeeding care to providing breastfeeding education to families?
• To  reach out to lactation consultants, counselors, or peer counselors in the community and explore collaboration?

Understanding the training and support of different lactation service providers and your practice needs helps focus the next steps.