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I'm an OT/OTA and Want to Help Families Breastfeed!

Updated: Jan 6, 2021

I'm an occupational therapist/occupational therapy assistant (OT/OTA) and want to better support families with their breastfeeding/lactation/infant feeding goals. I am considering pursuing the IBCLC or other breastfeeding/lactation education to complement my occupational therapy practice. How do I get started? What else should I consider?



I love this question and love the increasing interest and specialization among occupational therapy professionals in breastfeeding and lactation (and all of the various alternative infant feeding methods available to families today). It is absolutely within the scope of the OT/OTA to treat the breastfeeding dyad!

Families frequently aren't educated about all of their options when it comes to infant feeding and breastfeeding. Occupational therapists (like all healthcare professionals including physicians, RNs, SLPs, PTs, RDs, etc) are not typically adequately educated on breastfeeding and related alternative feeding methods either. The majority of our training in infant feeding methods typically focuses on bottle feeding, which is just one of the many ways a family can choose to nourish their baby.

Getting into Breastfeeding and Lactation as an OT/OTA

Fortunately, occupational therapy education programs are beginning to incorporate more breastfeeding and lactation education into their pediatric/feeding training. For those of us who completed our occupational therapy education and did not receive much breastfeeding/lactation training I am going to try to outline steps you can take to acquire breastfeeding/lactation training in order to support more families in your therapy practice.

I will specifically focus on occupational therapy and breastfeeding/lactation here as I am an occupational therapist and feel that I can personally best speak to OT and how our specific training/attributes/gifts situate us in the field of breastfeeding and lactation, as well as, what sort of additional education/training could be beneficial.

However, I imagine that this information could be helpful for other types of therapists too.

Additionally, many OTs already specialize in infant feeding therapy, but not as many specifically focus on breastfeeding/lactation. Thus, I am also addressing a gap in service that is currently present in OT and feeding therapy.

OT + Lactation = Perfect Fit

OTs graduate with an excellent educational foundation in gross anatomy, neurology, physiology, kinesiology, psychology, sociology, human growth and development, task analysis, ergonomics, environmental modification, adaptive equipment and tools, social justice, sensory/fine/gross/oral motor treatment and assessment, etc. OTs practice in many traditional settings such as acute care, geriatrics, pediatrics, NICU, home health, outpatient clinics, school systems and more. They also specialize and treat a range of diagnoses, populations, and health and wellness issues such as mental health challenges, sleep hygiene, hand therapy, chronic pain, pelvic health, maternal health (perinatal health), therapeutic feeding, infant therapy, and so much more, covering a variety of occupations across the lifespan.

This foundational breadth and depth of knowledge and scope of practice that allows continued specialization, makes OT a perfect fit for treating the breastfeeding dyad.

Because occupational therapy is a diverse healthcare field with many specialties, different OT/OTAs will come into the field of breastfeeding/lactation with varying experience. Thus, there is no one right path. It is up to each OT/OTA, as a professional, to make sure they are adequately educated and trained.

The more you know...

We can unwittingly harm a breastfeeding dyad when we aren't adequately educated and trained and try to practice beyond our competence (just like in any other specialization). However, doing nothing leaves many families who would like to breastfeed without support.

Knowing our limitations and strengths and knowing enough to know when a referral could be beneficial is key. Breastfeeding and lactation is extremely nuanced and I can attest that the more I learn, the more I realize that there is so much more to learn!

It is also important to remember that while it is within OT's scope to treat the dyad, most OTs traditionally treat either the mother/caregiver or the baby primarily. For instance, an OT providing infant feeding therapy or bodywork may consider the caregiver's mental health as part of the baby's environment, but their main focus is typically on the baby. Alternatively, an OT specializing in maternal mental health or pelvic health might consider how a baby with feeding challenges is impacting mom's wellbeing, but they don't always provide oral motor/feeding therapy. These OT/OTAs will need to either work closely with a lactation professional (such as an IBCLC) or change their practice to incorporate full comprehensive treatment of both mom and baby.

There are, of course, exceptions to this in the OT world. And generally, OT/OTAs treat in a very holistic manner, with the big picture and optimal function for the whole family in mind.

Start With Your Goals

With that being said, one of the first things to think about is what your long term goals are.

Do you want to primarily work in breastfeeding/lactation? Or do you want to gain breastfeeding/lactation knowledge to support families as part of an OT practice in pediatrics, feeding, and/or maternal health?

For the former I suggest looking into becoming an IBCLC eventually (it can take a few years). For the latter, you could eventually become an IBCLC, but other certifications might also suffice depending on your particular practice needs. I will first briefly discuss options for certifications other than the IBCLC before spending the rest of this article addressing OT and IBCLC, as this process can at first seem complicated.

IBCLC and Other Breastfeeding/Lactation Certifications

There are many breastfeeding/lactation certifications out there and their various acronyms can be confusing to both parents and those interested in entering the lactation field. (For example IBCLC and CLC are two completely different certifications with different requirements.) Some certifications are quite expensive, while others are more affordable. Trainings that are provided through volunteer organizations are often very inexpensive. Many breastfeeding/lactation certifications provide partial to full lactation specific education hours also required for the IBCLC. I will link a few websites that describe various courses/certifications and some of the differences between IBCLC and other breastfeeding certifications.

Who's who in Lactation?

Alphabet soup of breastfeeding support.

I would love to see an additional section for Breastfeeding Therapy (Breastfeeding Therapists) added to this older article. Just as Breastfeeding Medicine (Breastfeeding Physicians) has its own unique scope of practice, so too, does Breastfeeding Therapy (Breastfeeding Therapists).

(For more information on the Breastfeeding Therapist’s scope of practice check out this link to another blog post I wrote .)

Becoming an IBCLC

If you decide that your primary focus (or a large focus) will be on providing breastfeeding and lactation support, becoming an International Board Certified Lactation Consultant (IBCLC) is beneficial, as it is the gold standard certification in the lactation field and ensures you have met a level of competence required to clinically treat mother-baby dyads struggling with breastfeeding and lactation challenges.

It is within OT's scope of practice and licensing to treat the breastfeeding dyad. Regardless of whether or not an OT decides to become an IBCLC, striving for training comparable to the IBCLC standards can help ensure the OT/ OTA has an adequate foundation.

To read further on OT’s scope of practice with regards to breastfeeding/lactation check out these articles:

https://ajot.aota.org/article.aspx?articleid=1867359

https://ajot.aota.org/article.aspx?articleid=2652875

https://www.verywellhealth.com/occupational-therapy-and-womens-health-2509982

To become an IBCLC you need 90 hours of lactation specific education, lactation specific clinical experience (up to 1,000 hours), and health sciences education in order to sit for the certifying exam.

Lactation Specific Education

Comprehensive 90 Hour Courses

Lactation specific education can be acquired in a variety of ways. Some choose to complete a comprehensive course that includes all 90 (or more) hours such as the courses listed below (this isn't an exhaustive list). The benefit to this is that you can feel more confident you have covered all topics that could show up on the exam (no gaps in your education), and there is ease in having your education all in one place. However, sometimes the courses are more expensive.

Lactation Education Resources

Health-E-Learning

Australasian Lactation Courses

Breastfeeding Outlook

Creating Your Own 90 Hours

Other therapists choose to combine various courses until they have reached 90 hours, based on their education needs. For example, most feeding therapists are already very strong in infant oral anatomy and most OT/OTAs working in pediatrics will already be strong in infant/child development. Additionally, some OT/OTAs working in breastfeeding/lactation choose to specialize further (such as working mainly with TOTs or families in or recently graduated from the NICU) and might decide concentrating much of their education on that area is more beneficial for their practice.

Conferences

Online breastfeeding conferences, such as the ones hosted by Gold and Ilactation are a great way to get the latest breastfeeding/lactation information and research- and often less expensive than full 90 hour courses.

Gold Lactation

iLactation

Shorter Comprehensive Courses with Certifications

There are several 45 hour or less courses that will also provide you with a certification such as the Clinical Lactation Counselor (CLC), CLEC, CLE, CBC- etc. These certifications could be stand alone certs, or stepping stones towards the IBCLC. Please see links above in the Other Breastfeeding/Lactation Certifications and Training section.

*Please note that for the April 2021 exam and on, five additional hours in communication skills will be also be required. To read more about this go here:

IBLCE FAQ

Health Science Coursework

Occupational Therapists, along with certain other healthcare providers, are considered to already have the required health science education. Thus, they can consider their health science coursework complete, but will need to show proof of being an OT (such as a license) if audited.

**The following section was updated on 1/2/2020 after I made a call to IBLCE for clarification. Please also call and confirm for yourself, as IBLCE does change its policies from time to time.**

OTAs, unfortunately, are not included on the list for already having coursework completed. However, while an OTA will need to show proof of their coursework, chances are as an OTA, you will have taken most, if not all, of the required courses as prerequisites and/or for your COTA education program. Per a phone conversation with IBLCE representative, these courses need to be completed before applying to sit for the exam, but there is no cut off for how long ago in the past they were taken, as long as you can provide proof. (The other requirements, however, clinical hours and 90 hours of education, must have been completed within five years before applying.) Again, please verify all of this for yourself and your particular situation as coursework will vary from program to program. The IBLCE representative I spoke with on the phone said IBLCE cannot verify individual courses for you, but there is very detailed information on what the courses should cover on their website, which I have linked below. You can click on each course to get more detail and compare IBLCE's requirements with the courses you have already taken. Then will be able to determine if any courses are still missing. As an example, I asked the IBLCE representative if a "Development Across the Lifespan" course would count for "Infant Child Growth and Development" and she said yes, if you look at the details you will find that it does count (though a Child Development course is preferred).

Clink here for a list of the courses.

OTAs may have another option as well, but I could not really get a clear answer on this. It seems if you can provide government documentation that you practice "clinical", key word, "clinical" health, this could suffice for the education requirement as well. I asked if a state license would count for documentation, and the representative said it needs to show that it is for "clinical health". I would again call yourself and verify this. This is what is stated in the FAQ section of IBLCE:

"If you are able to provide documentation that you are authorised by a governmental authority to practice as a clinical health professional, you will be considered to have fulfilled the Health Sciences Education requirements. Any health care professional from the Recognised Health Professionals list, be it a nurse, doctor, etc. must provide these documents too if audited."

Lactation Specific Clinical Experience


Update (8.10.20)- Please Check out this Updated Interim Guidance on the Use of Technology to Meet Pathways 1,2,and 3 Clinical Practise Requirements (issued on May 14 2020) along with the following section. In a nutshell, IBLCE now allows clinical supervision to be performed through "technology platforms". This may not change much for those pursuing their hours through Pathway 1 (though maybe it could), but it could make a big difference (and potentially really open up supervision possibilities) for Pathway 3.

IBLCE defines clinical hours as:

"Provide in-person consultations, telephone consultations, or online breastfeeding and lactation care that supports breastfeeding families, including lactation assistance to pregnant and breastfeeding clients and lactation education to families and/or professionals. These hours are to be obtained within the 5 years immediately prior to applying for the exam."

For many occupational therapy practitioners, acquiring the required lactation specific clinical hours is probably the most difficult step to IBCLC certification. Unlike RNs who can work in hospitals on mother-baby units and pediatrician's offices, OTs do not often have this option. However, many OTs have been successful in acquiring clinical hours in other ways.

IBLCE Pathways

IBLCE offers three pathways for exam candidates to earn their hours. Most OTs I am aware of, have accrued their hours through Pathways 1 and 3.

Here is a helpful decision tree to help you determine which Pathway is right for you.

Below is a brief description of the three pathways. I will cover pathways 1 and 3 as they relate to OT more in depth below. I encourage you to read further about these pathways on

IBLCE's pathways page on their website

.

Pathway 1: 1000 hours- For healthcare professionals and recognized support counselors.

Pathway 2: 300 hours at an accredited lactation education program.

Pathway 3: 500 hours of direct supervision with an IBCLE approved mentor.

IBLCE Pathway 1 and Occupational Therapy

Healthcare Professional Route

Many OT/OTAs earn their hours through Pathway 1 via both the qualified healthcare professional route and the volunteer breastfeeding counselor route. If an OT chooses to earn their hours via the licensed/registered healthcare professional route they will need to track and document their hours closely. OTs have earned these hours in a variety of settings, including working in the NICU, in outpatient feeding practice (specifically treating breastfeeding dyads), and in independent private practice. (This route often takes longer than other routes available. It took me five years total to acquire my 1000 hours-- but others have done so more quickly. It often depends on what opportunities you have available and how you can balance this with the rest of your life.)

IBLCE states that:

"Clinical practise hours can be earned through independent practise as a licensed/registered healthcare professional in non-healthcare settings."

While OTs miss out on mentorship if they determine that earning their hours through independent private practice is the best choice for them (and sometimes their only option), this option does allow for greater flexibility. Some OTs have chosen this path, but in addition, sought out additional unofficial mentorship, creating a sort of "hybrid" pathway, with greater flexibility compared to Pathway 3, but the added benefit of mentorship.

At this time I am not certain if OTAs are considered part of the independent private practice group as they are not on the recognized health professional list discussed above in the health sciences education section. OTAs are licensed healthcare professionals, however they do require OT supervision to practice. I will be contacting IBLCE to see if I can get more details on this. (If you are an OTA and know the answer please let me know!) I imagine this is another situation where you will need to call and ask about your particular situation.

Breastfeeding Counselor Route

Some OT/OTAs have also earned their hours by volunteering as breastfeeding counselors with IBLCE recognized breastfeeding organizations, such as La Leche League and Breastfeeding USA. Currently, volunteer breastfeeding counselors can earn 500 hours/ year for active in person service, or 250 hours/ year for mainly online service. This will change in 2022 and breastfeeding counselors will need to begin counting their hours individually.

Go here to learn more about this change.

Breastfeeding volunteer organizations provide their own training/certifications and mentorship. They also have their own requirements to qualify as a breastfeeding counselor, which usually includes personal breastfeeding experience.

In addition to acquiring my lactation hours as an occupational therapist providing breastfeeding support in early intervention (where I developed a "Breastfeeding Therapy" program), I also chose to volunteer with a breastfeeding organization in order to receive mentoring and be connected with other breastfeeding supporters in my community and online. So, I can share my personal experience, with Breastfeeding USA.


Breastfeeding USA requires one year of breastfeeding experience, an application with references, and an interview. Once accepted, a breastfeeding counselor candidate completes online training that takes on average 9 months to complete, but motivated candidates have completed it in less than four months (it took me about seven). I really enjoyed going through the breastfeeding counselor route as it provided me with a great foundation and support from other lactation professionals/volunteers and a way to begin serving breastfeeding families in a low pressure manner, before providing breastfeeding/lactation support more formally as an Occupational Therapist.

To check out if an organization is recognized by IBCLE follow this link.

IBCLE Pathway 3 and Occupational Therapy

Some OTs have also chosen to earn their clinical breastfeeding hours via Pathway 3 which requires 500 directly supervised hours. IBLCE requires prior approval for this Pathway. Some of the benefits of Pathway 3 are ongoing, in-person mentorship (which can be invaluable), providing you with connections to other professionals and future client referrals, and potentially completing clinical hours more quickly. However, there are also opportunities to learn “bad habits” of the mentor, as with any mentorship opportunity. Mentors are often compensated for their mentorship which can make this pathway more expensive. Additionally, it is often difficult to secure this kind of direct mentorship, and the schedule may not be as accommodating. Finally, since the mentorship must be direct, online and phone support hours usually cannot be counted.

Final Thoughts

While the process to become an IBCLC can seem confusing at first, once you spend time studying the various pathways and requirements it does start to make more sense. I highly recommend double checking the requirements on the IBLCE website as they have changed over the years. (For instance, IBLCE recently (Fall 2019) changed their policy on breastfeeding clinical hours to include phone and online support.)

You can also email IBLCE directly with any questions about the requirements. Their FAQ is also helpful.

I hope that this guide helps more OT/OTAs in their journey to become breastfeeding savvy therapists. Occupational Therapy and Breastfeeding /Lactation support are a perfect fit. As OT/OTAs we are able to truly treat both mother and baby holistically and comprehensively.

In fact, because we are also Occupational Therapy practitioners our scope encompasses so much more than consulting, counseling or education! We can provide therapeutic services for both mother and baby as well!

Check out this post I wrote about Breastfeeding Therapy and the sort of therapeutic services we, as breastfeeding savvy OT/OTAs can provide.

Stay tuned for another post all about additional training/education in infant and perinatal mental health, oral motor therapy, bodywork, ergonomics, pelvic health, sleep, lifestyle changes, and more that complement lactation and breastfeeding services and fall within the scope of the Occupational Therapy provider.

*** This guide is a work in progress. If you have additional incites, or questions, that would be helpful to include please contact me! I will try to update as IBCLC requirements change.

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