• Mckenna Brook

My IBCLC Clinical Experience

Hey guys! If you are currently trying to navigate the clinical portion of becoming an IBCLC, you are in the right spot! This blog details my clinical experience to become an IBCLC Lactation Consultant. To read up on the full process on how I became an IBCLC Lactation Consultant with NO prior medical background, click here.


HOW DO YOU FIND A CLINICAL LOCATION?

My clinical experience will always be a time I hold dear to my heart. It was a valuable time of experiencing the wonderful field of lactation consulting in real time. Not just in textbooks and educational videos but in real hospital rooms with real mommas and babies. So exciting! As fun as clinical was, getting there was just the opposite.


Personally, finding a clinical location willing to take me in as an intern was the most challenging part of my journey in becoming an IBCLC. Most locations were not opposed to the idea of having me as an intern, but many were unfamiliar with the process and unsure about how best to guide me through it. After some searching and many phone calls, I finally found a local hospital that took me in. I was their first intern of this kind. Although the hospital was not familiar with the certification process, they were willing to figure it out with me. I will mention that this specific hospital has the baby friendly designation meaning they have incorporated the 10 Steps to Successful Breastfeeding throughout the hospital. They value breastfeeding and therefore saw this internship as a valuable opportunity for the hospital. I recommend searching for baby friendly hospitals when searching for a clinical location as these hospitals seem to be more inclined to a clinical internship such as this. To read more on The Baby Friendly initiative, click here.


Since finding a clinical location seems to be a hold up for many candidates in this process, I recommend searching for a location from the very start! I began calling local hospitals and clinics when I started my 90-hour lactation specific training. By the time I completed the training (3 months) I had found and secured a clinical internship and was ready to start! Remember that the 90 hours has to be finished prior to clinical hours for the hours to start counting. Technically you can be observing at a clinical setting (not yet hands on) and be completing course work. This will make more sense when I cover the three-phase process of direct supervision regarding clinical hours. It can be frustrating when call after call you get turned down. I must have called twenty different locations near and far before I landed my internship, so please do not give up! There will be a location out there that will accept you with open arms. It may just take TIME, PATIENCE, and DETERMINATION until you get there.


Clinical hours do not have to be completed at a hospital! There are many other locations where you can complete your hours such as clinics (WIC offices are a good option), pediatric offices, and private practices. Lactation Consultants are also commonly speech pathologists and dietitians so practices with these individuals could also be an opportunity! Just remember that the individual(s) that train you have to hold the title IBCLC. An advantage of interning at a hospital or clinic is they tend to be busier which means there is more to be seen! You get to see more mommas and babies and have exposure to many different scenarios. At my hospital, I saw an average of ten patients on a typical day. From sleepy baby to engorged breasts to tongue tied, I’ve seen an abundance of mother-baby duos that allowed me to get good exposure and hands on experience.


WHAT DOES A CLINICAL LOOK LIKE?

This next bit of information is the logistics of clinical. The clinical portion makes up 500 hours of hands on experience helping mommas and babies breastfeed. Remember, these hours HAVE to be supervised by an IBCLC.


I was placed in the mother/baby lactation department and trained under an amazing team of five lactation consultants that had over thirty years of experience each. In my case, this was a non-paid internship that I worked full time. Personally, I decided to work my clinical hours full time because I wanted to get done with the process as reasonably possible. You can work these hours as fast or slow as you want as long as you are getting adequate experience in the field. Since I decided to dedicate my full time to my clinical hours, it took me a total of five months to complete the 500 hours. This was Monday through Friday, 8 am to 4:30 pm.


As mentioned above, there is a gradual three phrase process regarding supervision of the clinical practice.


Gradual Three Phase Process:

1. Observation

2. Mentor in room until skills are mastered

3. Independent practice with mentor close by (in same area)


You start by simply observing your IBCLC mentor doing her thing (Phase 1)! Basically, you are getting comfortable in the setting and shadowing your mentor’s every move. I really grew in my skills and confidence as an intern simply by watching. My mentor asked the patients for permission to allow me to observe and the majority of them didn’t mind one bit! I carried around a notebook that fit in my scrub pocket to take notes so I could look back on important information at the end of the day. I completed thirty hours of observation hours before I even started to interact with my patients hands on.


After some time, I felt comfortable taking the lead during a consult with my IBCLC by my side (Phase 2). To start I performed basic tasks such as explaining the basics of breastfeeding, showing mom different breastfeeding positions, and helping put baby to breast. Gradually I moved into performing more difficult tasks in order to start checking off items on the clinical competencies skill list.


What’s the clinical skill list? I’m happy to explain but promise you will not get anxious when you see it! You will have a checklist of clinical competencies that need to be mastered throughout your internship. These skills will be signed off by your mentor once mastered. The majority of these skills need to be mastered independently with your mentor observing you prior to independent practice. I am not going to lie; the list of skills is long and intimidating at first glance! it can be overwhelming, but don’t worry. You will find opportunity to practice most of these skills naturally over your clinical hours. For these skills that you do not get to practice, there are Alternative Learning Activities you can complete in exchange for the physical practice of that skill. These alternative learning activities could be a discussion over the topic with your mentor, watching an instructional video, literature research, or similar activities. The downside of the Alternative Learning Activities is that they do NOT count towards the 500 clinical hours.


Whenever I ran into an issue that I didn’t know how to handle, my mentor would step in and offer her expertise. Some of the more complicated situations included baby not maintaining latch, disorganized suck, no milk transfer, and more! Watching how my IBCLC mentor handled these more complicated situations gave me insight on how to handle a similar situation the next time. Do not be afraid to ask for help! It is not a sign of stupidity. We all, even professionals, have a knowledge deficiency! When a patient asked me something I did not know, my simple answer was: “You know what, I am not completely sure. Let me look that up for you and consult with my mentor before getting back to you.” My patients never looked at me like I was dumb when I didn’t know it all. In fact, they appreciated that I wasn’t feeding them incorrect information. With that said, know your limits of knowledge and don’t be afraid to ask for help! We all do it! I still do this even now as a practicing IBCLC.


Eventually, my mentor felt that I was ready to do my consults independently (Phase 3). I reached this phase after another thirty hours of taking the lead on consults with her by my side. There is not a specific number of hours you need to complete before you can do consults independently. This really depends on when your IBCLC mentor feels you are ready. I will add that knowing your limits of personal knowledge and skills as well as knowing when to ask for help is crucial before moving on to working independently.


I was terrified the first time I did a consult completely on my own, but I also felt ready. If there was ever a time when I felt stuck or that I was not able to give the best care for the situation, I would always get my mentor to help me out. It’s ok to ask for help! Second opinions are always a good thing. Patients actually appreciate this, a valuable lesson learned! Make sure your information is correct, never just giving an answer to give one. Even if this means having to tell the patient you don’t know but will figure it out for them.


After several consults independently, I began to find my groove and they started to flow naturally. Obviously not all consults were the exact same, however, they had a similar structure. I would get acquainted with momma and baby, ask how things are going/previous experience, review breastfeeding guide and basics, help put baby to breast, observe a feeding, create a feeding plan, and answer any questions or concerns. Length of consults varied from 20 minutes minimum to over an hour depending on momma and baby’s need for help.


I would love to say that all my consults ran smoothly but of course majority of them didn’t! From a sleepy baby to lots of company visiting, there is no such thing as a “perfect” consult and I constantly had to remind myself that giving my best was enough. Being available for the patient and offering quality care is all that’s important. A mother/baby duo having difficulties is out of our control as IBCLCs and our job is to offer the best help we can and to figure out the best possible feeding plan for baby while protecting mom’s milk supply along the way. Sometimes we can’t fix the problem. And that’s ok. Sometimes the problem fixes itself with time.

The typical day in the life of an IBCLC Intern was packed full, but I enjoyed every bit of it! The day typically looked like this:


8:00: Look up assigned patients and their stats needing a breastfeeding consult

9:00-12:00: Hit the unit and start visiting patients, charting consults in between

12:00-12:30: Catch up on any computer charting before lunch

12:30-1:00: Lunch and debriefing

1:00-3:00: Visit remaining patients on unit

3:00-4:30: Finish charting and complete any phone consults from lactation warmline.


PATHWAY 3 VERIFICATION INFORMATION! (see more about pathway 3 here!)

Lastly, I wanted to briefly touch on the verification of your Pathway 3 Plan. I also included documents that you will need to complete and kept in a safe place for your records. This is information and documents you do not want to overlook!


Verification of Pathway 3 Plan:

If you are seeking to obtain your IBCLC through Pathway 3, then you must submit a Pathway 3 Plan through an application process for verification. Your Pathway Three Plan includes: (1) name(s) of your mentor(s) and (2) your clinical setting. If both your mentor and clinical setting meet the needed requirements, then you should be approved. This application must be verified before clinical hours can count.


Submission Step by Step:

To submit a Pathway 3 Plan verification, create an account on the IBLCE login page: https://i7lp.integral7.com/durango/do/login?ownername=iblce&channel=iblce&basechannel=integral7

Here is the online application manual to help guide you through the verification process:

https://iblce.org/wp-content/uploads/2017/05/pathway-3-online-application-manual.pdf


There is a submission fee of $100. Once your plan is approved you are ready to tackle and count those clinical hours!


To My Future Collogues:

My hope in sharing my clinical experience is for an overall better understanding of the clinical process, giving you a little more insight in what a potential clinical could look like! Please reach out to me with any questions regarding clinical experience or becoming a lactation consultant in general! I am more than happy to help make this process easier for you. You got this!


Check out these other helpful resources:


DOCUMENTS

These forms are here to help you keep accurate records of your clinical hours. This is especially important come time to apply for the board exam just in case your application is randomly chosen for audit:


Pathway 3 Mentor Agreement Form, Pathway 3 Clinical Practice Hours Report, and Pathway 3 Time Sheet down below.

https://www.dropbox.com/s/pbnlo2h06arippp/pathway-3-plan-guide.pdf?dl=0