"Why does that doula charge so more than you? Is it because they offer a better service?"

So, you want some help with breastfeeding. Who do you turn to? There seem to be a lot of experts to choose from. What do their job titles mean and what experience and qualifications do they have? Breastfeeding Peer Supporters/ Breastfeeding Helpers These are parents who have breastfed themselves (usually to at least 6 months, with at least one child) who have been trained by the National Childbirth Trust (NCT), the Association of Breastfeeding Mothers (ABM), the Breastfeeding Network (BfN) or the NHS. The BfN call them Helpers, rather than the more commonly used Peer Supporters, but they are all very similarly qualified. The training, which usually spans several weeks or even months, gives these participants knowledge about how breastfeeding works, strategies for tackling many of the most common problems and, possibly most importantly, when to signpost to others, more qualified than themselves. They should be seen as are well-informed friends, who’ve been-there-and-done-that. They generally work as volunteers either on postnatal wards or at local breastfeeding support groups, although very occasionally they may be found in paid roles for either the NHS or other organisation. Breastfeeding Counsellors/Le Leche League Leaders These are also parents who have breastfed themselves (usually to at least 6 months, with at least one child) who have been trained by the NCT, the ABM, the BfN or La Leche League (LLL). LLL call them Le Leche League Leaders, rather than Breastfeeding Counsellors. Their training usually takes around 2 years and is much more academic. The NCT course, for example, is university accredited. Breastfeeding Counsellors are not allowed to charge parents for breastfeeding support, but sometimes work in paid roles for organisations, including the NHS. They may teach breastfeeding classes antenatally, as well as run breastfeeding support groups or work on telephone helplines. Each of the organisations that train Breastfeeding Counsellors expects their Counsellors (or Leaders) to keep their knowledge up-to-date, with continuing professional development (CPD). The title of Breastfeeding Counsellor is not permanent. If they let their registration/CPD slip, they can no longer call themselves Breastfeeding Counsellors. Like peer supporters, they are taught to know when to signpost on to health professionals. Midwives Many midwives are very skilled at breastfeeding support. Obviously some will be parents themselves, and of those who are many will have some personal breastfeeding experience. Some of them will have trained as peer supporters. A lot of women who choose to enter midwifery after having children of their own, train as peer supporters in order to help with their application to university. Some may have done their breastfeeding counsellor training (before, during or after their midwifery training) and some will even be IBCLCs (which is discussed further on). The training that midwives got during their initial training (and the amount they get as CPD after qualifying) varies enormously. Although the more newly qualified midwives should, in theory, have a fairly good level of breastfeeding training. If you happen to come across an Infant Feeding Specialist Midwife, you know that they have had extra training and have had convince their employers that their knowledge and skills of infant feeding are of a high level. Even those with no experience of their own, or specific breastfeeding qualifications, may have picked up a lot of knowledge and skills during their lives. But it is hard to know which midwives provide the really fantastic, up-to-date, evidenced-based support, and which are basing their support on outdated ideas or their own very negative experiences of breastfeeding. In hospitals accredited by the Baby Friendly Hospital Initiative (BFI), all health care workers, who care for mums and babies, should have received a certain amount of training in breastfeeding, roughly equivalent to that of a Peer Supporter. But of course midwives move about between hospitals and may be working in a BFI hospital for some time before getting the training, so this isn’t a guarantee of a midwife with a good level of training. Health Visitors Like midwives, not all health visitors are created equal. Some provide excellent support and really know their stuff, while others have had little training in breastfeeding support. You might be lucky enough to find yourself meeting a health visitor who is part of the Infant Feeding Team or maybe even the Infant Feeding Lead Health Visitor. In this case, you know that they have a particular interest in the area and that their knowledge and skills of infant feeding are likely to be of a high level. General Practitioners (GPs) Breastfeeding training for GPs is sadly lacking. Most GPs will have had one or two lectures on breastfeeding, most of which is likely to have been about the anatomy of the lactating breast, rather than how to help those who are having problems with breastfeeding. Of course, like midwives many will have their own experience of breastfeeding and a few may have chosen to do extra breastfeeding training. But as breastfeeding parents are only a small section of the huge variety of patients they see every day, they are far less likely to have done so than a midwife. There is no doubt that GPs do an amazing job, and have a huge knowledge base, covering a range of bodily functions and ailments. Most GPs will have few areas in which they have more specialised knowledge, but this varies, depending on the demographic of their patients and their own particular interests and experiences, and of course this does not always include breastfeeding. So much like Midwives and Health Visitors, how well your GP can help you with your breastfeeding concerns, will vary depending on the individual GP in question. Doulas Doulas work with expectant and new parents. Their training, qualifications and experience varies greatly. Most are parents themselves and some will have breastfed. Many Doulas, especially those who work mainly with new (rather than expectant) parents will have done a Breastfeeding Peer Supporter course And those who have not done Peer Supporter training will likely have attended study days on the subject. Some will also have trained as Breastfeeding Counsellors. However, as Breastfeeding Counsellors are not allowed to charge mums directly for breastfeeding support, they may have chosen to let their qualification lapse, in order to be able to charge specifically for breastfeeding support. Doulas can charge for general postnatal support (which may or may not include a degree of breastfeeding support) and retain their title of Breastfeeding Counsellor. However they cannot advertise or provide specific breastfeeding support as a chargeable service. International Board Certified Lactation Consultants (IBCLCs) This qualification is the gold standard of breastfeeding support providers. IBCLCs are usually health professionals (doctors, nurses or midwives) who have chosen to take on extra breastfeeding education. Unlike Breastfeeding Counsellors, they do not need to have any personal experience of breastfeeding. But becoming (and maintaining the title of) IBCLC is not easy. IBCLCs must gain many hours working with breastfeeding mums and have a large amount of formal health (including specifically breastfeeding) education before they can even sit the exam to gain their title. They must re-sit the exam every few years, as well as getting plenty of CPD. It is possible for someone who is not a health professional to become an IBCLC, but this is an even longer and more difficult journey. Those who do manage it will certainly have a real passion for breastfeeding. IBCLCs may work for the NHS or they may have a private practice. Access to NHS employed IBCLCs is free, but the cost for consultations with private IBCLCs varies. A few IBCLCs offer their services for free, on a voluntary basis. Others with infant feeding or breastfeeding training There are an increasing number of courses in breastfeeding/infant feeding available to those who work with either expectant or new parents, in a professional capacity, such as antenatal teachers, yoga instructors, osteopaths, massage therapists etc. To take these courses participants do not usually have to be parents or to have breastfed themselves. The courses vary in length from a single day to several weeks and their content and quality also varies. Some are great courses, run by those with appropriate qualifications, while others less so. The best of these courses are approximately equivalent to that of Breastfeeding Peer Supporter. The only exception to this, that I am aware of, is the ABM Breastfeeding Support Training: Advanced level, which is almost identical in content to their Breastfeeding Counsellor course, taking around 2 years to complete, but which you do not have to have breastfed in order to take. It does not qualify you as a Breastfeeding Counsellor, and allows those who have taken it to charge parents for support. What’s in a title? Unfortunately, the titles of ‘Breastfeeding Supporter’, ‘Breastfeeding Counsellor’ and ‘Lactation Consultant’ are not legally protected This means that anyone can call give themselves these titles, or similar ones, such as ‘Infant Feeding Consultant’ or ‘Lactation Specialist’. Please check what training and qualifications they have. Check that any they do have was awarded by an appropriate organisation and that have kept up-to-date with any requirements to maintain their qualification. Someone claiming to be a Breastfeeding Counsellor, who specifically advertises breastfeeding support as a chargeable service, has either chosen to let their qualification lapse, in which case they should not be calling themselves a Breastfeeding Counsellor (although they would not be incorrect in stating that that have trained as one) or never had a qualification from an appropriate awarding body to begin with. And a Lactation Consultant that does not have the letters IBCLC after their name is not as qualified as they would have you think.