I'm contemplating doing the CLE (Cert. Lactation Educator)....But, I'm wondering if it's worth the investment. (I'm already a BF Counselor)
Are there any CLE's out there and have you had enough business to feel it's worthwhile?
Appreciate any feedback or suggestions you might have!
Thanks!
Beth

i'm a certified breastfeeding counselor, i've thought about doing the ibclc thing. seems like a LOT of work tho.

...

One thing about CLE: It has been de-recognized (if that's a word, lol) by ILCA, so now the only position they recognize as being reputable is the IBCLC, which requires one taking and passing the IBLCE. CAPPA bought the rights to "CLE," which in my mind makes me wonder how far you can get with it? Sure, you are a "Certified Lactation Educator," but only through and recognized by CAPPA.

As per what a CLE can do, it is not supposed to be anything but education -- it's not supposed to be "hands-on" work -- they ar supposed to refer out to IBCLC for that.


I did not know that. I was thinking about becoming a CLE.

Susan

I hadn't heard about the controversial status of the "CLE" credential, but I'm not surprised...I understand the importance and drive to have consistent standards for the IBCLC, but I've worked with enough IBCLC's to know that it doesn't really translate! Some are amazing resources of info, while others....Let's just say "not so much!"
Anyway, I think there's plenty of room for varied levels of BF professionals in the field. Seems ILCA wants to be the ONLY source and authority on the matter. I feel their program is prohibitive...(i.e. They will not count any "doula" hours towards the BF Consulting req.--only contact hours through Dr., hospitals or WIC-type agencies. As a Postpartum Doula, I've had 100's of extensive BF hours that they won't consider...)
My main incentive is more to offer more confidence to clients, who would likely be blissfully unaware of the ILCA's politics.....

I should really let Jaye answer this one. I'll let her know that the thread is up and we'll see if she "takes the bait" so to say. for the newbies Jaye is my best freind and she is an IBCLC in private practice. She has a membership to AllDoula's but I don't think she reads all the post like some of us addicts do! :bounce

IMO, just me, my :cents is that ILCA should be the ones to administer the educational componements of breastfeeding and the health care community. To me it just makes sense that the same body would educate, test, and certify ALL lactation professionals.

That said, I'm getting my CLE through Cappa. I was a LLL Leader for over 7 years so I don't think I'll learn a lot during my certification process. I'm sure some things have changed and it will be a blast to do a 3 day workshop about breastfeeding. I can hardly wait!!! Breastfeeding Kelsey is what led me to the path that I'm on now of becoming a Liscenced, Certified Profesional Midwife. and a certified birth doula, post partum doula, cle, etc... the name expectations... has a lot to do with my expecatations also.

I made a decision about 5 years ago that I didn't want to limit myself to boobs. I wanted to care for the entire package. Having my CLE will enable me to teach classes and do basic breastfeeding counseling and support. When it becomes clinical ie: check babies suck, feel for palate, etc then I refer out to our local LC.

...

Stacie,

To be honest I really don't know anything about the hours required to sit the exam. I think they changed the rules so that you have to have some college credits. Since I don't have any official education after I completed high school I felt it would be too expensive and take too much time for me to get my IBCLC.

The other thing is that after my first Doula birth I have no question as to my purpose on this earth. I'm supposed to work with pregnant couples to help them acheive the birth that they want. Also I really like the "whole package" instead of just boobs.

K-now I'm really going to bed.

:ghug :ghug :ghug :ghug

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Hi All,
Yeah Jill, I'll take the bait. :) BUt you may not like what I have to say...then again - you might.

Here is the deal. IBLCE decided that it could only focus on one main certification. ILCA does NOT have anything to do with certifying anyone as an IBCLC. ILCA is simply the International Lactation Consultants Association. IBLCE is the International Board of Lactation Consultant Examiners - two entirely different entities. This being said - both are made up of mostly volunteers who have their own lives to deal with. For IBLCE to try and certify everyone in everything lactaiton realted would be near impossible - tho it would be better if they could.

Why won't IBLCE count doula hours as BF hours? Proabably because there is no way to know what doulas are teaching. Just as was stated by one person here that she has worked with LC's out there who shouldn't be - there are doula's out there in my area who had no business giving out BF information or education - how do I know? Because I came in to fix the train wreck they created. We all need to remember where our education and expertise is - I am NOT a doula or a CBE - therefore I give out NO information regarding childbirth or pregnancy - even tho I had 3 kids - one at home. This is where we all need to remember to REFER out - even if we think we know what is correct. That is my opinon and others may feel free to disagree with it. But, I will not take advice from a Heart Dr. on my podiatry needs...know what I mean?

Re: IBLCE de-recognizing CLE - no they did not. My understanding of the situation was that they simply could not handle the work of doing both certifications. There has been discussion of having an introductory type certification just below IBCLC - but even that has rasied a lot of issues and concerns of how would they do it -0 how would it be structured - who would administer the test - who would design the tes and so on.

CLEs are Educators - they are not supposed to be doing hand's on work UNLESS they are being supervised by an IBCLC. BF counselors should also NOT be doing hands on work unless supervised by an IBCLC. Now, this being said I recognise that in a perfect world this is the way it would be. But we are not in a perfect world and sometimes things happen and we CLE's (I still consider myself one...) find ourselves in situations where we need to get hands on. However, it should not be the norm.

The bottom line is that whether or not IBLCE should be responsible for all things lactation related, the fact is they can not and therefore are not. IBCLC is where they are at - we are still in our infancy in this field. Someday we will be licensed -and actually recognized as true health care providers and given the respect we deserve. Someday, CLE's wil be given the respect they deserve and will be the IBCLC's right hand - the one's who do the educating, triage out the simple cases so the LC can handle the truly tough cases. What I see happening too often, and it really pisses me off actually, is that people get all uppity about CLE and IBCLC as if one is better than the other. The fact is that they are different but similar - they have very specific guideines of practice and those guidelines should be followed as best as possible. We should be working together - not playing stupid jealousy games.

Re: CAPPA - good for them for taking the CLE and running with it. If IBLCE can't do it someone should. UCSD has a CLE type program too from what I understand. We need more programs out there to address the educational needs of CLE's and IBCLC's. We need the lactation education to be consistent between programs. We need to find some way to filter out the crappy LC's that give us good one's a bad name. We need to filter out the crappy CLE's who take liberties by calling themselves LC's and giving us all bad names. Doula's need filters for the same reason...how mayn times do you get pissed that some broad out there is calling herswelf a doula and has NO education? She just heard the word, thought it sounded cool and helped her friend give birth. But those filters are not yet in place. They will be someday. But for now - we should be working together.

Re: Hours and requirements to sit the exam - check out the IBLCE website for those details. They are getting more and more stringent - and it is a good thing. It is the only way to weed out those who really shouldn't be doing this. Yes, it makes it hard for some of us who want to do this but may have to struggle to meet the requirements - the idea is sound, however. I needed 5000+ hours to sit the exam and on-line hours on chat boards shouldn't, in my opinion, count at all. Only programs that have been recognised by IBLCE as sound BF education should count. Call me picky - but I have seen the education of some LC's myself and I would dearly love to strip them myself of thier IBCLC title.

Anyway, those are my thoughts. I think it is well worth anyone who is truly invested in breastfeeding education to become a CLE and act like a CLE. We IBCLC's need good CLE's out there. BF counselors are needed too as peer support. A good BF counselor can be a helpful addition to a busy LC's practice - good for triage and to weed out the simple vs complex cases. We need good IBCLC's to assist moms in correcting what our societies medical establishment screws up so often. So, can we all work together and appreciate our similarities and our differences?

Take care...

Jaye

I agree there should be something that is just one step below the IBCLC. There needs to be something, as you said, that will enable those of us willing to do the book work, a venue to help the "simple" breastfeeding issues while refering the more complex cases. Unfortunately, a lot of women who have problems with breastfeeding simply aren't getting enough rest or are feeling like their milk supply is low because their boobs don't feel huge etc. I think we would all agree that the majority of the problems are simple ones due to lack of information. Of course LLL is a one way but, lets face it, some women are turned off by LLL. I am rambling here....my point is, I know I could do a lot to help women with breastfeeding but with a family and no nursing degree there is no way I could get the hours to sit for IBCLC any time in the near future. But, you never know what the future holds!!

let me get this right so a Laction educator and a LLL cannot do any "hands-on" except for a IBCLC. So if i have a client that has a simple problem and know I can help I am to send her to a IBCLC? IBCLC cost by the hour don't they?

I would so like to take the IBCLC test but there no way I would be able top the get the hours. :(

Susan

Susan,

We're talking technicalities here. Which is why I allerted Jaye that this thread had started. Jaye is my bestest freind in the whole, wide, world and I knew she would do her best to clear up the confusion. As many of you can tell this is a touchy subject among our peers (breastfeeding or childbirth related).

As a LLL Leader there were many times that I did "clinical" work. At that time there really weren't that many LC's around and I didn't realize how serious some of the situations were. Gosh I hope I didn't lead any nursing dyad's into a "train wreck" that an LC or pediatrician had to clean up. :pray The other thing to keep in mind is that LLL has insurance on their Leaders. This gives the Leader something to fall back on, KWIM? I no longer know how LLL works, as I've been retired for over 6 years and haven't kept up on LLL's stuff.

Susan, yes an IBCLC can be pricey. Usually they don't charge by the hour. Most of them are like us Doula's. Free phone counseling and do a visit only if necesary. I personally doubt that an IBCLC is out there making oodles of money. For them, it's their passion and most of them are really good at what they do. I'm thinking it's like $100-$150 for a 2-3 hour consult. Now remember for all the hours the LC has put into this dyad she may end up making pennies if she figured it out per hour.

One of the things I like to tell new parents that are balking at paying for an LC. "Have you looked at the price of formula lately? If you run to the grocery store, price the formula and look at the ingredient list then decide if you can afford an LC." By saying this I'm asking them to look at the long term ramifications of formula feeding as opposed to a maybe $200 or $300 initial investment in their child's life.

I'm not sure about the CLE's and hands on stuff. When I say clinical I mean sticking your finger in the kids moth and evaluating his suck. Not "here Mama, let's put these pillows here and turn the baby" to get proper positioning. Whether it's in their scope of practice. I don't know, that would be a Jaye question and may be up to that CLE.

OK-I got long winded there. Gotta get the kids off to school. :ghug

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Well said Stacie. I'm looking at Cappa for my CLE, I didn't realize that the Seattle Midwifery school offered a CLE program. And did you say Evergreen, as in "the greeners" that my hubby and his brother remember from their teen age years while their step-mom was getting her Master's. Greener's were kinda like hippie's from Berkely? My FIL and step MIL still live in Olympia in the same house since 1962, we have strong ties to that area. The thing that is hiarious is that he married a "greener"!

...

Hi All,
Just checking in quickly. Susan - As I said in my post, sometimes CLE's and LLLL's find themselves in situations where they need to do hands on - it just shouldn't be a regular thing. By hands on I don't mean that assisting with positioning and latch - although some people truly don't know how to help a mom latch a baby - even tho they may have breastfed themselves... I guess what I mean by hands on is the more intensive work that comes along with the train wrecks or the babies who refuse to latch or are causing mommy PAIN, bleeding, etc. Suck evaluations should only be done by someone who has been trained to know what they are looking for - there are many IBCLC's out there who DO NOT KNOW HOW to do a suck eval!! In that case they need to get the training before trying to figure out what is up with a baby's suck.

I really liked Stacie's post a lot. Good information - thank you! It is too bad that IBLCE cannot regulate the educational model for CLE. It would be best if they could. However - they aren't so we need ot take what is available - evaluate the programs and utilize (advertise) the best ones. Someday it will all be regulated. THe RLC addition to the IBCLC is only a couple years old - some of us use it some of us don't. I like it, but since California doesn't recognise it yet I am inconsistent with using it...If I wanted I could put the following after my name:

Jaye Simpson, CLE, IBCLC, RLC, CIIM - damn that's a lot! Looks impressive...but long-winded. I usually stick with IBCLC, CIIM (Certified Instructor of Infant Massage). Takes less time to type up. :)

I also agree that we need to work together...infighting is just plain STUPID. Someday...I do have to say that those IBLCL's I have talked to all feel that CLE's are neccessary and needed. I believe that if you hang in there the CLE will eventually be recognized and appreciated. Just like it is taking time for IBCLC's to get that recognition - so will it take time for CLE's...sad tho... :(

Ok - off to bed...I think you all have the right idea - CLE is important - it is needed. If you can't do the IBCLC, please consider the CLE - at least as a stepping stone. God knows I would love to have a good CLE to work with sometimes... :)

Warmly,
Jaye

I've been really intrigued by this thread...A lot of valid and interesting points. I would like to respond to this though:

"CLEs are Educators - they are not supposed to be doing hand's on work UNLESS they are being supervised by an IBCLC. BF counselors should also NOT be doing hands on work unless supervised by an IBCLC. Now, this being said I recognise that in a perfect world this is the way it would be. But we are not in a perfect world and sometimes things happen and we CLE's (I still consider myself one...) find ourselves in situations where we need to get hands on. However, it should not be the norm."

In my experience with WIC, BF Counselors are often sent to "triage" moms with latch issues, etc. and refer to the LC's when necessary. There are very clear definitions for what is within our Scope of Practice and what needs to be referred. I've done several Home Visits and while I'm in contact with the LC, they are not there to observe. This system can work very well when people are properly trained and educated.
Again, I feel it's a shame that there aren't more options and levels of BF Professionals. Ultimately, the more variety we can offer BF moms, the more likely they are to find what they need and successfully breastfeed. (which to me, is the bottom line!!)

Hi, There is good reason for ILCA setting standards for breastfeeding education programs. Some are quite good and some are substandard. It is not difficult to conform to ILCA standards.

One thing to consider is that the IBCLC exam is norm-referenced, psychometrist developed (like Lamaze, ACNM, and CPM exams) and therefore mean something! You know something measurable. No wonder it's the "gold standard."

I got my hours as a LLL leader for the past 14 years. My advice -- don't mess with anything not ILCA-approved. ILCA isn't trying to 'rule the roost,' they are protecting providers and consumers from substandard "credentials."

Anne
http://health.groups.yahoo.com/group/BirthBiz/

I am a Certified Breastfeeding Educator. I mostly now use it just to supplement my doula business but I did work for WIC in that capacity. I also use to teach a Breastfeeding 101 class as well as facilitate a support group. I can honestly say that the designation has been benificial to me. Good luck.

never mind :wiggle

Hmmm I was trained to do suck evals...

I am wanting to become a CLE after I become certified with the birth doula..

This is the third time that I have read this thread since it was started and every time that I read it I learn something new ,lol.
I wanted to saY that Iam in the middle of completeing the UCSD program with Gini Baker and she is an awsome teacher !I would retake her class just for fun in a heartbeat if I could afford it .She is teaching it at the family resource Center in Stockton though it is listed as Lodi .Theres a lot of homework but as she says "inch by inch its a cinch" .When finished I will be a CLEC Certificated Lactation Educator Counselor .
Anyone interested should check this program out ......I applied for and was awarded a scholarship to attend .It is an extension course through the University California San Diego UCSD .

Wow. I am sure learning that the program I took seems to be much more then some others. Perhaps because it is designated for Health Care Providers. Here is the agenda of the program I took. You can see exactly what we covered.
http://www.lactation-consultant-services.com/breastfeeding_educator_program.htm#program-agenda
Breastfeeding Educator Program™
Program Agenda
Day One
6:45 - 7:15 Registration
7:15 - 7:25 Welcome, Announcements, Introductions
7:25 - 9:00 Breastfeeding: Is It Still the Best?
Informed infant feeding choice
Risks/Benefits of infant feeding choices
Why aren't more mothers breastfeeding?
Breastfeeding support team members
Baby-Friendly Initiative
9:00 - 9:15 Break
9:15 - 10:50 Breastfeeding: Is It Still the Best? (continued)

Prenatal Care for Breastfeeding Families
Prenatal assessment
Social support, Cognitive preparation
Three phase process for promotion and education
Breast and nipple assessment
Previous breast surgery
Update on prenatal recommendations
Prenatal baby feeding classes
"Flags" indicating additional assistance & support needed
10:50 - 11:00 Break
11:00 - 12:15 Optimizing First Feedings
Impact of early experiences on breastfeeding
Optimal labor support
"Welcoming" babies at birth
Creating optimal feeding readiness
Influence of analgesia and anesthesia on breastfeeding
Breastfeeding immediately after birth
Infant states of consciousness related to feeding
12:15 - 1:15 Lunch
1:15 - 2:40 Positioning and Latch-On
Positioning at breast
Classic cradle hold, transitional hold, football (clutch) hold,
side-lying hold
Cuing baby (eliciting mouth-opening reflex)
Latching baby on breast
Assessing the infant at breast
Role play with dolls and breast models
2:40 - 2:50 Break
2:50 - 4:00 Demystifying Milk Supply
Milk removal principle of milk production
Frequency and length of breastfeeding sessions
Milk ejection reflex
Routine supplementation; Artificial Nipples; Pacifiers
Key factors to get breastfeeding off to a good start
4:00 - 4:10 Break
4:10 - 5:30 Maternal Learning Needs
Prioritizing content with shorter birth setting stays
Evaluating educational materials
How to assess "If baby is getting enough?"
Food myths and maternal nutrition
Alcohol, nicotine, caffeine, exercise recommendations

Day Two
7:30 - 9:00 Later Breastfeeding
High need/fussy babies
Sexuality and breastfeeding
Vitamin and mineral supplementation
(including Vitamin D, iron, and fluoride recommendations)
Weaning techniques
Tandem nursing
9:00 - 9:15 Break
9:15 - 10:50 Later Breastfeeding (continued)
Difficult Latch-On
Premature termination of breastfeeding
Communication considerations in challenging situations
Assessment-based interventions for difficult latch-on
(Sleepy baby, nipple and breast variations, unsustained latch-on,
preference for one breast, maternal anxiety)
Appropriate use of nipple shields
Fluid enticement
Follow-up care with challenging latch-on
10:50 - 11:00 Break
11:00 - 12:15 Difficult Latch-On (continued)
When Supplementation is Indicated
Guidelines for supplementation
When to supplement
How much to supplement
Types of supplements
(advantages and disadvantages)
Methods of supplementation
(advantages and disadvantages)
Practice using supplementation equipment
Supporting continued Lactation
12:15 - 1:15 Lunch
1:15 - 2:40 Sore Nipples
Preventing or minimizing nipple trauma
Assessment of nipple trauma
Assessment-based management of nipple trauma
Correcting disorganized suck
Management of candidiasis (yeast infection)
Comfort measures for sore nipples
Enhancing healing of sore nipples
Follow-up care
2:40 - 2:50 Break
2:50 - 4:00 Additional Early Challenges
Hypoglycemia and breastfeeding management
Review of Academy of Breastfeeding Medicine's recommendations
for assessment and management of hypoglycemia
How breastfeeding influences jaundice
Physiologic, pathologic, and breastmilk jaundice
Prevention and treatment of pathologic engorgement
Management of leaking
Review of management goals for breastfeeding challenges
Telephone counseling
Triage, third/fourth day follow-up calls, anticipatory guidance
Optimizing care when breastfeeding is discontinued
4:00 - 4:10 Break
4:10 - 5:30 Special Maternal and Infant Situation - Part I
Ill infants
Hospitalized infants
Fasting prior to general anesthesia
Babies with cleft lips and cleft palates
Babies who gain weight slowly
Insufficient milk supply - factors influencing production
Strategies to increase milk production
Lactagogues

Day Three
7:30 - 9:00 Special Maternal Situations - Part II
Promotion of breastfeeding among adolescent mothers
Breastfeeding after a cesarean birth
Breastfeeding multiples
Ill mothers
Psycho-social issues related to breastfeeding
Postpartum depression
Less-than-optimal childhood history
Treatment of obstructed ducts and mastitis
Maternal medications
Relactation and induced lactation
9:00 - 9:15 Break
9:15 - 10:50 Combining Employment and Breastfeeding
Concerns of employed breastfeeding mothers
Strategies to facilitate continued breastfeeding
Feeding options
Developing a personal plan
Methods of milk expression
Practice manual expression techniques with breast model
Criteria for selection of breast pumps
Practice assembling manual breast pumps
Strategies to optimize effectiveness of breast pumps
Breastmilk storage
Storage containers, storage guidelines (freshly expressed,
refrigerated, frozen, and thawed breastmilk)
Maintaining/increasing milk supply while employed
10:50 - 11:00 Break
11:00 - 12:15 Breastfeeding Critically Ill Infants
Supporting mother's decision
Maintaining milk supply
Storage recommendations for hospitalized infants
Kangaroo (skin-to-skin) care
Early direct feeding
Follow-up care
12:15 - 1:15 Lunch
1:15 - 3:00 Creating An Effective Team
Correcting misinformation among colleagues
Consumer advocacy - Making Changes
"Baby Friendly" Initiative
World Breastfeeding Week opportunities
Change Activity
3:00 Adjournment and Check-Out of Skills Kits
Awarding of certificates of attendance
(For participants who are not certifying as
Breastfeeding Educators)
3:00 - 3:10
Break
(For participants who are completing certification)


Optional Certification Activities
3:10 - 3:40 Role Play Demonstrations
3:40 - 5:30 Certification Examination
(Some participants may finish before 5:30)

CLEs are Educators - they are not supposed to be doing hand's on work UNLESS they are being supervised by an IBCLC. BF counselors should also NOT be doing hands on work unless supervised by an IBCLC. Now, this being said I recognise that in a perfect world this is the way it would be. But we are not in a perfect world and sometimes things happen and we CLE's (I still consider myself one...) find ourselves in situations where we need to get hands on. However, it should not be the norm.

Take care...

Jaye

I agree that CLE's shouldn't be working hands on, but I just can't agree that CBC's shouldn't, but I must qualify that to mean depending on their training.

Some CBC courses actually train to work hands on with women and the course counts for 50+ Lcerps towards IBCLC certification or recertification. The one I took was one of those. It also wasn't a 3 day workshop either.

Now my scope of practice is working with healthy women and healthy babies with *typical* breastfeeing issues. I refer to an IBCLC when I assess problems outside of my scope or even if I just have a dyad that is having normal issues but it's particularly difficult *for me* to assist them. I'm also really fortunate to have what I consider one of the best IBCLCs in this town just a phone call away to help my clients or even just to call and say "Hey, here's the situation, here's what I did, did I miss anything obvious?".

I also have a pretty good professional relationship with other IBCLCs in my community so if I see something concerning even right after birth at a particular hospital I can leave them a message at 1AM and go to bed knowing they'll round on that dyad first thing the next morning to pick up where I left off.

There are certainly CBCs who overstep their boundaries, but I don't think that it's fair or accurate to say that they shouldn't be working hands on with breastfeeding dyads unless under the supervision of an IBCLC. Frankly, I think that has the very real potential to do more harm than good. Especially since it's often difficult if not nigh impossible to have that kind of professional realtionship with an IBCLC in many communities.

I really do hope to see the day where CBCs, CLEs and IBCLCs are working as a seamless team to assist breastfeeding mothers. But we're not there yet. Some day, hopefully!

I have a question regarding all of the CBC, CLE and IBCLC stuff....

If one wanted to eventually become a IBCLC, but has no nuring degree, and has no desire to become a LLL Leader, how in the world do you get the hours required to sit the exam? I read a couple of people mention WIC - what do you need in order to work with them?

Liz

...

Interesting thread...

I'm in Canada, so we have a bunch of different titles and programs. There are a few IBCLC's where I live, but less than a handful. We also have a program here in BC which is a Certificate in Breastfeeding Counselling offered by Douglas College. This is what I have. It's 40 hours of classwork, midterm, final exam and final project, plus a 40 hour observational practicum with a multitude of learning experiences (in LDR, Mother/Babe Unit, Breastfeeing Clinic etc). It's a great program. I did consider doing CAPPA's CLE program, but for me although I enrolled in it, I never finished it. I learned much more from doing my CBC and it's local. I thought the CAPPA program would have more information on teaching classes (mind you that was quite a number of years ago - so I don't know what they offer in it now).

Part of me would love to work towards being an IBCLC, but the hours are prohibitive to me as a person who didn't finish a degree. As well, I do have issues with the reasoning behind obtaining 2500+ hours doing breastfeeding counselling before you're actually certified to do so. It doesn't make sense to me. I mean, truly, isn't that backwards? Shouldn't lactation consultants be trained before they work with nursing women? And not the other way around?

Jacquie.

you can often ask ibclcs if you can shadow them. often, when they don't have the mentality of "eating their young," they will be happy to help. wic's sometimes have peer counselors and in that program you can get hours.

i hit 2000 hours this month. :) i am going to work this year hard to see if i can sit the exam next year!

I just choked when I read "eat their young" mentality! That is too funny, yet sadly accurate.

Congrats on hitting 2000! If I wait to sit the test for a couple of years I'll have my BS in psychology and will need 2500 hours, so I need to start now. I guess I should just start calling IBCLCs and asking around.

Liz

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