I read these two, very short, bullet-pointed documents and learned what I need to adjust when I work with patients. It was very simple and very powerful. When I picked up these documents I thought: dull, boring, dull but necessary. I was wrong. They’re actually very informative: the Clinical Competencies and the Scope of Practice.

Did you know the Clinical Competencies basically lays out what your lactation consultation should include? I mean, not in those exact words, but kind of. If you are in private practice, or have free reign in your consultations to use whatever format you choose, take a look at section III to make sure you are covering the bases in your visits.

And, maybe I’m the only one who has thought this, but when it comes to maternal nutrition while breastfeeding, I’ve wondered, ‘is it within my scope of practice to discuss this, or do I need to punt them off to a registered dietitian?’ (I practice in the US). Turns out “Provide evidence-based information regarding lactation and foods, including their potential impact on milk production and child safety” is in the Clinical Competencies (Section III Develop, Implement and Evaluate an Individualised Feeding Plan in Consultation with the Client 4.)

Which means I have to stay educated and keep abreast of evidence based nutrition guidance for lactating women.

I’m going to assume, someone correct me if I’m wrong, that as long as A) I’m staying educated and keeping up to date with nutrition guidelines; and B) I have a clear understanding of when I should refer to a registered dietitian; then I need to incorporate maternal nutrition into my visits with patients. (After this long maternity leave)

When might be a time for me to refer to a registered dietitian?

• Maybe if … there is a mom who has a history of disordered eating and whose child is diagnosed with Cows Milk Protein Allergy (she needs to cut dairy from her diet temporarily while breastfeeding)
• Maybe if … I have a mom who has low supply and is not eating enough calories. I would probably give her advice once, follow up and if she is still not eating enough then send her to a registered dietitian

So. Nutrition is included in my scope of practice. Got it.

Guess what else is included…

In my blog post Tips and techniques I picked up while observing a lactation consultant: Lactation Station and more (https://forlactationprofessionals.com/2025/10/10/tips-and-techniques-i-picked-up-while-observing-a-lactation-consultant-lactation-station-and-more/ ) I admit that I rarely thoroughly assessed infant reflexes, just the basics like the gag reflex. Assessing reflexes of the infant is in the Clinical Competencies (See section III. Skills to Assist Breastfeeding Dyad 3.). That’s an oversight on my part. And that, my friends, is exactly why I am doing this blog and podcast. To go from a good lactation consultant to an extraordinary lactation consultant. An extraordinary LC assesses infant reflexes. Lesson learned. Now I have to educate myself on infant reflexes so that I can competently include them in my future exams. Stay tuned for a post about reflexes down the road.

These documents certainly help to give me clarity on exactly what is in my scope of practice.

I think one reason I tend to second guess myself is that I have worked in both a pediatric clinic and a hospital, where I have worked very closely with physicians, physical therapists, and speech therapists. Not wanting to step on any toes, I found myself asking frequently, is this within my scope of practice? I think this has led to appropriate restraint in some areas, and also too much timidity in other areas. See above. While I did thoroughly assess these documents back when I was initially training to become an IBCLC, I never really thought to look at them again. I now recognize that I need to review these documents more often. Perhaps yearly? And, certainly anytime I ask the question: is this in my scope of practice?

Now… go glance at these 9 pages of documents, it’s quick and easy and bullet pointed. You’ll find both documents under the heading IBCLC Professional Standards here https://iblce.org/about-iblce/bylaws-iblce-documents/

Just to pique your interest, I’m going to include a few bullet points from the documents:

• Assess social support and possible challenges. (Clinical Competencies III History Taking and Assessment Skills 11.)
• Support the client to make evidence-based decisions for themselves and their child(ren). (Clinical competencies III Develop, Implement and Evaluate an Individualised Feeding Plan in Consultation with the Client 12.)
• Providing evidence-based information regarding complementary and alternative therapies during lactation and their impact on milk production and the effect on the child. (Scope of practice III 5.)
• Assess the child’s growth using World Health Organization Child Growth Standards. (Clinical Competencies III Skills to Assist a Breastfeeding Dyad 24.) See my post all about the WHO Growth Chart. https://forlactationprofessionals.com/2025/06/01/who-growth-chart/

Are there areas in your practice that you are missing? Are there areas in your practice that are outside of your scope?

Suzanne Sanders, IBCLC

Resources

• IBLCE Scope of Practice for IBCLCs, Effective Date: December 2018 https://iblce.org/about-iblce/bylaws-iblce-documents/ under the category IBCLC Professionals Standards
• IBLCE, Clinical Competencies for the Practice of IBCLCs, Effective Date: December 2018 https://iblce.org/about-iblce/bylaws-iblce-documents/ under the category IBCLC Professionals Standards

Listen to this podcast episode