Lactation Education Resources - Uncategorized

Wait ... Do Plugged Ducts Still Exist?

2026-05-01T09:31:09-04:00

If you've had a client call in a panic about a painful lump in their breast, convinced they have a plugged duct, you've been in a familiar situation. And if you've recently read ABM Clinical Protocol #36 and wondered how to explain what's happening, you're in good company.

A growing number of lactation providers are navigating a real tension right now: Clients and colleagues still use the term "plugged duct" freely. But the 2022 protocol says that it's not physiologically or anatomically possible for a single duct to become obstructed by a macroscopic milk plug.

So what do you do with that? And more importantly, what do you do for the parent sitting in front of you, in pain?

What's Changed and Why

The traditional picture of a plugged duct was straightforward: Milk gets stuck in a single duct, forms a blockage, and causes a discrete, painful lump. The fix was to massage aggressively and pump frequently to push it through. It made intuitive sense.

But the anatomy doesn't quite support it. Breast ducts are innumerable and interlacing, not discrete pipelines that can be individually blocked and cleared.

The ABM protocol reflects this, repositioning what we call "plugged ducts" as localized inflammatory mastitis sitting at the early, milder end of the breast inflammation spectrum.

What does that mean clinically? It means the painful, firm, wedge-shaped area a parent is describing is most likely a pocket of localized inflammation, not a physical plug sitting in a duct waiting to be dislodged.

That's not a small difference, because the old treatment approach, aimed at dislodging it (aggressive massage, heat, frequent pumping) can actually worsen inflammation rather than resolve it.

That said, the science here is still evolving, and clinical experience sometimes pushes back on theory.

Dr. Melody Jackson, whose LER course on breast inflammation informs this series, notes that while the protocol's anatomical argument is clear, she has observed what appears to be macroscopic milk material expressed during these episodes in her own practice.

The current clinical picture: We may not have full consensus yet on the precise mechanism, but we have very good guidance on what helps and what causes harm.

How This Connects to the Rest of the Spectrum

Localized breast inflammation, no matter what we call it, sits at the early end of the spectrum that runs from physiological engorgement through inflammatory mastitis, bacterial mastitis, and abscess. That positioning is clinically important.

It means early, gentle intervention can prevent escalation. It also means the instinct to reach for aggressive drainage or antibiotics at first presentation is almost always the wrong move.

Most of these presentations will resolve with conservative care. The goal is to calm the inflammation, not fight it.

What to Do

Use anti-inflammatory medication early. Ibuprofen is safe in lactation and genuinely effective. It addresses the inflammatory process directly, rather than just managing pain, and can prevent a mild inflammatory episode from progressing.
Continue gentle, responsive feeding. Milk removal is key, but the key word is gentle. Continued breastfeeding from the affected side helps maintain flow without overstimulating the system. Short, comfortable feeds are the goal, not marathon sessions aimed at "clearing" the lump.
Apply cool compresses for pain relief. They address the inflammatory component directly. Cool is now preferred over heat, which can worsen vascular congestion.
Try gentle lymphatic techniques. Light strokes moving fluid toward the axilla (feather-light, not deep tissue) can help reduce interstitial edema without causing the tissue damage that firm massage can produce. The evidence base is limited, but the risk of harm is low.
Reassure and educate. These episodes are frightening for parents, especially when they've heard the phrase "plugged duct" and imagine something physically stuck. Reframing what's happening as localized inflammation that responds well to gentle care can reduce panic-driven behavior like aggressive self-massage or frantic pumping.
Follow up, sooner than you think. Early breast inflammation can shift quickly. Dr. Jackson's clinical cases illustrate that 48 hours can be the difference between a resolving episode and a progressing abscess. A clear follow-up plan and a shorter window if anything is worsening is essential.

What to Stop Doing

Stop recommending aggressive massage. This is probably the most important shift. Deep tissue massage of tender, inflamed breast or chest tissue can cause damage, worsen edema, and escalate the inflammatory process. It's one of the most commonly reported contributing factors in clients who progress from early inflammation to phlegmon or abscess. The impulse to "work it out" is understandable, but it causes harm.
Stop defaulting to frequent pumping. Telling a parent to pump every hour to clear a blockage is outdated advice, and in parents with a normal or generous supply, it can drive hyperlactation, one of the root contributors to recurrent breast inflammation. More removal is not always better. Responsive, comfortable removal is what the evidence supports.
Stop leading with heat. Warm compresses and warm showers feel intuitive and soothing, but prolonged heat can worsen vascular engorgement and edema. Cool compresses are now preferred for acute inflammation.

The Bottom Line

Early, gentle care for localized breast inflammation can prevent escalation to more serious presentations. When parents receive accurate guidance, and when providers resist the pull toward aggressive intervention, most of these episodes resolve quickly.

The terminology may be shifting, but the clinical opportunity to help is exactly the same as it's always been.

Ready to Learn More?

This blog draws on Dr. Melody Jackson's LER course, Navigating Breast Inflammation: Engorgement, Mastitis, and the Evolving Science of Care. For a thorough, critically-engaged review of the current evidence, her course is an excellent next step.

View the course

See the Full Series

We've covered the whole spectrum. Explore the other two posts:

Mastitis Care Has Changed
It's Not Just Milk: Understanding Engorgement

It's Not Just Milk: Understanding Engorgement

2026-05-01T09:30:01-04:00

If you've ever had a client describe their breasts or chest as rock-hard, burning, and impossible for their baby to latch onto, you know engorgement.

It's one of the most common and most distressing breastfeeding experiences. And yet it's also one of the most misunderstood.

A lot of the confusion comes from treating engorgement as a single problem with a single fix: drain the breast. But engorgement isn't just about milk. Understanding what's actually happening in the tissue changes how you support clients, and it's also the foundation for understanding the whole spectrum of breast inflammation we'll cover in this series.

What's Actually Happening

Engorgement involves three overlapping processes at once.

First, there's vascular engorgement: increased blood flow to the breast causes warmth and swelling. Second, interstitial fluid builds up in the tissue, creating that tight, stone-like feeling that has nothing to do with milk. Third, milk accumulates in the alveoli faster than it's being removed.

That last point is worth pausing on. As Dr. Melody Jackson explains in her LER course on breast inflammation, not all of that engorged feeling is milk waiting to be drained. Some of the fluid simply can't be expressed. Pushing harder to remove it can make things worse, not better.

Engorgement typically peaks around days three to five as milk transitions from colostrum, and this is considered physiological: a normal, expected part of the process. Pathological engorgement is different. It's driven by factors like infrequent milk removal, latch difficulties, or anatomical barriers that prevent milk from being removed effectively.

How This Connects to the Rest of the Spectrum

Engorgement sits at one end of the breast inflammation spectrum described in ABM Clinical Protocol #36 (2022). Unmanaged engorgement is one pathway toward inflammatory mastitis, and some of the most common advice around it can actually make things worse.

Here's what the most up-to-date guidance looks like in practice.

What to Do

Prioritize hand expression over pumping in the early days. It's gentler, more effective for clearing edema behind the areola, and won't overstimulate supply the way a pump can. Teaching parents to hand express before a feed can soften the areola enough for the baby to latch, which then allows for better milk removal overall.
Try reverse pressure softening. Gentle inward pressure around the areola just before a feed temporarily moves interstitial fluid into surrounding tissue, making it easier for the baby to latch. This is especially helpful when the breast is so full it's hard for the baby to latch.
Support rooming-in. Keeping baby and parent together encourages responsive feeding: frequent, comfortable feeds that help regulate supply without overstimulating it.
Use cool compresses for pain and swelling. They address the inflammatory component of engorgement, not just the milk component.
Set realistic expectations about IV fluids. Parents who received significant IV fluids in labor may experience more pronounced swelling in the first days. It's worth naming this proactively so they don't assume something is wrong.

What to Stop Doing

Stop recommending breast binding. It's still out there as advice, and it worsens congestion and pain. It's not a management strategy; it's a harm.
Stop leading with the pump. Frequent pumping in the early days to "drain" an engorged breast can drive oversupply and set up the conditions for recurrent inflammation. The goal is regulated, responsive removal, not maximum output.
Stop using prolonged heat. Heat can worsen vascular engorgement and edema. Cool compresses are now preferred.
Stop framing the goal as "emptying." There is no empty breast. Chasing that outcome leads to overstimulation, frustration, and often a worsening of the very problem you're trying to solve.

Engorgement is common, but it doesn't have to escalate. When nursing parents receive accurate, up-to-date support, many of the more serious presentations further along the inflammation spectrum can be avoided altogether. The guidance above reflects what current evidence tells us works best, and your clients will feel the difference.

Ready to Learn More?

View the course

See the Full Series

We've covered the whole spectrum. Explore the other two posts:

Mastitis Care Has Changed
Wait ... Do Plugged Ducts Still Exist?

Mastitis Care Has Changed

2026-05-01T09:27:02-04:00

If you've heard that the Academy of Breastfeeding Medicine released new mastitis guidance and found yourself wondering how to actually apply it, you're not alone.

ABM Protocol #36 (2022) introduced a spectrum-based model for understanding breast inflammation. And while the core principles aren't entirely new, they do challenge some long-standing clinical habits.

Here's a practical breakdown of what's changed, what to do, and what to stop doing.

What Changed, And Why

The biggest conceptual shift is this: mastitis is an inflammation-first condition, not an infection-first one. As Dr. Melody Jackson explains in her LER course on this topic, "Inflammation is at the heart of mastitis, and infection, while possible, is not always present or even necessary to explain the symptoms."

ABM #36 describes mastitis as a spectrum, from physiological engorgement on one end, through inflammatory mastitis and bacterial mastitis, to abscess on the other. This framing matters clinically because where someone falls on that spectrum should drive your management decisions. Not every red, sore breast needs antibiotics. Many presentations are inflammatory in nature and will resolve with supportive care.

The other key update is how we think about antibiotic decisions. Duration of symptoms is no longer the recommended framework. A parent can have bacterial mastitis at 12 hours or inflammatory mastitis at 48 hours. What matters are systemic symptoms: fever, chills, spreading redness, and malaise. Those are your signals for antibiotics, not the clock.

Finally, there's the matter of skin presentation. The classic "red breast" description fails patients with melanated skin. Dr. Jackson is direct on this: "In more melanated skin, there might be dusky areas or areas of swelling." She recommends using the back of your hand to compare warmth across both breasts, and looking for skin that appears darker brown, purplish, or violet compared to surrounding tissue, or skin that looks shiny and taut rather than red. Palpation is essential.

What To Do

Suggest anti-inflammatories first. Ibuprofen and diclofenac are safe in lactation, effective, and should be your first-line treatment for breast inflammation. For inflammatory mastitis without systemic symptoms, this is often sufficient.
Support responsive milk removal. This means removing enough milk to relieve pressure and maintain flow. It does not mean aggressive emptying. A short, comfortable feed or a few minutes of gentle hand expression is the goal. As Dr. Jackson puts it: "More isn't always better, and in the case of mastitis, it's usually not."
Use cool compresses to relieve heat and pain in an inflamed breast.
Reserve recommending antibiotics for bacterial mastitis. Systemic symptoms are the threshold, and should prompt you to refer. When antibiotics are indicated, flucloxacillin or dicloxacillin are first-line, with cephalexin for penicillin allergy.
Assess pump fit and suction settings in anyone using a pump, especially with recurrent mastitis. Poor flange fit is a hidden and common cause of microtrauma and recurring inflammation.
Continue breastfeeding. It is both safe and protective. It helps resolve inflammation and is one of the most important tools for preventing abscess formation.
In cases of hyperlactation, reduce stimulation (don't add more). Block feeding, reclined positioning, and paced removal are the right tools here. The worst thing you can do is tell these parents to drain more.

What To Stop Doing

Stop assuming antibiotics are needed for every red, sore breast without systemic symptoms. Most early mastitis is inflammatory. Unnecessary antibiotic use disrupts the gut microbiome in both parent and baby and contributes to resistance.
Stop recommending "empty the breast." As Dr. Jackson notes, "There is no such thing really as an empty breast." Chasing full drainage drives oversupply, increases milk stasis, and can worsen the very problem you're trying to solve.
Stop recommending heat. Prolonged heat can worsen edema and engorgement. Cool compresses are now preferred.
Stop recommending deep tissue or firm massage. This is one of the most harmful things we've continued to do out of habit. It can damage breast tissue, increase inflammation, and worsen pain. If you're recommending any massage, it should be gentle lymphatic drainage, with light strokes toward the axilla only.
Stop recommending frequent pumping at the first sign of inflammation. For parents with normal or high supply, this worsens the problem. "Pumping really is a double-edged sword," Dr. Jackson says.
Be cautious about routinely recommending therapeutic ultrasound, lecithin, or probiotics. These appear in ABM #36, but the evidence base is limited. If you discuss them, include that context and let families make informed decisions.

Ready to Learn More?

This blog draws Dr. Melody Jackson's LER course, Navigating Breast Inflammation: Engorgement, Mastitis, and the Evolving Science of Care. For a thorough, critically-engaged review of the evidence, Dr. Jackson's course is an excellent next step.

View the course

See the Full Series

We've covered the whole spectrum. Explore the other two posts:

It's Not Just Milk: Understanding Engorgement
Wait ... Do Plugged Ducts Still Exist?

Lactation After Cesarean

2026-03-30T15:12:02-04:00

If you work with birthing families, you will encounter cesarean birth, and the lactation challenges that can follow. Whether a cesarean was planned or unexpected, the experience introduces a unique set of hurdles for the breastfeeding dyad.

The good news: With the right knowledge and support, most of these challenges can be overcome. Here's a practical rundown of the most common lactation issues after cesarean birth, and the best guidance the research has to offer.

If You Know a Cesarean Is Coming: The Prenatal Opportunity

When a cesarean is planned, there's a valuable window that doesn't exist for unplanned cesarean births: time to prepare. A prenatal lactation consultation can meaningfully change how a family experiences those first days.

Sarah Stilling, PNP, emphasizes in her LER course Facilitators and Barriers to Initiation of Lactation that prenatal combined with postnatal interventions are more effective than usual care in prolonging breastfeeding duration.

Use the time before birth to:

Set realistic expectations. Walk families through the challenges below (delayed milk onset, a potentially sleepy baby, positioning limitations) so they aren't blindsided when they occur. Families who know what's coming are far better equipped to stay the course.
Practice hand expression. Dr. Allison Ward Moore, OB-GYN and IBCLC, recommends in her LER course Postpartum Recovery and Its Effects on Lactation encouraging families to practice in the final weeks of pregnancy so the skill is ready when they need it most.
Discuss skin-to-skin in the OR. Where it is supported, intraoperative skin-to-skin significantly improves exclusive breastfeeding rates after cesarean birth. Families should know it's possible, and know to ask for it.

And When the Cesarean Wasn't Planned...

The following challenges apply to any cesarean birth, planned or not. But parents who didn't expect to deliver surgically may be navigating all of this while also processing a birth experience that didn't go as hoped. Your skilled support can make all the difference.

Delayed Milk Onset

The Challenge: It's one of the most common and discouraging experiences after cesarean birth: milk that takes longer to arrive. Research has consistently found that cesarean birth is associated with delayed Lactogenesis 2, the onset of copious milk production.

Dr. Ward Moore explains in Postpartum Recovery and Its Effects on Lactation that there are likely many factors involved: pain, limited mobility, fewer early feedings, physical separation after surgery, and the surgery itself potentially impacting prolactin levels. For a parent who is already exhausted and recovering, a slow milk onset can feel like one more thing going wrong.

Your Best Advice: Reassure first, then act. Early and frequent milk removal is essential, and if the baby isn't latching well in the first hours, hand expression is a powerful tool. Dr. Ward Moore notes that greater than five hand expressions per day in the first three days improves daily volumes at eight weeks. Help families hold onto hope: a slow start is not a sign that milk won't come. It very likely will, with support.

Perceived Excessive Weight Loss Due to IV Fluids

The Challenge: Cesarean births typically involve significant IV fluid administration, and this can set up a scenario that worries everyone: a baby who appears to be losing too much weight.

Courtney Polk, RN, IBCLC, explains in her LER course From Birth to Breast: The Effects of Labor Medications on Lactation that IV fluids administered to the mother during labor and birth can artificially inflate a baby's birth weight. When the baby sheds that excess fluid in the days after birth, it can look like alarming weight loss, sometimes triggering unnecessary supplementation. For a parent already anxious about feeding, this can feel like confirmation that something is wrong.

Your Best Advice: Help families understand what's actually happening. The weight loss is largely physiological fluid loss, not a sign that the baby isn't getting enough. Monitoring wet diapers and feeding cues alongside weight often gives a much more complete and reassuring picture.

Positioning, Lifting, and Holding Baby

The Challenge: A cesarean is major abdominal surgery, and the incision site creates real physical limitations, especially in those first days. Lifting restrictions (typically nothing over ten pounds) apply, and parents sometimes need a gentle reminder that they just had significant surgery, even when they're beginning to feel better and their instincts are telling them to do everything for their baby.

Your Best Advice: Dalaney Young, IBCLC, points out in her LER course Essentials of Latch and Positioning that football hold is especially helpful after cesarean birth because it removes pressure from the incision site entirely. Dr. Ward Moore adds that side-lying is another comfortable option. A few simple tools (rolled receiving blankets, extra pillows for back support) can make a meaningful difference in those early days and help a parent feel capable rather than limited.

Sleepy Baby

The Challenge: After a cesarean, baby may be hard to rouse and slow to show feeding cues. Polk notes in From Birth to Breast that anesthesia medications cross the placenta and can result in temporary drowsiness and a dulled suckling reflex. Disorganized suck rhythm is also common. This can be confusing and discouraging for parents who are working hard and still struggling to get a good feed.

Your Best Advice: Skin-to-skin contact is your best tool here. It naturally stimulates feeding behaviors even in a sleepy baby, and it's something parents can do right now to feel connected and helpful. Help families recognize early feeding cues, before the baby reaches the crying stage, so that feeding attempts happen while the baby is in a more receptive, quiet-alert state. And remind them: This phase is temporary. Feeding behavior typically improves within days.

Pain Medications and Breastfeeding Safety Concerns

The Challenge: Many parents worry that the pain medications they need after a cesarean will harm their baby through breast milk. It's an understandable concern, and one worth taking seriously. But that worry can itself become a barrier, leading parents to under-treat their pain and then struggle to relax and feed effectively.

Your Best Advice: Dr. Ward Moore emphasizes in Postpartum Recovery and Its Effects on Lactation that maximizing non-narcotic pain relief, scheduled ibuprofen and acetaminophen at full doses, reduces the need for opioids. When opioids are necessary, she notes that common postpartum options are considered safe while breastfeeding at typical doses, though families should watch for unusual drowsiness in the baby.

The message worth repeating: Untreated pain is itself a barrier to breastfeeding. Adequate pain control is lactation support. Reliable resources like LactMed and Hale's Medications and Mothers' Milk can help when questions arise about specific medications.

When Birth Didn't Go as Planned

The Challenge: For many families, cesarean birth, especially an unplanned one, carries emotional weight that goes well beyond the physical recovery. Sarah Stilling, PNP, notes in Facilitators and Barriers to Initiation of Lactation that stressful birth experiences are associated with delayed Lactogenesis 2 and can significantly impact breastfeeding initiation. A parent who is grieving a birth experience they didn't have needs support to process that grief.

Your Best Advice: Ask open-ended questions. Listen first. Honor their experience before moving to the clinical work. Breastfeeding and skin-to-skin contact may be the one thing that helps normalize a difficult birth experience, and the oxytocin released can actively support mood and reduce stress. Dr. Ward Moore reminds us that a parent who feels seen and supported is far more likely to stay engaged with the feeding relationship. That starts with you.

Ready to Learn More?

Each course offers in-depth, evidence-based education to help you better support every family you serve, including those navigating the unique challenges of cesarean birth.

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Understanding Individual CERPs: Your Guide to Continuing Education Documentation

2026-03-09T11:11:28-04:00

Understanding Individual CERPs: Your Guide to Continuing Education Documentation

At Lactation Education Resources (LER), we remain committed to our core mission: developing and delivering high-quality, affordable lactation education that serves learners around the globe.

CERPs at LER: What You Need to Know

Nearly all LER courses offer pre-approved CERPs, and you can find this information clearly listed in each course description. However, in a few cases, we have chosen not to apply for CERP approval because the overwhelming majority of students enrolling in those specific courses are not seeking continuing education credits.

If you're taking one of these courses and do need CERPs for recertification, you can use the "individual CERP" pathway. We provide all the documentation you'll need for this process.

Our Commitment Remains Strong

LER continues to stand by our values of providing outstanding education while keeping costs accessible. This means:

Quality Content: All our courses align with IBLCE's requirements and the IBCLC Detailed Content Outline
Affordable Education: We're committed to keeping lactation education accessible to learners worldwide
Diverse Learning Options: We offer the variety of courses you need to grow throughout your career, whether you need CERPs or not

What Are Individual CERPs?

According to IBLCE's Individual CERPs Guide, IBCLCs may submit educational activities that have not already been recognized for Continuing Education Recognition Points (CERPs). These activities can be used for recertification purposes.

There are three types of CERPs:

L-CERPs: Lactation-specific education (topics directly related to lactation and breastfeeding)
E-CERPs: Ethics and legal topics for lactation consultants
R-CERPs: Related health topics that support lactation practice

How to Document Your LER Courses for Individual CERPs

When you complete an LER course, we provide the documentation described in IBLCE's Individual CERPs Guide. Here's your step-by-step guide:

Step 1: Gather Your Documentation

After completing your course, save these materials:

Certificate of completion showing the hours you've completed
Course outline and objectives demonstrating content alignment with the IBCLC Detailed Content Outline
Program schedule showing the total number of instructional minutes

LER provides all of these materials with every course completion.

Step 2: Determine Your CERP Type

Most LER courses qualify for L-CERPs since they focus specifically on lactation and breastfeeding topics. Education eligible for CERPs must cover subjects found on the IBCLC Detailed Content Outline.

Step 3: Calculate Your CERPs

According to IBLCE guidelines, education that has been awarded educational credit by another board or organization may be counted as CERPs.

Many LER courses are awarded either Nursing Contact Hours from the American Nursing Credentialing Center or Continuing Medical Education (CME) credits from Accreditation Council for Continuing Medical Education (ACCME).

1 CERP = 60 minutes of instructional time
Check your certificate for the total course hours
Convert to CERPs (example: a 3-hour course = 3 CERPs)

There is no limit to the number of Nursing Contact Hours or Continuing Medical Education credits that can be counted as CERPs.

Step 4: Store Your Documentation Safely

Individual CERPs use a self-reporting process. Keep all course materials organized and easily accessible. According to IBLCE, if you are randomly selected for audit, you have 10 business days to provide:

Certificate of completion (or attendance verification clearly showing credits received)
Detailed objectives and outlines
Program schedule showing the exact and total number of instructional minutes

IBLCE advises: "If recertifying by CERPs, make sure you have access to your certificates before you apply in the event you are randomly selected for audit."

Step 5: Stay Current with IBLCE Guidelines

IBLCE policies and procedures can change over time. Always verify the most current requirements:

Review the latest Individual CERPs Guide (currently dated August 2018)
Check IBLCE's recertification FAQs for updates
Review the Step 1: Prepare for IBCLC Recertification page
Contact IBLCE directly if you have questions about current policies

We're Here to Support You

As always, LER provides comprehensive documentation with every course completion. Our friendly support team is available to help you understand what materials you have and answer questions about your course documentation.

For questions about IBLCE's individual CERP process, requirements, or how to record them in your account, please contact IBLCE directly:

IBLCE Website: www.iblce.org

Helpful IBLCE Resources

Have questions about the documentation LER provides? Our expert team is here to assist you.

How to Get IBCLC Clinical Hours

2026-02-04T17:07:18-05:00

The IBCLC clinical hours requirement can be the single biggest obstacle to sitting for the IBCLC exam for many candidates. But here's the good news: With the right strategy, getting your lactation consultant hours is absolutely doable. We’ll explain exactly what your options are so you can choose the best one for you.

The Clinical Hours Breakdown

Think of clinical practice requirements as IBLCE’s way of ensuring every board certified lactation consultant has real-world experience. The number you need depends on the IBLCE Pathway you choose:

Pathway 1 (Experience-Based): Requires 1,000 hours of lactation-specific clinical practice. These hours may come from paid employment or IBLCE-approved volunteer roles.
Pathway 2 (Academic Program): Requires 300 hours of directly supervised clinical practice under a currently certified IBCLC, while being enrolled in an accredited college or university lactation program.
Pathway 3 (Mentorship): Requires 500 hours of directly supervised clinical practice completed under an IBCLC mentor or group of mentors who are pre-approved by IBCLE.

Regardless of which pathway you choose, all your hours must be earned within the five year period immediately preceding the date you apply for the exam.

How to Get Lactation Consultant Hours: Your Five Options

Here’s how aspiring IBCLCs actually get their hours:

If you already work with lactating families: Healthcare professionals in hospitals, birth centers, pediatric offices, or other private practices can count lactation-specific work toward their requirement. Document every interaction where you’re providing direct lactation support.

Volunteer with an IBLCE-approved breastfeeding support organization: you can earn clinical hours while volunteering with programs like La Leche League, WIC, and other peer counseling groups. LER HOURS, LER’s breastfeeding support organization, provides this pathway—you support families in your community, and LER endorses your hours so they count toward exam eligibility.

Enroll in a clinical internship: internship programs place you in supervised clinical settings where you gain hands-on experience. LER's Clinical Internship Program is here to help facilitate placement in hospital settings in the United States and provide structure to both mentors and interns alike to help you meet your Pathway 3 clinical requirements. (Pathway 3 candidates in LER's internship program must be LER students and must have completed either the CORE or LCTP course).

Work with an IBCLC mentor: When you pursue Pathway 3, a certified IBCLC must supervise your clinical work. (If you choose this pathway, you must apply through IBLCE before beginning, and your mentor must also be pre-approved by IBLCE. Learn more here.)

Academic program clinicals: If you’re enrolled in a lactation-specific academic program, your clinical hours are built into the curriculum with faculty supervision.

Which option works for you depends on your location, your network, and your schedule. Take stock of what's accessible: Are there IBLCE-recognized volunteer groups near you? Do you know any IBCLCs who might serve as a mentor? Does your current role involve lactation work you could document?

If nothing feels obvious right away, keep digging—there's almost always a path forward.

Protect Your Hours With Solid Documentation

Here’s the unglamorous truth: Regardless of how you earn your clinical hours, they only count if you can prove they happened. Document every single interaction. Date, duration, presenting issue, your care plan. Use a calendar, a spreadsheet, a notebook—whatever system you’ll actually maintain. Back up digital records diligently.

Trying to reconstruct months of clinical work from memory is a nightmare. Worse, it puts your exam eligibility at risk. Make documentation non-negotiable from session one.

Your Next Move

You have a passion for helping lactating families. Don’t let the IBCLC clinical hours requirement discourage you from your goal.

Getting your IBCLC clinical hours requirements met is achievable, and LER is here to support you.

LER HOURS removes barriers for candidates pursuing the volunteer route, while our Clinical Internship Program provides structured, supervised experience. Both programs are designed around one goal: getting you exam-eligible without unnecessary roadblocks.

Ready to start earning hours that count?

LER HOURS Details

LER Clinical Internship Details

Quick Quiz: What’s New in Lactation?

2025-11-27T08:22:58-05:00

How up-to-date is your breastfeeding knowledge?

Lactation research is evolving faster than ever—and even experienced professionals can miss important updates that shift how we support families.

Take this quick quiz to see whether your clinical instincts match the latest evidence—each is based on a recent finding.

T or F? Breastfeeding can help prevent food allergies … but if there is a strong family history, it probably won’t help.

False! New evidence shows that the allergy-prevention effect of breastfeeding is the most pronounced in babies with a genetic predisposition.

Q: According to the Academy of Breastfeeding Medicine (ABM), what is the most common reason parents do not meet their breastfeeding goals?

A: According to a position statement released by the ABM, the answer is: Feeding commercial milk formula without a medical indication.

The ABM advises avoiding unnecessary supplementation, noting how supplementation with commercial milk formula disrupts natural nursing rhythms, and urges practitioners to address nursing difficulties first when an infant is not gaining weight appropriately.

T or F? It’s better if lactation care providers avoid offering parents who have experienced a pregnancy loss or stillbirth information about donating their milk, because doing so can trigger more grief.

False. Studies show that many parents who experience a loss wish they had been told about the option to express and donate their milk.

Q: A recent study has found that a parent’s lactation history affects their age of menopause onset. What is the effect?

A: Duration of lactation was associated with later onsets of menopause in a dose-response manner, with those lactating over 13 months achieving, on average, the latest menopausal ages.

T or F? Current theories posit that B-cell precursor acute lymphatic leukemia is present pre-birth—meaning human milk feeding is not helpful in preventing it.

False. New research shows that human milk feeding impedes pre-leukemia from developing into leukemia.

Keep Up to Date—The Easy Way

Surprised by a few answers? That’s exactly why we built our new course, Evidence in Action: What's New in Lactation 2025.

We’ve distilled the biggest recent advances into one practical, time-saving class. No deep-dive reading required—just clear insights you can bring straight to families, enriching the care you provide.

Enroll now to find out what’s new!

Explore the course

Changes to CERP Availability at LER

2025-10-13T08:20:20-04:00

At Lactation Education Resources, we're committed to providing high-quality education that prepares you to become the best lactation consultant you can be, while ensuring you get the continuing education you need to meet your goals. We're writing to share an important update about the International Board of Lactation Consultant Examiners'® (IBLCE®) Continuing Education Recognition Points (CERPs) accreditation changes and great news about LER's course approvals.

TL;DR — What You Need to Know

Great news! All LER continuing education courses that we submitted for CERP approval have been approved by IBLCE under the new Preferred Provider Programme.
Most courses began offering CERPs on January 1, 2026, with a small number of courses receiving approval in late January or February. Courses completed by December 31, 2025 awarded CERPs under LER's previous long-term provider status.
Important note: Courses designed for initial IBCLC certification (LCTP, Core, Bridge) do not offer CERPs under IBLCE's new policies. This is an industry-wide change affecting all education providers.

The Detailed Version

Understanding IBLCE and CERPs

The International Board of Lactation Consultant Examiners® (IBLCE®) is the independent, international certification body for the lactation consulting profession. Founded in 1985, IBLCE develops and administers the IBCLC examination and manages the credentialing process for over 38,000 IBCLCs practicing in 136 countries worldwide.

CERPs are the continuing education credits that IBCLCs need for recertification. To maintain their credential, IBCLCs must recertify every five years, either by retaking the IBCLC exam or by completing 75 CERPs (including specific categories for lactation-specific content, ethics, and related topics) along with clinical practice hours.

What Changed at IBLCE

IBLCE fundamentally changed how it accredits all providers of continuing education.

Previously, IBLCE offered "long-term provider" status to organizations like LER. This designation allowed approved long-term providers to assign CERPs to their own educational activities while submitting course information to IBLCE with streamlined notice and requirements.

Effective December 31, 2025, IBLCE eliminated all long-term provider designations industry-wide. This affected not just LER, but all education providers who previously held this status.

Under IBLCE's new system, called the "Preferred Provider Programme," education providers must now submit each individual course to IBLCE for review and approval. IBLCE—not the provider—has sole authority to assign CERPs to education. This represents a significant shift toward centralized approval for every educational activity.

How LER Responded — and the Great News

LER successfully obtained CERP approval for all continuing education courses we submitted to IBLCE.

Our team worked diligently through the application process, and we're pleased to report that:

The majority of our continuing education courses received approval to begin offering CERPs on January 1, 2026
A small number of courses received approval dates in late January or February 2026
All approved courses now operate under IBLCE's new Preferred Provider Programme

CERPs for IBCLC Recertification

If you're already an IBCLC seeking continuing education for recertification purposes, LER's continuing education courses continue to offer the CERPs you need.

What This Means for You

Courses completed by December 31, 2025: These courses awarded CERPs under LER's previous long-term provider status.

Courses completed on or after January 1, 2026: CERP availability depends on each course's individual IBLCE approval date:

Most courses: Received IBLCE approval effective January 1, 2026. If you complete one of these courses on or after January 1, you can earn CERPs.
A few courses: Received IBLCE approval with later effective dates (late January through mid-February 2026). These courses award nursing contact hours immediately, but CERPs are only available for courses completed on or after the specific IBLCE approval date.

Certificate availability: As we transition to the new system, there may be a brief delay in certificate availability for courses approved on January 1st while we update all certificates with new IBLCE approval numbers. If you need your certificate urgently, please contact our customer support team, and we'll prioritize your request.

For courses with later approval dates, certificates with CERP information will be available once the IBLCE approval becomes effective.

All courses continue to award nursing contact hours regardless of CERP approval timing.

Our Commitment to You

This transition represented a significant change in how continuing education is approved across the entire lactation education field. We're grateful for your patience as we navigated this transition, and we're proud to continue offering the high-quality, evidence-based, inclusive education you've come to expect from LER.

LER's mission remains unchanged: to develop and deliver learning opportunities in lactation and breastfeeding skills from novice to expert, contributing to the health of families by training breastfeeding supporters to promote, protect, and support breastfeeding and chestfeeding.

If you have questions or concerns about your specific situation, please don't hesitate to contact our customer support team. We're here to help you achieve your professional goals.

*Please note that no certificate can be released for a course while its approval is still pending.