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Misinformation About Clinical Hours for IBLCE Exam Eligibility

Over the years, the staff here at my office have fielded many calls about the clinical hours requirement for taking the IBLCE™ Exam. Our first step is always to recommend the IBCLC candidate check the IBLCE site. But if they are still confused, we try to help. I thought I’d “heard it all” but last week an aspiring IBCLC called with a new problem. She had misinformation about clinical hours. Specifically, she had misinformation about how to calculate the required clinical hours and whether a shortage of clinical hours would bar her from getting her 90 lactation-specific education hours.

Her role, her involvement

The caller was a certified nurse midwife (CNM) who has been in practice for more than 25 years. She works part-time in a clinic, doing what you’d expect any CNM would do: diagnosing (including lactation-related conditions), prescribing medications (including medications for such ailments as mastitis), counseling mothers about breastfeeding, determining whether the breastfed baby is making adequate weight gains and meeting developmental milestones, and more.

The caller thought she would be ineligible for the IBLCE Exam in July, because someone had told her she did not have enough clinical hours. I listened carefully to her story, and felt she was operating on misinformation about clinical hours. I couldn’t reach the same conclusion.

Calculating her hours

I’m not a CNM myself, but I imagine that a CNM in the clinic setting would spend at least 50% of her time with breastfeeding mothers. (In the state where she works, breastfeeding rates are high.) Using rough numbers, I calculated that if she worked only 25 hours a week for 50 weeks a year, she would have accumulated over 1200 work hours in two years.

That would easily exceed the IBLCE’s requirements of a “minimum of 1000 hours of lactation specific clinical practice that was obtained within the 5 years immediately prior to applying for the IBLCE examination.”

I was stumped. So I asked: “What makes you think you don’t have enough hours?”

Some pesky 10% number

Someone  had told her that only 10% of the hours worked in a clinic counted as “breastfeeding” hours. I had never heard that. I’d never read it before. A thorough search of the IBLCE’s website did not produce such a rule. (If you’ve heard it before, please comment below with where you heard it!)

Somewhere in this discussion, the caller said she had been denied admission to an education course because of her lack of clinical hours. I wondered if she might have confused an academic institution’s admission requirements with exam requirements. Those are two different things.

Over the years, we have had many, many IBLCE exam candidates to our 90-hour courses. Perhaps some other educators have clinical hour requirements for course admission, but we do not. In fact, some candidates have come to the course even though they have accumulated no clinical hours whatsoever.

Misinformation about clinical hours? Get the facts.

We can all learn a few lessons from this calller:

  • First, requirements for admission to a course and requirements to sit for the IBLCE Exam may be very different. (And requirements vary between Pathways 1, 2, and 3 as well; we know it can be confusing!)
  • Second, it’s best to go to the primary source for information; a friend, colleague, or other person might unknowingly mislead you.
  • Finally, don’t hesitate to call us if you have questions — even if you think you’ve been stopped in your tracks. We’re here to help you land your dream job.

Get help if you have questions or doubts about the IBLCE Exam requirements. Leave us a comment (or give us a call).

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  1. Anna Utter

    Marie is right. There can be a lot of misinformation out there about IBLCE eligibility requirements. The best sources for the correct information about IBCLC certification requirements are the IBLCE website and the IBLCE staff.

  2. Renee P. Lomax

    Hi, I am a LPN working in an outpatient clinic, and I am a CLC. I received my training for LPN in the military, 20t years ago. I have taken over the past 15 years, several Lactation courses. My concern is that I don’t have all of the coruses, like maternal child and health and chemistry. I assist, on a daily basis, several moms with breastfeeding. I need help in deciding what college courses I need to take. Thank you.


      • Marie

        Maybe. It all depends on your pathway. I’m assuming that if you are wanting to accumulate 1000 hours, then you are going Pathway 1, right? If you are on their list of Recognized Health Professionals, then you can go Pathway 1, do your “regular” job, and get your 1000 hours without any special documentation. They ask you to take a best estimate. I’ve addressed that on a YouTube video if you are still confused.

  3. Joanne

    I am still having a tough time trying to figure out which pathway would be best for me. Hoping for some guidance. I have been a nurse for over 18 years now. I have always done PostPartum, L&D, special care and NICU! But sadly my husband got sick and I had to leave work for the last five years. I Have started my LC training courses and am just over the five year mark for all the beast feeding education I did in my past job :/.. I am wondering how many hours I will need to get. 1000 seems like it will take so long, with my background. Pathway two i don’t think is the right one. Pathway 3??? Any advise !

  4. Marie

    Joanne, my first inclination is to say Pathway 1. While in “theory” anyone can go any pathway, I like to remind people that there’s the easy way, and the hard way to everything! Seems like Pathway 1 would most certainly be the easy way for you.

    However, you have a bunch of other stuff going on here. All lactation-specific hours and all clinical experience needs to be within the past 5 years. I offer a free LIVE webinar. It’s easy to join. I cover lots of common questions, give good tips, and you get to ask real questions and I’ll give you real answers, on the spot! Just sign up for it.

    You may sign up here: or you can read more about it here if you wish:

    Or you can just call our office! 703-787-9894. We are on our summer hours, but approximately 9 to approximately 4 pm Monday through Friday, Eastern time.

    Let us know how we can help!

  5. Dr.Ahoud

    im a general physician who worked in a fertility clinic for 2 years ( 8hrs a day – 6 days a week) , my role was prenatal and antenatal care. i did give advise for breastfeeding and helped breast feeding mother. i just completed my 90 hr lactation specific education in december and since then started organising cafes and volunteer to help women with breast feeding issues but i never documented any of it.
    I’m wondering if I’m still eligible ?

    • Marie Biancuzzo

      Probably! I’d need to take a clearer “history” of your clinical activities, but it certainly sounds like your clinical experience, past and present, would make you eligible for the IBLCE Exam. As a physician you would probably want to qualify through Pathway 1. (I’ve helped many physicians, and that’s what they have all done, which doesn’t mean that’s what you need or want to do, but in all likelihood, it’s probably a best “fit” for you.) I think your most pressing question here is about the documentation. Understand, I am NOT a representative for IBLCE, I am an independent educator. So you should always check the primary source to get the most authoritative answer. However, I have never seen anywhere in their requirements that a healthcare professional needs to document their hours. (I know that if a person is qualifying through Pathway 3 they must have a clear paper trail for their hours.) You should check the IBLCE’s site yourself, and, if you are still uneasy, drop them an email and say that you are a physician and ask what, if anything, you need to do in order to document your hours.

  6. Arushi Agrawal

    I am IBCLC aspirant from non -medical background. I have completed the required health science courses and have worked in an hospital for my clinical hours, The hospital has given me certificate stating I have completed 1000 clinical hours. Will that suffice as a proof for my clinical hours? What else do I need?

    Thanks for your help!

    • Staff at Breastfeeding Outlook

      There are a few things here that need to be clarified:

      -You say that you have completed 1000 clinical hours, which is the requirement for those who are:
      1. Health care professionals
      2. Have a valid state license.
      -You are from a “non-medical background” and have completed your health science courses.

      The short answer is yes, a certificate from you employer along with contact information for two individuals who can testify to you experience should suffice. However, before you apply to take the exam, you need to know which pathway you are following. I assume it’s Pathway 3 and you have accumulated more hours than what is required (500 hours). If you are following Pathway 3, you must do the following:
      Approved Pathway 3 Plan: Review the Pathway 3 Plan Guide, submit your Pathway 3 Verification Packet on the IBLCE’s website, pay the fee, and wait for approval from IBLCE.
      Health Sciences Education: You will need the required college and continuing education courses
      Lactation Education: You’ll need 90 hours of lactation-specific education
      Clinical Experience: You will need 500 hours of lactation-specific clinical experience, directly supervised by your mentor AFTER you have completed an indeterminate amount of time observing and learning from the mentor.

      Feel free to call or email us at

  7. Leah Wilson

    I am a nursing student in a traditional BSN program. I am currently doing clinical hours in mother/baby as well as rounding with lactation consultants. I’ve also done community education about breastfeeding with teen moms, and started a breastfeeding support group this week at our local YWCA, which is supervised by nursing faculty. If I track and have faculty sign of, do any of these hours count towards my requirement? Is it worth tracking them or should I wait until I finish school and begin working as an RN? Would it be reasonable to go ahead and pursue the lactation education coursework at this point, perhaps over the summer?
    Thank you for your help!

    • Marie Biancuzzo

      Leah, wow, someone asked me this question earlier this year, too. I think there are two things to keep in mind here. (1) I can’t speak for IBLCE–I don’t work there, never have never will! But my understanding is that if you want to go Pathway 1, you need to actually BE a recognized healthcare professional, not just be “in training” to become a recognized healthcare professional. Meaning, I don not think this kind of experience “counts” if you want to go Pathway 1. (And if you were going Pathway 3, you’d need to have your plan approved by IBLCE before your hours would “count.”) But more importantly: (2) The aim is to PASS the IBLCE exam, not just become eligible. Over more than 2 decades of helping people to prepare for the IBLCE exam, I’ve seen too much focus on what makes the person “eligible” rather than “successful” or “safe.” You cannot imagine how difficult this exam is, so focus on getting all of the “ideal” preparation you possibly can. Hope that helps.

  8. MTD

    Hi! I am a pediatrician from a developing country with over eight years of clinical experience including completing a three-year residency training program. I am currently doing private practice. I deal with mother-infant dyads and give them advice on breastfeeding practices. I wonder if my private practice will count as clinical hours for Pathway 1? Thank you!

    • Marie Biancuzzo

      Thank you for your inquiry. Understand, of course, that I am not an official representative for IBLCE. However, IBLCE has recognized my company as a long-term provider for 20 years, so I feel very confident that I can answer your question. I can see no reason why your private practice would not count for clinical hours. You are giving clinical care to patients. You are practicing on your own license. Furthermore, I have had many physicians attend my live course in the past, and they have had their own private practice, and they have told me that they have used their private practice hours to “count” for their clinical experience. Honestly. I have had many, many pediatricians, and some family practice doctors and other, too, so it seems to me that you could move forward, confidently, on this. You may be too late to complete your 90 hours of lactation-focused education for this season (eligibility requirements must be completed by May 29 in order to qualify for the fall exam), but perhaps you could get started now for the round, with my all online course. Where are you? I’m curious? How did you find me?

  9. MTD

    Thank you for your reply! I am from the Philippines and I am planning on taking a step further in my career by becoming an IBCLC. I found your website through a series of Google searches while looking for available online courses I can take and info on how to start my journey. I never realized my clinical practice will count. I’ve always had this idea that the clinical practice should be under supervision. Thank you very much for keeping my hopes high.

  10. Angela Sima

    HI Marie. I am a fulltime NICU nurse. I am trying to meet the December 11 deadline for the exam in March and am almost done with your course. My plan after qualifying for the exam is to take your review course and to shadow the LCs in my hospital. What is a reasonable percentage a NICU nurse can claim for breastfeeding/lactation clinical hours when working 36 hours/week 50 hours/year?

    • Marie Biancuzzo

      Oooooh, good question, Angela!

      Remember, it’s the hours you’ve accumulated over a 5-year period. I’d imagine you’ve done a lot in those years! Also remember, shadowing does not count. You must be actively “doing.”

      That being said, I’d encourage you to look at what you do to support breastfeeding families. It’s not just helping with positioning and latch. (Although, certainly, that does count!) But here are just a few other activities that I’d say would “count”:

      Helping to mothers actually pump, and that includes setting it up, and so forth
      Teaching a family how to clean the pump equipment
      Teaching families how to collect and store milk
      Helping families to get donor milk (if needed/appropriate)
      Teaching hand expression
      Teaching other nurses how to help parents to do the tasks you do
      Explaining to families the importance of colostrum
      Advocating for policies like breastfeeding in the recovery room
      Counseling the mother about her nutrition
      Counseling on how to make more milk
      Doing discharge planning for the baby’s nutritional needs after discharge
      More, more, keep thinking about what you do in a day

      Understand, I am not the official voice of IBLCE. But after years of doing this, I am just going by the Detailed Content Outline, and I believe that all of these fall into the general role and the Scope of Practice of the IBLCE as I understand it.

      Let me be quick to say that I applaud you for shadowing an IBCLC at your facility. It will presumably be a good learning experience for you. I just want to caution you once again that IBLCE is very clear in saying that the hours that “count” are the “doing” hours.

      Respectfully, I want to warn you and anyone else who is listening that you need to keep in mind two things: (1) what is required to sit for the exam, and (2) what it takes to actually pass the exam. In my experience teaching hundreds of NICU nurses, most of them have trouble getting their heads around “normal” behaviors, capabilities limitations etc of well infants and children, and knowing what happens to well babies after the first several weeks of life. I recommend you get liberal exposure to breastfeeding babies up to 2 years of age.

      I know I didn’t answer your question about percentage, but it’s hard to say. It all depends on what you do in a day.

  11. Angela Sima

    Thank you for your answer. I am often floated to mother-baby as well and believe I spend at LEAST half my time assisting with breastfeeding/teaching, I am thinking 20% is being very reasonable, which gives me plenty of clinical hours. I may see what it takes to volunteer with WIC or another breastfeeding support group in my area.

    • Marie Biancuzzo

      Oh, good, Angela. This is all good news. If you do the math, I suspect that you’ll have more clinical hours than you need in order to meet the requirements. Volunteering at WIC would be one idea to get more experience with “older” kids. Also, Baby Cafe USA or daycare center or La Leche League meeting or anything along those lines. I’d venture to say that some of the questions you might face on the exam about the “older” baby are not always specific to breastfeeding. Any setting where you can see feeding behaviors and developmental milestones in action would be helpful for you.

  12. Liana

    Hi Marie,
    Thanks so much for this post and for your thorough answers in the comments as well; hugely helpful! Another clarification question for you on clinical hours under pathway 1. In the IBLCE candidate handbook it reads “Clinical practise hours can be earned through independent practise as a licensed/registered healthcare professional in non-healthcare settings.” From your experience helping aspiring IBCLCs in their journey, do you have any knowledge as to whether this means a Registered Nurse (current license holder, but not a physician or other advance practice role) could count hours spent directly supporting or educating lactating persons outside the hospital setting in independent practice? Some examples might be running breastfeeding support groups or one-on-one breastfeeding education/support as long as the RN operates within the SOP of their license, for example, a mother baby RN? The language in the handbook seems to indicate yes, but I could not find definitive answers on the website, and it’s a bit confusing since clinical hours in pathway 1 are to be done “in an appropriately supervised setting,” but then it says they can be earned through independent practice. Grateful for any insight you can provide, understanding you don’t represent IBLCE of course 🙂

    • Marie Biancuzzo

      Liana, I’m so glad you found this helpful. Believe me, you are not the only one to find this confusing. We get these questions in the office ALL the time! And sometimes, honestly, my team and I have to really hunker down to understand it ourselves! So you are not alone. The wording is vague enough to accommodate a global audience. So “registered nurse” might not be how you and I think of “registered nurse” in non-US countries. And I most certainly know that even here in the US, I have had many licensed practical nurses or licensed vocational nurses in my live course, either as candidates or a re-certifiers. It just says “nurse.” So can I assume you’re a registered nurse? If you are, Pathway 1 seems to me like your best best, given the information you’ve given here. If you are NOT a registered nurse, then I’d probably expound on my answer, but sounds like you could move forward okay with Pathway 1 if you wish. Let me know if this helps.

  13. Anna

    I am a pediatric SLP and do a lot of feeding therapy and contract with the NICU. I am trying to decipher the “clinical practise hours in a supervised setting.” Does this mean that I need to have an IBCLC directly supervising my clinical practice hours? Do I need indirect supervision from an IBCLC?

    • Marie Biancuzzo

      Hi Anna, whether or not you will need supervision depends on your background and the Pathway you pursue. I encourage you to see my free video series, “How to Become a Lactation Consultant,” where I help you understand the requirements and plan your next steps. You may also find this blog helpful in determining which Pathway is right for you.

  14. Holly

    Hello. I am an RN and I work at a hospital as a case manager. I have taken your course and completed my 90 CEs. I am struggling to get my clinical hours. Everyone seems to decline. Any advice on what I should do? I’ve been trying for months to get my hospital to allow me to work with a LC (who said she would mentor me). I’m also assuming I have to use pathway 3, since I don’t work with breastfeeding mothers? Thank you.

    • Marie Biancuzzo

      Oh Holly. This is a little complicated. Let me see if I can break it down. (1) No, no one “must” use any particular pathway. Anyone can use any pathway. But having helped literally thousands of people who are pursing the IBCLC certification, I can tell you that with rare exception, there’s a best pathway “fit” for each candidate. I usually try to steer RNs away from doing Pathway 3 because it often involves some hassles that could be avoided. I’d suggest you strongly consider Pathway 1. But that’s a quick answer. If you haven’t already done so, please view my short video series on “How to Become a Lactation Consultant.” Among other issues, I try to explain some of the ins and outs of the Pathways. What I think is massively complicating everything these days is the pandemic. This may not be “you” so much as it is the fact that hospitals are stretched pretty thin these days with personnel, finances, and more. I don’t know the surrounding circumstances, but that’s a common “theme” these days. Also, remember. IBLCE gives you up to 5 years to take the exam after you have completed your 90-hour course. I know you don’t want to wait that long, and I can’t blame you! But just know that at least the time lapse will not necessarily be a deal-killer. Meanwhile, watch the video series, with special attention to the “clinical” discussion, and then let me know if you still need help.

      • Holly

        Thank you for the reply. I watched the videos and read through the links. I’m definitely open with going through pathway 1, but I guess I’m still not positive on how without getting a new job. Would volunteering at La Leche League count or another organization? Thank you!

        • Marie Biancuzzo

          Holly, volunteering always counts. Yes. The question is, in what capacity or role. Since you are already a licensed healthcare professional, you are doing any and all breastfeeding support by practicing on your own RN license. Breastfeeding support is what an RN is licensed to do (along with administering meds, changing dressings, etc. etc.) So you do not need to be “supervised” if you’re doing something you’re already licensed to do, which is what Pathway 1 is. It doesn’t matter if you’re being paid or not. But here is the kicker. Will you learn enough in that volunteer capacity? Maybe! That’s a distinct possibility! But maybe not. Here’s the thing. People are always focused on what they must do in order to “sit” for the exam. But what they really want is to pass the exam! So have I seen people who get all of their clinical experience through something like La Leche League? Absolutely. Will this meet 100% of your learning need? Only you know the answer to that. Remember, too, that “observing” is not considered for clinical hours, which is often (not always) what happens in a volunteer role. You must be “doing.” So in the short haul, I’d say by all means, see how you can serve in a volunteer capacity. In the longer haul, though, try to find a situation such as you described earlier, i.e., functioning in an RN role on a hospital unit that is dedicated to mothers and/or babies. If so, it would be IDEAL to have the RN-IBCLC to mentor you, but under Pathway 1, that is not necessary. You are practicing on your own RN license. There are lot of points to unravel here. (1) paid and volunteer, (2) roles and responsibility as related to what you are legally authorized to do (or not do, in some cases) and what “counts” for candidacy, (3) being eligible for the exam versus actually passing the exam. Make sense?

          • Holly

            Yes, thank you! I have a meeting with the nursing education specialist at my hospital tomorrow to see what my options are there. I will reach out to La Leche League as well. I’m definitely excited to start this journey.

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