In this episode of Behind the Latch, Margaret Salty interviews Marsha Walker—nurse, IBCLC, author, and president of the National Lactation Consultant Alliance (NLCA). They dive into everything you need to know about IBCLC licensure: what it is, why it matters, and how it can improve safety, access, and professional recognition for lactation care providers and the families they serve.

Marsha’s Path to the IBCLC Profession

Marsha shares:

• Her own positive breastfeeding experience—but lack of support—sparked her journey
• She began as a volunteer breastfeeding counselor, then became a Lamaze instructor, nurse, and eventually an IBCLC
• She helped write the very first IBCLC exam and has spent decades shaping the field through education, writing, and advocacy

Certification vs. Licensure: What’s the Difference?

Marsha explains:

• Certification (what IBCLCs currently hold) confirms education and clinical competencies but doesn’t carry legal standing
• Licensure is a legal designation granted by a state to protect public safety and ensure practitioners are vetted to provide care
• Licensure defines legal scope of practice, while certification outlines competencies

Why Licensure Matters for Access & Equity

Key points:

• Families can’t access care they can’t afford—licensure allows for insurance reimbursement
• Vulnerable populations are most likely to experience poor health outcomes when care isn’t accessible
• Licensure gives insurers, Medicaid, and policy makers a clear, trusted pathway to include IBCLCs in networks

Scope of Practice, Ethics & Protecting Families

Marsha emphasizes:

• Scope of practice is legally defined through licensure—not certification alone
• Without licensure, there is no formal oversight or legal accountability if an IBCLC causes harm
• Ethics matter: working for formula companies or interpreting labs without proper credentials can erode public trust
• Licensure offers a system of recourse for patients and safeguards our profession’s integrity

Common Misconceptions About Licensure

Marsha addresses:

• Licensure is not surveillance—it’s not about micromanaging your practice
• It doesn’t mean you have to be a nurse or advanced practice provider
• Costs are typically nominal and vary by state
• Most licensure laws adopt existing IBCLC competencies, so the work doesn’t change dramatically—just the legal recognition

Building Models That Work

They discuss:

• Massachusetts’ WIC model, where peer counselors refer to regional IBCLCs
• The importance of teamwork and risk-appropriate care—educators/supporters provide foundational support, IBCLCs manage complex cases
• How licensure helps close the care gap with structured referral systems

Becoming a Licensed IBCLC

In states where licensure exists:

• IBCLCs can join insurer panels (including Medicaid), even without being RNs
• Access expands for families and job opportunities increase for consultants
• Licensure becomes a tool for both professional recognition and public health improvement

Guest Info:

Marsha Walker, RN, IBCLC is the president of the National Lactation Consultant Alliance (NILCA), a longtime advocate for ethical, evidence-based lactation care, and the author of Breastfeeding Management for the Clinician.

🌐 Website: www.nlca.us

📘 Book: Breastfeeding Management for the Clinician: Using the Evidence

📥 Download NILCA's licensure briefs and model bill on their website

Resources Mentioned:

📌 NLCA – National Lactation Consultant Alliance

📌 US Women’s Preventive Services Initiative (WPSI)

📌 IBCLC Scope vs. Competency Guidance

📌 Academy of Breastfeeding Medicine

📌 State licensure legislation efforts

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Marsha Walker, RN, IBCLC

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #IBCLCLicensure #LactationProfessionals #ScopeOfPractice #LactationEthics #PublicHealth #AccessToCare #BreastfeedingSupport #NLCA #IBCLCPolicy

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