I have found working as an IBCLC in Private Practice to be really enjoyable, interesting, rewarding and challenging on so many different levels. I’m sure my more seasoned colleagues will be nodding and thinking to themselves, ‘yes, I could have told you that,’ but some things you just have to figure out for yourself. Admittedly I probably was a little naïve when I started out, but you can’t know what you can’t know until you jump right in! I’ve listed below a few things that fellow IBCLCs who are considering starting out in private practice might like to give some thought to. Hopefully there will be something here that will help them in that journey.

• Insurance. It goes without saying, you cannot start working in private practice until you are insured to do so. I got my insurance through Brian Mullins Insurance Brokers in Sligo for €165 for the year. They are brokers for Holistic Insurance in the UK, but this company no longer directly provides insurance for Irish clients.
• Do you have an informal mentor(s)? The first few months in private practice are a huge learning curve and you will encounter a lot of new and sometimes challenging situations/issues. I feel that it’s absolutely vital that you have the support of one or more very experienced IBCLCs during this time, to give you guidance and advice on issues you may not have experience with. Also, know that it’s ok to say to a mother “would you mind if I consulted with one of my more experienced colleagues?” when you’re unsure about something. You owe it to your clients to ensure you have this kind of help and support for yourself in place before you go it alone.
• Counselling Skills. What kind of counselling skills and experience do you have? If you come from a volunteer background, you probably have a great deal of experience with active listening and counselling. If not, it might be worth considering how you go about improving your counselling skills eg by doing a course. Some of the issues you might encounter in private practice (in addition to ‘fixing’ breastfeeding problems) are birth trauma and/or post traumatic stress disorder, infant loss, extreme anxiety, post partum depression, and coming to terms with low milk supply.
• The Money Side of Things. Whether you’re already self-employed, working in the home or a PAYE worker, I think it is a good idea to meet with an accountant and figure out the money stuff, eg how much tax are you likely to have to pay, what kind of expenses can you claim for, if you are already in a full time position, what does this mean for you if you start earning additional income? Also think about accounting apps or systems you will use to issue invoices and receipts. Most of the clients you will see will be using your invoices to claim back on their private health insurance policy.
• Self-Care. This is something I have to admit I haven’t been very proactive about, but I have promised myself that as soon as the kids go back to school I’m going to book myself in for a few acupuncture sessions. Before I started in PP, I never gave any thought to the need for self-care. But the reality is that lactation consultancy is a caring profession that requires some degree of debriefing with colleagues and self-care, whatever form that may take eg yoga, acupuncture, hill walking, gardening, massage, meditation, or whatever else helps you to switch off and be present. I’ve had consults where mothers cried solidly for over 2 hours due to issues such birth trauma, anxiety, difficulties with breastfeeding, and these kinds of sessions can take their toll on you emotionally. I’ve had nights where I’ve woken at 3am worrying about a baby I’ve seen, or stressing about whether or not I missed something or made the right call. I’ve also had times when I’ve felt overwhelmed with everything – work, life, family, and the joys of the perimenopuase (that’s a whole other blog – coming soon!) – to the point where I can feel it in my body. So learning to switch off, maintain a healthy home-life/work balance and care for myself are things that I am determined to address over the coming months.
• Know your Limits. Consider how many consults you can realistically do per week without burning out. This might be 2 or 3. Or 10. Only you can figure that out for yourself. Accepting what your limit is, might mean learning to say no more often. It will probably also mean being disciplined about taking regular breaks.
• The hands-on Stuff. How competent do you feel about assessing for tongue tie? Have you had an experienced IBCLC show you how to do an oral assessment? As an IBCLC in PP you will need to feel competent enough to assess a baby’s tongue function, and to know when to refer for tongue tie assessment/release. So if this is an area you are not confident in, you should consider how you might develop skills in oral assessment.
• What’s in the Bag? You’re going to need stuff – vinyl gloves, nipples shields, french tubes for at the breast supplementation, a demo breast and various other bits and bobs so talk to other IBCLCs about what you’ll need and where to get supplies at trade prices.
• Join the Association of Lactation Consultants in Ireland (http://www.alcireland.ie/) or other professional body if you live outside of Ireland. ALCI provides several opportunities for ongoing education dur the year via its’ National Conference, annual study days and free online Cerps. Being a member of ALCI also provides good opportunities to network and meet other IBCLCs around the country, many of them also working in private practice. Networking with IBCLCs in your area can lead to more work for you, because they will pass on your name when they may be too busy to see some mothers. As an IBCLC in PP you are very much on your own, so I feel it’s vitally important to have the support of ALCI and other IBCLCs in PP. While on the one hand we may be in competition with each other, there are plenty of boobs to go around (IMO)!
• Don’t forget the basics! I know this is stating the obvious, but it can happen that you over look the basics of positioning and attachment when you start in private practice. Sore and cracked nipples do not necessarily mean tongue tie!
• Be kind to yourself. Allow yourself time to learn, gain experience and grow into your new role. Don’t expect that you are going to know everything or that you’re going have instant ‘success’ with every client. When you get results it can be amazing, especially when you get emails from clients weeks down the line telling how well everything is going. But sometimes, you just don’t get the results you would have hoped for. Don’t hesitate to reach out to your mentor or other IBCLC colleagues when you feel you need help or support. Make some time for reflection on your work. I often find it helpful to reflect on a consult by making a list of things which I felt went well and also things which I felt I could have done differently. Always be open to learning. One of the things I love most about this work is that you are always learning. No two dyads are the same.