DOI: 10.1111/j.1740-8709.2008.00160.
Book Review
Core Curriculum for Lactation Consultant Practice,
Second Edition
Rebecca Mannel, Patricia Martens and Marsha
Walker, eds. 774pp. Jones and Bartlett Publishers,
Sudbury, MA, USA. ISBN: 9780763745035. Price:
US$60.
The Core Curriculum for Lactation Consultant Prac-
tice, Second Edition, edited by R. Mannel, P. Martens
and M. Walker is a practical, succinct and user-
friendly guide for those who plan on taking the exam
to become board certified lactation consultants. The
book follows the exam blueprint, reviewing all topics
covered by the exam, and a mapping plan that cross
references topics for more in-depth study, including
by chronology (preconception to 12 months and
older). The book uses an easy-to-read outline format
of use to students. The second edition has added chap-
ters on qualitative research, quantitative research and
maternal mental health, and combined chapters on
induced lactation, re-lactation and adoption. But this
774-page book is more than an examination guide; it
is a valuable resource for everyone concerned about
supportive breastfeeding and infant feeding practices.
All chapters have been updated with new references
reflecting the latest information available at the time
of printing. Almost all authors are themselves IBCLC
(International Board Certified Lactation Consultant),
and all are recognized experts in their fields.
The book opens with a section on the profession of
lactation consulting. Part 1, Chapter 1 begins with the
code of ethics – a topic often relegated to appendices.
As the chapter concludes, ‘Lactation consultants take
ethics seriously’ (p. 18).The authors provide examples
of controversial topics such as conflict of interest
regarding renting or sale of breast pumps, inducing
lactation in the non-biological parent of a lesbian
couple, referring clients to private practice, and
recommending particular brands of infant formula,
stressing the need to avoid the appearance of a con-
flict of interest. One concern that lactation consult-
ants may have is resolved in the ethics chapter; adhere
to the International Code of Marketing of Breast-
192 © 2009 The Author. Journal compilation © 2009 Blackwell Publishing Ltd Maternal and Child Nutrition (2009), 5, pp. 192–193
Milk Substitutes, but it is acceptable to give emer-
gency supplementation when necessary (p. 17).
Other chapters in the first section review United
Nations statements relevant to infant feeding policy
such as the Global Strategy for Infant and Young
Child Feeding, the Code for the Marketing of
Breast-milk Substitutes, BFHI (Baby Friendly Hospi-
tal Initiative) and the Innocenti Declaration; other
topics include communication and counselling skills
(how to capitalize on teachable moments); parental
roles, with recognition of cultural differences; mater-
nal mental health and breastfeeding, with emphasis
on depression; breastfeeding and working women;
and caring for vulnerable populations, including low
income and immigrant women, and women facing
emergency conditions during man-made and natural
disasters. The latter chapter refers to the available
guidelines for infant feeding in emergencies, when the
breastfeeding mother is too easily forgotten in the
throes of makeshift shelters and baby food donations.
Chapters on professional development provide new
material on quantitative and qualitative research, and
legal information relevant to practitioners.
Section two reviews the science of lactation, with
sections on anatomy and physiology, and nutrition
and biochemistry. This information is summarized
clearly and illustrated with line drawings and graphs
for easy reference. Those not biomedically trained
could learn enough in this section to make the neces-
sary connections between cultural context and
biological conditions, so necessary to produce a full
understanding of breastfeeding as a biocultural
process. The list of over-the-counter medications
and their effect on breastfeeding will be particularly
useful. However, it is likely that prescription medica-
tions cause more concern to both mothers and prac-
titioners; the inclusion of examples of drugs that are
considered too toxic to allow breastfeeding might be
reassuring for both.
Section three, the largest, is devoted to lactation
management, covering breastfeeding techniques,

technology and problem solving. The assessment
chapters focus on infant oral anatomy, breastfeeding
assessment and guidelines for establishing lactation;
chapters address the special situation of feeding
preterm infants and multiples. The chapter on breast-
feeding and growth makes full use of the new 2006
World Health Organization (WHO) growth stan-
dards where breastfed infants are now the norm.
Questions about mothers with disabilities or specific
diseases such as multiple sclerosis, arthritis or cere-
bral palsy are addressed, with a reminder that
mothers with sensory impairments might find breast-
feeding the easiest way to feed an infant. Milk expres-
sion with hand, manual or electric pumps is discussed
along with other specialized technology such as
nipple shields, shells and everters, creams, droppers,
spoons, pacifiers and tube feeding devices. These
items, and human milk banking discussed at the end
of the section, all hint at the complexity – both ethical
and practical – that lactation consultants must face as
breast milk becomes commodified in the modern
world. The last part of the book addresses a wide
range of problems that practitioners might be
expected to solve, from birth traumas to breast
pathologies, from failure to thrive to insufficient milk.
It is difficult to conceive of a subject related to
breastfeeding that is not addressed in this text, albeit
in outline form. But with substantial bibliographies
© 2009 The Author. Journal compilation © 2009 Blackwell Publishing Ltd Maternal and Child Nutrition (2009), 5, pp. 192–193
Book Review 193
following all 40 papers, readers and researchers have
materials to delve deeper into every subject. Future
editions may need new sections to address cross-
cultural issues related to supporting breastfeeding
internationally. For example, cultural competency
may not be an adequate concept for adapting advice
regarding HIV and infant feeding if the book has
wider international circulation. References to WHO/
UNICEF guidelines may be of little help to lactation
consultants faced with complex conditions in coun-
tries with high prevalence rates. For example, the
section on Maternal Diseases and Breastfeeding ends
with the statement that ‘the lactation consultant does
not have a decision-making role in caring for families
with this disease’; this leaves unclear the role of the
lactation consultant in helping HIV+ women make
the best decision for themselves and their babies
about breastfeeding. The real measure of this excel-
lent book can best be evaluated by the success rates of
those who use it to prepare for the certification exam
for lactation consultants.
Penny Van Esterik
Department of Anthropology
York University
Toronto
Canada