I was considering becoming a IBCLC... still kind of am. But, I've been really discouraged.
There are 3 pathways to qualify to sit for the IBCLC exam. All three pathways require some coursework (check the website for more info).
Pathway 1: You are already a health care professional. Examples would be an RN, physician, midwife, and perhaps a RD. Once you take some classes, you just track the hours you spend providing breastfeeding counseling. From what I understand, doulas do not count. If you are a breastfeeding counselor, I believe 1 year = 500 hours, if you have someone who can sign off for you on those hours. I also believe that if you are an LLL leader, that counts for 500 hours.
Pathway 2: Go to a specific university that trains IBCLC's and provides them with mentorship. There are only 2 in the country- I think one is in California? (maybe) and the other in Cincinnati.
Pathway 3: Find an IBCLC in your area who has been re-certified. They can act as your mentor. You and the mentor set up a personalized plan to qualify you for the exam. I honestly don't know too many re-certified IBCLC's who have taken on this additional responsibility in their work.
Some hospitals may provide people with internship opportunities. Somehow, you would have to pass yourself off as a health care professional, and then have your preceptor sign off on your hours.
It gets really complicated. Also, I think a lot of hospitals, when hiring a lactation consultant, would rather just hire a nurse who is also an IBCLC. It makes more economic sense, I think. Some IBCLC's have a private practice as well.
I personally feel very discouraged from all this. There are perhaps some avenues open to me to start clinical hours, but, honestly, at this point... I don't know if all this trouble is worth it in the end because I am not a "health care professional". I have a Masters in Public Health but that's it. However, I do know some women in my area who are getting their clinical work done and they are not health care professionals either. They are hopeful about their careers. I know these women because I am taking the monthly seminars to gain coursework hours. But, given my hesitancy about all this, I think I may stop.