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CERTIFIED LACTATION CONSULTANT EXAM
QUESTIONS & ANSWERS VERIFIED
1. The World Health Organization and UNICEF have set out three strategies
needed for increasing breastfeeding initiation and duration in every country. What are the 3 strategies?: Breastfeeding Promotion Breastfeeding Protection Breastfeeding Support
2. Focuses on advantages of breastfeeding on a personal (personal con-
nection), community, country (amount spent on healthcare), or global level (waste from formula & formula products) Focuses on the good "advantages" of breastfeeding: Breastfeeding Promotion
3. Focuses on government, manufacturer, and social responsibility to assure
breast feeding's ability to compete with commercial interests. Includes addressing improper marketing practices Addressing breastfeeding in public, at work, jury duty, family law, mothers in prison, etc..: Breastfeeding Protection
4. Focuses on the interaction of "helpers" with family as well as program
development and implementation: Breastfeeding Support
5. Women how do not breastfeed are at a greater risk for what diseases?: -
Myocardial infarction Metabolic syndrome Coronary artery disease Stroke
DMII
HTN
Hyperlipidemia Cardiovascular disease Breast, endometrial, and ovarian cancer
6. Reason #1 why women do not exclusively breastfeed: Unrealistic expecta-
tions from society about motherhood. Along with lack of preparation for what the newborn period would be like.
7. Reason #2 why women do not exclusively breastfeed: Lack of timely inter-
ventions. Mother's problems at 3-7 days posed the greatest risk for stopping which is when they are home from the hospital and alone with no support. The fastest drop-off is in the first 10 days following discharge from the hospital
8. The International Code of Marketing of Breast milk Substitutions: An inter-
national health policy framework to regulate the marketing of breast milk substi- tutes in order to protect breastfeeding. It was written in response to the marketing activities of the infant feeding industry which were promoting formula feeding over
12. How to support exclusive breastfeeding: Increase hospital and health
system capacity including revitalizing, expanding, and institutionalizing the baby-friendly hospital initiative in health systems Provide community based strategies including communication campaigns tailored to the local context Strengthen the monitoring, enforcement, and legislation related to "The Code" and subsequent resolutions. Enact at least 6 months paid maternity leave Invest in training and capacity building in breastfeeding protection, promotion, and support
13. What is the role of the pituitary glade in milk making?: Messages from
certain stimulation travels through the breast to the pituitary gland which triggers it to produce prolactin and oxytocin which are two hormones needed to make milk.
14. How in prolactin produced?: Breast stimulation
Nipple stimulation (makes the most)
15. What is the first way oxytocin can be triggered?: Conditioned re-
sponse/Conditioned Milk Ejection Reflex (Let down). Automatic response that comes with the association of smell, touch, sounds of baby at the breast. Also occurs on babies end with knowing what to do when placed at the breast.
16. What is the second way oxytocin can be triggered?: Nipple stretching that
occurs with a proper latch
17. What is a third way oxytocin can be triggered?: Baby hand massage
18. What does prolactin do?: Enters receptor sites in the milk making cells and
helps produce breastmilk
19. What does oxytocin do?: Allows for the milk to move from the milk making
cells and through the nipple with "contractions" that squeeze the cells and the ducts.
20. Preterm milk: Appears to have different composition for the first 5-7 weeks
after delivery independent of gestational age Preterm milk appears to be higher in protein, fat, and electrolytes than mature milk This is determined by being preterm not just having a small baby therefor it does not matter if the baby is SGA or LGA only dependent of gestational age
21. 1+ year of lactation: After one year of lactation the milk expressed has
significantly increased fat and energy contents, compared with milk expressed by women who have been lactation for a shorter time.
24. 1 breast or 2?: There is no difference in baby's net fat intake according to the
number of breasts suckled per feeding or the breastfeeding frequency Offer the 1st breast 1st and the 2nd breast 2nd it really doesn't matter 1 breast or 2 whatever they want
25. Lactogenesis 1/Secretory Differentiation: Production of colostrum from the
placental hormones (progesterone) When placenta delivers the progesterone levels drop to allow for prolactin to take its place in the milk making cells
26. Lactogenesis 2/Secretory Activation: Begins when progesterone leaves the
cells and prolactin enters the receptor sites Milk will be a mix of colostrum and mature milk
27. Lactogenesis 3/Galactopoesis: Long term production of mature milk Need
frequent removal of milk and frequent nipple stimulation to continuously produce milk
28. How does pH of the gut effect babies: Gut pH of breastfed babies is higher
than those who are formula fed or even mixed fed. Higher pH means less harmful bacteria is able to grow which helps have less issues with diarrhea
29. How does iron effect baby's gut: Low iron in the gut is good, breastmilk has
relativly low iron content Tons of different bacteria thrives on excess iron so having to much can cause issues
30. How does the presence of lactobacillus bifidus affect baby's gut: Pres-
ence of bifidus factor in breast milk promotes the growth of lactobacillus bifidus
which helps maintain the low pH and crowd out the harmful bacteria
31. How does the presence of SIgA antibodies effect baby's gut: Antibodies
such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. Mothers IgA has been found to protect against the development of necrotizing enterocolitis in preterm infants
32. Weight loss in breastfed infant: No more than 7% weight loss from with birth
weight and no more weight loss by day 5 and should be back to birth weight by 2 weeks Weight loss greater than 7% from birth weight indicates a possible breastfeeding problem and requires more intensive evaluation of breastfeeding and possibly in- tervention (not supplementation!) to correct problems and improve milk production and transfer
removing milk often enough
40. How do we assure an adequate milk supply?: Universal understanding of
how breastfeeding works Early initiation and adequate breastfeeding (10-12x per day) Appropriate breastfeeding assessment Improved and early breastfeeding support Appropriate HCP and LCP follow-up in the postpartum period Admitting there is no magic bullet More nursing= more milk
41. Negative influences on milk production: Long spaced between feedings
Long, slow feedings-can effect prolactin production
42. Negative influences on milk production: Excessive pressure in the
breast: Pressure on the milk making cells causes less milk to be made
Pressure can result from: vascular, lymphatic, and third spacing forces Too much milk in the breast (engorgement) Missed feedings Restrictive bras and clothing Brest implants: decrease storage and capacity and also increase the pressure on the milk cells
43. Engorgement: Breasts hard, hot, and shiny
Temp above normal Feels discomfort in the breast Nipple difficult to grasp, makes difficult for baby to latch Occurs most commonly day 3- As the pressure builds up inside the breast milk production decreases, this is natures early dry up mechanism Failure to effectively resolve prolonged symptomatic engorgement may have a negative impact on continued adequate milk supply Placing breasts in a bowl of warm water will stimulate the milk to flow out to relieve some pressure so you can then feed
44. Negative influences on milk production: Breast surgery or injury: With
surgery concern centers on damage to nerves which makes stimulation difficult or impossible, and damage to ducts which makes milk flowing out of breasts difficult or impossible Counseling implication after breast surgery: Likelyhood of full breastfeeding is unknown The hormonal exposure of pregnancy and lactation may mitigate some effects of surgery
Classification is about function during feeding not about how inverted or flat the nipple looks at rest Does the nipple ever evert? Look over the mothers shoulder to see what the nipple looks like immediately following feeding
47. Negative influences on milk production: Sub-optimal or altered physiol-
ogy: Iron deficiency Anemia: Physiologic (poor O2 to milk making cells) or due to exhaustion or depression altering mothers coping behavior Hemorrhage: Sheehan's syndrome (the pituitary gland is deprived of blood and its functions are impaired) Hormone imbalance: Thyroid, obesity, GDM PCOS Certain drugs: Pseudoephdrines & corticosteroids (betamethasone)
48. Smoking and breastfeeding: Smoking mothers make less milk
Smoking mothers may have lower prolactin levels because prolactin doesn't rise like it should Babies tended to nap less when fed milk from mothers who smoked vs those who did not smoke Quiting smoking during pregnancy resulted in a lower chance of preterm birth 22% of SIDS cases can be directly attributed to maternal smoking during pregnan- cy
49. Canabis use and breastfeeding: Exposure of infant to any kind of passive
smoke is a concern. There is no safe threshold limit for cannabis use in pregnan- cy. Among pregnant women cannabis use was significantly associated with an increased risk of preterm birth and low birth weight
The high fat solubility of cannabinoids make them difficult to analyze in breast milk. THC (delta-9-tetrahydrocannabinol) is measurable in milk 6 days after maternal use
50. Anemia and breastfeeding: Postpartum hemorrhage can cause sheehans
syndrome which in turn causes hormonal issues including milk making hormones Retained placenta fragments prevents the shift from lactogenesis stage 1 to stage 2 which can affect your mature milk coming in
51. Is nursing during pregnancy safe?: It is safe as long as you are not at risk for
preterm delivery, however the composition of your milk might change due to placental hormones being on board and your toddler may not want to feed anymore
52. Tandem Nursing: The practice of breastfeeding 2 babies not from the same
pregnancy at the same time
Short, easy, comfortable Nothing to remember You may need to be an advocate
56. Receivers of knowledge: Believe that all authorities tell the truth
Like to learn the right answer and repeat it to the teacher Can not tolerate ambiguity Submit to the command of authority-not inner voice Sense of self is embedded in external definitions and roles Live at the behest of those around them To develop a relationship with Receivers of knowledge: Teacher or counselor must project authority Never be ambiguous
Advantages must be concrete and appropriate for her Teaching should be centered on the right way and include return demo
57. Subjective knowing: Believes knowing is personal, private, and based on
intuition and/or feeling states, rather than on thought and articulated ideas that are defended with evidence Sense of self is embedded in external definitions and roles Sense of authority arises primarily from the power of a group Trust their own intuition Inner voice helps guide them Distrust male authority figures "Experts don't know what they are talking about" Trust other women with similar experiences Find female support groups helpful Attracted to natural things, like breastfeeding Want to be helped by someone who has breastfed Interested in breastfeeding from her own point of view To develop a relationship with Subjective knowers: Create time for them to talk about themselves and what they think about breast- feeding Offer help with possible misconceptions about breastfeeding Offer to make contacts and referrals
58. Procedural Knowing: The position at which techniques and procedures for
acquiring, validating, and evaluating knowledge claims are developed and hon- ored Invested learning, constantly taking in new information
59. Constructed Knowing: The position at which truth is understood to be con-
textual, knowledge is tentative, and it is understood that the knower is part of the known Have abandoned either/or thinking Have learned to live with conflict and have high tolerance for internal contradiction and ambiguity Believe all knowledge is constructed and the knower is an intimate part of the known Want to avoid compartmentalizing thought and feeling, home and work, self and other Want to embrace all the pieces of the self in some ultimate sense of the whole: mother-daughter-wife-artist Aspire to work that contributes to the empowerment and improvement in the quality of life of others Believe that ideas and values must be nurtured Have a unique and authentic voice
60. Storing fresh expressed or pumped breast milk: Up to 4 hours on the
countertop Up to 4 days in the refrigerator Within 6 months but up to 12 months in the freezer
61. Storing thawed, previously frozen breast milk: Up to 1-2 hours on the
countertop Up to 24 hours in the refrigerator Never re-freeze previously thawed milk
62. Storing breast milk that is leftover from a feeding: Use within 2 hours after
the baby is done feeding
63. Formula preparation and storing: Formula needs to be mix with water that
is at least 70ºC or 158ºF in order to kill Enerobacter Sakazakii Formula made with hot water need to be cooled quickly to body temperature if it is being fed to the baby immediately If the formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeling
64. Hierarchy of infant feeding choices: 1. Baby at mothers breast
2. Mother's own expressed milk
3. Milk from a milk bank
4. Cows milk forumla
5. Soy formula
