CERTIFIED LACTATION COUNSELOR UPDATED EXAM
SCRIPT QUESTIONS AND ANSWERS RATED A+
✔✔What is the first way oxytocin can be triggered? - ✔✔Conditioned
response/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.
✔✔What is the second way oxytocin can be triggered? - ✔✔Nipple stretching that
occurs with a proper latch
✔✔What is a third way oxytocin can be triggered? - ✔✔Baby hand massage
✔✔What does prolactin do? - ✔✔Enters receptor sites in the milk making cells and
helps produce breastmilk
✔✔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.
✔✔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
✔✔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.
The volume of milk does not have to change as the baby gets older/bigger because the
composition of the milk changes
✔✔Breast milk composition changes... - ✔✔Over the course of lactation
Within the day there are variations on the composition of milk
Within a feeding
By the way it is taken during a feeding
and also between feedings
✔✔Fat content in breast milk - ✔✔Longer times in between feedings made for a lower
fat content but faster feedings made for a higher fat content where as feedings lasting
longer than 30 mins made for a lower fat content
Breastfed babies can regulate fat intake quickly and thus mothers should be
encouraged to practice baby led feeding
Maximum fat levels were obtained 30 mins post-feed
, ✔✔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
✔✔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
✔✔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
✔✔Lactogenesis 3/Galactopoesis - ✔✔Long term production of mature milk
Need frequent removal of milk and frequent nipple stimulation to continuously produce
milk
✔✔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
✔✔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
✔✔How does the presence of lactobacillus bifidus affect baby's gut - ✔✔Presence of
bifidus factor in breast milk promotes the growth of lactobacillus bifidus which helps
maintain the low pH and crowd out the harmful bacteria
✔✔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
✔✔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
intervention (not supplementation!) to correct problems and improve milk production and
transfer
✔✔What causes infants to lose weight in the first postpartum days - ✔✔Labor
medications
SCRIPT QUESTIONS AND ANSWERS RATED A+
✔✔What is the first way oxytocin can be triggered? - ✔✔Conditioned
response/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.
✔✔What is the second way oxytocin can be triggered? - ✔✔Nipple stretching that
occurs with a proper latch
✔✔What is a third way oxytocin can be triggered? - ✔✔Baby hand massage
✔✔What does prolactin do? - ✔✔Enters receptor sites in the milk making cells and
helps produce breastmilk
✔✔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.
✔✔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
✔✔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.
The volume of milk does not have to change as the baby gets older/bigger because the
composition of the milk changes
✔✔Breast milk composition changes... - ✔✔Over the course of lactation
Within the day there are variations on the composition of milk
Within a feeding
By the way it is taken during a feeding
and also between feedings
✔✔Fat content in breast milk - ✔✔Longer times in between feedings made for a lower
fat content but faster feedings made for a higher fat content where as feedings lasting
longer than 30 mins made for a lower fat content
Breastfed babies can regulate fat intake quickly and thus mothers should be
encouraged to practice baby led feeding
Maximum fat levels were obtained 30 mins post-feed
, ✔✔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
✔✔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
✔✔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
✔✔Lactogenesis 3/Galactopoesis - ✔✔Long term production of mature milk
Need frequent removal of milk and frequent nipple stimulation to continuously produce
milk
✔✔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
✔✔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
✔✔How does the presence of lactobacillus bifidus affect baby's gut - ✔✔Presence of
bifidus factor in breast milk promotes the growth of lactobacillus bifidus which helps
maintain the low pH and crowd out the harmful bacteria
✔✔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
✔✔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
intervention (not supplementation!) to correct problems and improve milk production and
transfer
✔✔What causes infants to lose weight in the first postpartum days - ✔✔Labor
medications
