CERTIFIED LACTATION COUNSELOR FINAL EXAM ACTUAL
QUESTIONS AND ANSWERS RATED A+
✔✔How do I know my baby is getting enough milk? - ✔✔One wet diaper for how old the
baby is (however this can be skewed by the diuresing process and is not a good
indicator of adequate hydration)
4 wets on day 4 and each day after
Multiple poops each day that change in consistency and color
✔✔How much weight should my baby be gaining - ✔✔Approximently 1 ounce per day is
expected in the early months by more may be needed for babies with metabolic or
respiratory distress because they tend to burn more calories breathing, keeping warm,
etc..
✔✔Size of the breast relates to the amount of milk produced - ✔✔No!! the proportion of
glandular and fat tissue and the number and size of the ducts are not related to milk
production
✔✔Need to drink a lot of fluids to produce a lot of milk - ✔✔No!! There is not enough
evidence to support increasing fluid intake beyond what breastfeeding mothers are
likely to require to meet their needs
✔✔Maternal exercise is related to infant weight gain growth - ✔✔No!!
✔✔Increased worry of stress my diminish milk supply - ✔✔Not necessarily, worry/stress
may alter behavior which could alter supply but not nursing enough or removing milk
often enough
✔✔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
✔✔Negative influences on milk production - ✔✔Long spaced between feedings
Long, slow feedings-can effect prolactin production
✔✔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
✔✔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 3-5
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
✔✔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
Assessment and close follow-up are the keys
Assure adequate nutrition for the infant
✔✔Negative influences on milk production: Sub-optimal breast anatomy -
✔✔Anatomical concerns
Absence of breast changes in pregnancy or early days postpartum
No postpartum breast fullness or signs of abundant milk production
Hypoplastic breast(s) (underdeveloped, tubular, or inadequate glandular tissue)
Discrepant breast size (Unilateral underdeveloped breasts)
✔✔Inverted Nipples - ✔✔Grade 1: are easily pulled out with a breast pump or infant
nursing (look inverted with rest but evert with use)
Grade 2: can be pulled out but don't maintain their projection (may invert as soon as
baby comes off breast)
Grade 3: difficult or impossible to pull out
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
QUESTIONS AND ANSWERS RATED A+
✔✔How do I know my baby is getting enough milk? - ✔✔One wet diaper for how old the
baby is (however this can be skewed by the diuresing process and is not a good
indicator of adequate hydration)
4 wets on day 4 and each day after
Multiple poops each day that change in consistency and color
✔✔How much weight should my baby be gaining - ✔✔Approximently 1 ounce per day is
expected in the early months by more may be needed for babies with metabolic or
respiratory distress because they tend to burn more calories breathing, keeping warm,
etc..
✔✔Size of the breast relates to the amount of milk produced - ✔✔No!! the proportion of
glandular and fat tissue and the number and size of the ducts are not related to milk
production
✔✔Need to drink a lot of fluids to produce a lot of milk - ✔✔No!! There is not enough
evidence to support increasing fluid intake beyond what breastfeeding mothers are
likely to require to meet their needs
✔✔Maternal exercise is related to infant weight gain growth - ✔✔No!!
✔✔Increased worry of stress my diminish milk supply - ✔✔Not necessarily, worry/stress
may alter behavior which could alter supply but not nursing enough or removing milk
often enough
✔✔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
✔✔Negative influences on milk production - ✔✔Long spaced between feedings
Long, slow feedings-can effect prolactin production
✔✔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
✔✔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 3-5
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
✔✔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
Assessment and close follow-up are the keys
Assure adequate nutrition for the infant
✔✔Negative influences on milk production: Sub-optimal breast anatomy -
✔✔Anatomical concerns
Absence of breast changes in pregnancy or early days postpartum
No postpartum breast fullness or signs of abundant milk production
Hypoplastic breast(s) (underdeveloped, tubular, or inadequate glandular tissue)
Discrepant breast size (Unilateral underdeveloped breasts)
✔✔Inverted Nipples - ✔✔Grade 1: are easily pulled out with a breast pump or infant
nursing (look inverted with rest but evert with use)
Grade 2: can be pulled out but don't maintain their projection (may invert as soon as
baby comes off breast)
Grade 3: difficult or impossible to pull out
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
