Certified Lactation Consultant Exam Questions and Answers

Certified Lactation Consultant Exam Questions and Answers 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 Focuses on advantages of breastfeeding on a personal (personal connection), community, country (amount spent on healthcare), or global level (waste from formula & formula products) Focuses on the good "advantages" of breastfeeding Breastfeeding Promotion 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 Focuses on the interaction of "helpers" with family as well as program development and implementation Breastfeeding Support 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 Reason #1 why women do not exclusively breastfeed Unrealistic expectations from society about motherhood. Along with lack of preparation for what the newborn period would be like. Reason #2 why women do not exclusively breastfeed Lack of timely interventions. 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 The International Code of Marketing of Breast milk Substitutions An international health policy framework to regulate the marketing of breast milk substitutes 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 breastfeeding, which in turn was leading to a dramatic increase in maternal and infant morbidity and mortality. What does "The Code" do? Regulates the marketing of breast milk substitutes which includes infant formulas and any other food or drink, together with feeding bottles, and teats, intended for babies and young children. Sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries. Aims to make sure that parental choices on feeding are based on full, impartial information, rather than misleading, inaccurate or biased marketing claims. The Global Strategy for Infant & Young Child Feeding Is intended as a guide for action; it identifies interventions with a proven positive impact, it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties. What contributes to low rates of exclusive breastfeeding globally? Caregiver and societal beliefs favoring mixed feedings (believing that breast milk is not enough or that babies actions/issues are related to the breast milk/breastfeeding) Hospital and healthcare practices and policies that are not supportive of breastfeeding Lack of adequate skilled support Aggressive promotion of infant formula and other breast milk substitutes rather than promoting support for breastfeeding Inadequate maternity and paternity leave legislation and other workplace policies Lack of knowledge about the dangers of not exclusively breastfeeding and of proper breastfeeding techniques 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 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. How in prolactin produced? Breast stimulation Nipple stimulation (makes the most) 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 More intrapartum fluids are given, they have more fluid to loss which is a normal process No labor prior to a c-section, maybe they weren't ready to be born 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 Negative influences on milk production: Sub-optimal or altered physiology 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) 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 pregnancy 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 pregnancy. 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 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 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 Tandem Nursing The practice of breastfeeding 2 babies not from the same pregnancy at the same time Milk volumes increase faster but less engorgement is experienced with two nurslings May require specific teaching to manage faster flow Help parents respond to different needs of each child Nurse newborns frequently Find time for non-nursing interactions with older babies Negative influences on milk production: Physical objects Pacifier use may be an indicator that parents need extra breastfeeding teaching Ask questions Nipple shields Postpartum depression Women who are more likely to wean early are those who have experienced depression either in pregnancy or postpartum Among women with breastfeeding difficulties, women who had a negative experience with breastfeeding support had a significantly higher risk of postpartum depression and more likely to show symptoms at 2 months Silence learner A position of not knowing in which the person feels voiceless, powerless, and mindless Afraid of words See themselves as relatively powerless and dependent on others for survial Do not trust their ability to understand or remember Have little awareness of their intellectual capabilities Live at the behest of those around them To develop a relationship with Women in Silence: Few words Familiar words Short, easy, comfortable Nothing to remember You may need to be an advocate 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 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 breastfeeding Offer help with possible misconceptions about breastfeeding Offer to make contacts and referrals Procedural Knowing The position at which techniques and procedures for acquiring, validating, and evaluating knowledge claims are developed and honored Invested learning, constantly taking in new information Interested in obtaining and applying knowledge Want to understand other people's points of view Assume that every one including themselves can be wrong Will read a variety of books with different points of view May attend several classes and change health care providers easily May be viewed as inconsistent by others May want very technical information about breastfeeding To develop a relationship with Procedural knowers: Be prepared to back up statements with evidence Be knowledgeable about multiple sources of reference Limit personal stories Understand that options and change are part of the process Constructed Knowing The position at which truth is understood to be contextual, 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 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 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 Storing breast milk that is leftover from a feeding Use within 2 hours after the baby is done feeding 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 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 Colic An easily identifiable childhood problem that has no clearly identified treatment Does not seem to be associated with GERD Colicky babies had more than double the abundance of microbia in the gut How much milk do moms make on average? 750-1000mL per day If baby is diagnosed with Galactosemia recessive genetic disorder; characterized by body's inability to tolerate galactose Can be rapidly fatal is lactose is not completely removed from the infants diet Breastfeeding is contraindicated If mother is infected with HIV Breastfeeding or feeding at the breast is not advisable If mother is infected with T-cell lymphotopic virus Breastfeeding or feeding at the breast is not advisable If mother is using illicit street drugs such as PCP or cocaine Breastfeeding or feeding at the breast is not advisable Exceptions being narcotic dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection If mother is suspected or confirmed of having Ebola Breastfeeding or feeding at the breast is not advisable If mother is infected with untreated brucellosis Mothers should temporarily not breastfeed or feed expressed breast milk If mother is taking certain medications (medications and decrease cells proliferation: cancer drugs) Mothers should temporarily not breastfeed or feed expressed breast milk If mother is undergoing diagnostic imaging with radiopharmaceuticals Mothers should temporarily not breastfeed of feed expressed breast milk If mother has an active herpes lesion on the breast Can breastfeed from unaffected side if affected side is completely covered If both sides are affected mother should temporarily not breastfeed or feed expressed breastmilk If mother has active TB Mother should temporarily not breastfeed but can feed expressed breast milk If mother has active chicken pox that developed within the 5 days prior to delivery to the 2 days following delivery Mother should temporarily not breastfeed but can feed expressed breast milk