ALPP CLC Exam 2026 Certified Lactation Counselor REAL

ALPP CLC Exam 2026 Certified Lactation Counselor REAL breast feeding: a public health priority has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US costs to prevent needless deaths less than $6 billion/year worldwide suboptimal breastfeeding accounts for more than 3,340 maternal and child deaths a year, 80% are maternal nursing a baby for a year or more decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease women who do not breastfeed are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer WHO and UNICEF three strategies for increased breastfeeding initiation and duration in every country: promotion, protection, and support breastfeeding promotion focuses on advantages of breastfeeding on a personal, community, country, or global level breastfeeding protection focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc. breastfeeding support focuses on the interaction of "helpers" with family as well as program development and implementation community expertise variety of community expertise is needed to promote, protect, and support breastfeeding International models for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols CLC nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified CLCs and IBCLCs health professionals who provide lactation support why is breastfeeding so difficult? 1. unrealistic expectations 2. lack of timely interventions unrealistic expectations lack of preparation for what the newborn period would look like lack of timely interventions mother's problems at 3 to 7 days posed as the greatest risk to stopping breastfeeding trends last 150 years or som rates have declined international code of matketing of breastmilk substitutes (the code) an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding - published by the WHO in 1981 - internationally agreed voluntary code of practice - written in response to the marketing activities of the infant feeding indurstry which were promoting formula feeding over breastfeeding, which in turn was leading to dramatic increases in maternal and infant morbidity and mortality - subsequent clarifying and extending resolutions have been passed by the world health assembly the code regulates the marketing of breastmilk substitutes which includes infant formulas, follow-on 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 restricting marketing does not mean that the products cannot be made available, neither does it restrict parents choice; it simply aims to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims the strategy 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 - it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties the world breastfeeding trends initiative intended to track, assess, and monitor the implementation of the "global strategy" at the country and sub-country level what contributes to low rates of ebf globally? - caregiver and societal beliefs favoring mixed feeding -hospital and healthcare practices and policies that are not supportive of BF - lack of adequate skills and support - aggressive promotion of infant formula and other breastmilk substitutes - inadequate maternity/paternity leave legislation - workplace policies - lack of knowledge about dangers of not exclusively BF and proper BF techniques how to support ebf increase hospital and health system capacity regarding baby friendly hospital initiative -provide community based strategies including campaigns tailored to local context -strengthen monitoring and enforcement of the code -enact at least 6 months paid maternity leave -invest in training and capacity building in protection, promotion, support disparity of US breastfeeding trends according to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents" anatomy of milk cells myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells anatomy of human breast glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings making milk messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system hormone pathways two separate hormone pathways, pituitary gland is important to both prolactin levels go down in between nursing and rise during nursing infrequent nursing leads to lower levels and less rise even with the same amount of nipple contact ongoing milk production positively associated with suckling within the first 2 hours after birth initiation for mothers of preemies initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 triggering oxytocin mechanism #1 conditioned response - conditioned milk ejection (let down) reflex - was probably given too much importance in the years we didn't understand the other mechanisms - conditioned over time and lasts a lifetime - is faster for women who already have one from previous breastfeeding - to condition response.. smell, touch, hear the stimulus triggering oxytocin mechanism #2 nipple stretching, happens with a proper latch triggering oxytocin mechanism #3 baby hand massage, each hand movement releases oxytocin hormones of lactation have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust milk composition is complex - each species of mammal milk is different - milk is "species specific" nest or cache mammal species with high fat/protein and low water content = infrequent feeds nest = bunnies cache = deer carry, follow, or hibernate mammal species with hither water content milk have more frequent feeds carry = koala follow = elephants hibernate = bears our culture wants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers the brain most rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth nursing pattern should be frequent to accommodate human milk composition stages of making human milk lactogenesis I, lactogenesis II, lactogenesis III lactogenesis I secretory differentiation, placental hormones, colostrum lactogenesis II secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk lactogenesis III lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk breastmilk composition human milk changes continually, makes it impossible to obtain a single representative sample of milk preterm milk appears to have a different composition for the first 5-7 weeks after delivery independent of gestational age at delivery - appears to be higher in protein, fat, and electrolytes than term milk - if baby is SGA, LGA, or AGA, does not make a difference in milk composition after 1 year of lactation has significantly increased fat and energy contents fore vs hind milk foremilk is milk at the beginning of a feed, hindmilk is at the end of a feed - used to think that hindmilk contained more fat content but it is more complex than originally described - foremilk does not mean "low fat" and hindmilk is not always highest in fat - sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk breastmilk composition changes - over the course of lactation - within the day - within a feeding - between feedings is also changes by the way it is taken babyled feeding "the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding" maximum fat levels obtained 30 mins post-feed - mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants milk composition, milk action milk composition is complex, milk action is redundant - milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements less diarrhea most readily acknowledged advantage od breastfeeding, ebf makes the biggest difference in rates and severity - 86% of diarrhea-associated infant deaths occurred among LBW infants - if breastfed baby does get diarrhea, keeping breastfeeding makes a difference in maintaining the microbiota mechanisms by which ebf protects from diarrhea 1. ph of gut 2. low iron in gut 3. presence of bifidus factor 4. presence of hormones 5. antibodies such as SIgA 6. white blood cells 7. cell wall disrupters 8. B12 binding factor 9. lactoferrin 10. antimicrobial activity boosters 11. mucosal wall protectors 12. microbes 13. absence of exposure to contaminants 14. antibodies 15. synergistic effect diarrhea mechanisms 1 - ph of the gut breastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies diarrhea mechanisms 2 - low iron in the gut relatively low iron content in human milk diarrhea mechanisms 3 - presence of bifidus factor promotes intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms diarrhea mechanisms 4 - presence of hormones hormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as: - GI hormones - prolactin - EGF (epidermal growth factor) - prostaglandins diarrhea mechanisms 5 - 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. mother's IgA has been found to protect against the development of NEC in preterm infants. maternal IgA shapes the host-microbiota relationship of pretern neonates that IgA in maternal milk is critical and necessary factor for the prevention of NEC diarrhea mechanisms 6 - white blood cells kill microbes directly or mobilize other defenses diarrhea mechanisms 7 - cell wall disrupters kill microbes by destroying the cell walls, these include fatty acids and lysozymes diarrhea mechanisms 8 - B12 binding factor reduces the amount of B12 in the intestines available to microbes diarrhea mechanisms 9 - lactoferrin deprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms diarrhea mechanisms 10 - antimicrobial activity boosters such as fibronectin and gamma interferon diarrhea mechanisms 11 - mucosal wall protectors such as mucins and oligosaccharides, which also function as food for beneficial bacteria, adhere to microbes binding them so that they can't attach to the gut wall diarrhea mechanisms 12 - microbes from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring diarrhea mechanisms 13 - contaminants absence of contaminants (bottles, teats, water) and formula ingredients diarrhea mechanisms 14 - antibodies a. when a mother is exposed to organisms she makes antibodies and secretes them into her milk b. another way baby is protected - cells go from the baby's mouth into the breast and antibodies are made in the breast the process of breastfeeding has effects beyond the components of the milk. breastfeeding changes both I'mmune system gastrointestinal hormones - gastrin, chloecystokinin promote induced insulin release and growth promoting effects in the gut gastrointestinal hormones - somatastin inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut what increases gastrin and decreases somatostatin in babies? - sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation - species own milk - decreased stress - touch - wellness adult GI hormones also impacted by suckling when mother suckles her gastrin and cholecystokinin go up. this increases the efficacy of insulin and increases the storage of ingested nutrients pregnancy & breastfeeding in re: to T2DM pregnancy itself may bring an increased risk for Type 2 diabetes in the mother, which breastfeeding can negate. compared with women who have not had children, childbearing women who do not breastfeed have a 50% increased risk of T2DM in later life