IBCLC Lactation Management Techniques 2 — Questions and Answers
Question 1: Which breastfeeding position is most recommended for a mother who has had a cesarean birth and is experiencing incisional pain?
- Cradle hold
- Football (clutch) hold (Correct answer)
- Cross-cradle hold
- Prone position
Correct answer: Football (clutch) hold
The football hold positions the infant alongside the mother's body rather than across her abdomen, avoiding pressure on the incision.
The football (clutch) hold positions the infant at the mother's side, tucked under her arm, with the infant's body extending along her side rather than across her abdomen. This avoids direct pressure on the surgical incision. The side-lying position is another good alternative.
Question 2: A mother experiencing engorgement is having difficulty achieving latch. What technique should be recommended before attempting to latch the infant?
- Apply ice packs for 30 minutes
- Express a small amount of milk manually or with a pump to soften the areola (Correct answer)
- Take a hot shower to stimulate full let-down
- Apply cabbage leaves and wait for swelling to reduce
Correct answer: Express a small amount of milk manually or with a pump to soften the areola
Expressing a small amount of milk softens the areola enough for the infant to latch effectively.
Severe engorgement can make the areola so taut that the infant cannot compress it effectively. Brief hand expression or gentle pumping (just enough to soften the areola) is the recommended first-line approach. Prolonged pumping should be avoided as it may increase production.
Question 3: What is the recommended storage duration for freshly expressed breast milk at room temperature (up to 25C/77F)?
- 1-2 hours
- Up to 4 hours (Correct answer)
- Up to 8 hours
- Up to 12 hours
Correct answer: Up to 4 hours
Freshly expressed breast milk can be stored at room temperature for up to 4 hours according to ABM guidelines.
The Academy of Breastfeeding Medicine recommends that freshly expressed breast milk can be stored at room temperature (up to 25C) for up to 4 hours. This is possible because breast milk contains antimicrobial properties including lactoferrin, lysozyme, and secretory IgA.
Question 4: A mother wants to increase her milk supply. Which approach is most evidence-based?
- Drinking large quantities of water throughout the day
- Increasing the frequency and thoroughness of breast emptying through more frequent feeding or pumping (Correct answer)
- Taking fenugreek supplements
- Eating oatmeal daily
Correct answer: Increasing the frequency and thoroughness of breast emptying through more frequent feeding or pumping
Milk production operates on a supply-and-demand principle; the most effective way to increase supply is to increase the frequency and completeness of breast emptying.
Milk production is primarily regulated by the feedback inhibitor of lactation (FIL). When milk is removed frequently and thoroughly, FIL is cleared and production increases. Studies show that excess fluid intake does not increase milk production. Galactagogues should be secondary to addressing feeding frequency.
Question 5: When teaching hand expression, what is the correct technique for compressing the breast?
- Squeeze the nipple directly to extract milk
- Place fingers behind the areola, compress toward the chest wall, then compress fingers together toward the nipple in a rhythmic motion (Correct answer)
- Apply firm pressure across the entire breast surface
- Use a rolling motion from the base of the breast toward the nipple
Correct answer: Place fingers behind the areola, compress toward the chest wall, then compress fingers together toward the nipple in a rhythmic motion
The Marmet technique involves placing the thumb and fingers behind the areola, pressing back toward the chest wall, then compressing and releasing rhythmically.
The technique involves: 1) Position thumb and index finger 2-3 cm behind the nipple. 2) Press straight back toward the chest wall. 3) Compress the thumb and finger together without sliding on the skin. 4) Release and repeat rhythmically. This mimics the compression cycle of infant suckling.
Question 6: A mother is returning to work and wants to maintain breastfeeding. How often should she pump during a typical 8-hour workday?
- Once during her lunch break
- Every 2-3 hours, approximately 2-3 pumping sessions (Correct answer)
- Only if she feels full
- Every 4-5 hours is sufficient
Correct answer: Every 2-3 hours, approximately 2-3 pumping sessions
Pumping every 2-3 hours during an 8-hour workday mimics the frequency of infant breastfeeding and helps maintain supply.
To maintain milk supply while separated, mothers should pump with approximately the same frequency that the infant would breastfeed. During an 8-hour workday, this translates to approximately 2-3 pumping sessions of 15-20 minutes each. A double electric pump maximizes efficiency.
IBCLC Lactation Management Techniques 2
Which breastfeeding position is most recommended for a mother who has had a cesarean birth and is experiencing incisional pain?