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  • 1. Candidate Information Guide IBLCE Regional Office in Europe IBCLC: The International Standard in Lactation Consultant Certification
  • 2. IBLCE Exam - Candidate Information Guide, version 2.9EU INTRODUCTORY INFORMATION IBLCE Contact Details and Key Dates 2 About the IBLCE and IBCLCs 3 THE EXPERIENCE, KNOWLEDGE & SKILLS REQUIRED Eligibility Requirements 4-5 Breastfeeding Counselling Experience 6 Lactation Education 6 IBLCE Exam Blueprint 7 Code of Ethics for IBCLCs 8 Clinical Competencies Checklist 9-11 ILCA Standards of Practice (reprint) 12-13 IBLCE Competency Statements 13 Suggested Reading List 14-15 Attending Mother Support Group Meetings 15-16 APPLYING TO BE AN IBLCE EXAM CANDIDATE Sending your Application 16 MILCC Financial Assistance 16 1. Identification Details 17 2. Address and Contact Details 17 3. Exam Site City 17 4. Exam Fees 17 5. Eligibility Pathways 17 6. Accompanying Materials 18 7. Breastfeeding Counselling Hours 18-19 8. Professional Lactation Education Hours 19 9. Principal Experience Setting 20 10. Workplace 20 11. Biographical Details 20 12. Individual Considerations: Disabilities; 20 Pregnancy; Translations; Bilingual Dictionary 20 13. Signed Statement 20 Fees and Deadlines 21 Incomplete Applications 21 Withdrawal Deadlines 22 Is your employer paying? 22 Exam Fees and Professional Ethics 22 EXAM INFORMATION & PREPARATION Study Strategies 23 Lactation and Exam Preparation Courses 23 Checklist of Suggested Activities 24 Exam Content 25 Exam Question Referencing 25 IBLCE Exam Committee 25 Exam Confidentiality 25 Exam Questions 26 How the Exam is Scored 26 Exam Critique Form 26 Sample Exam Questions 27-29 Exam Strategies 29 AFTER THE EXAM Notification of Results; Appeals Policy 30 Maintenance of Certification 30 Joining Professional Associations 30 SUMMARY OF IBLCE EXAM ADMINISTRATION PROCEDURES 31 IBLCE Discipline Procedures (Preamble) 32 www.iblce-europe.org
  • 3. IBLCE CONTACT DETAILS and KEY DATES IBLCE in Europe SERVING EUROPE, THE MIDDLE EAST AND NORTH AFRICA The IBLCE office in Austria manages all IBLCE operations in Europe, the Middle East and North Africa, working in close consultation with the IBLCE International Headquarters in the USA and the IBLCE Office in Australia. International Board of Lactation Consultant Examiners, incorporated in Virginia USA, members’ liability limited IBLCE OFFICE IN EUROPE Steinfeldgasse 11 2511 Pfaffstaetten AUSTRIA PHONE +43 2252 20 65 95 FAX +43 2252 20 64 87 office@iblce @iblce- office@iblce-europe.org www.iblce- www.iblce-europe.org ILSE BICHLER, IBCLC REGIONAL DIRECTOR FOR FURTHER COPIES OF THIS GUIDE, FOR THE APPLICATION SUPPLEMENT SPECIFIC TO THE EXAM YEAR AND YOUR COUNTRY, OR FOR FURTHER INFORMATION ABOUT ELIGIBILITY, PLEASE CONTACT IBLCE OFFICE IN AUSTRIA OR YOUR LOCAL IBLCE COORDINATOR. APPLICATIONS MUST BE SENT TO THE IBLCE OFFICE OR TO THE ADDRESS STATED ON YOUR APPLICATION SUPPLEMENT. ELSEWHERE AROUND THE WORLD If you are a resident of another region of the world, please ask us how to contact the relevant IBLCE Office or Coordinator. If, because of your travel plans, you might need to do the exam in a country other than your country of residence, please contact us to discuss possible arrangements. Each year, there are exam sites in many countries in the Americas, the Pacific, Asia, Africa, the Middle East and Europe. KEY DATES 31 January Deadline for mailing MILCC Scholarship applications 28 February Early deadline for mailing complete exam applications with fees 31 March Standard deadline for mailing complete exam applications with fees 30 April Late deadline: final day for mailing complete exam applications with fees by end May All exam applications will have been reviewed 20 June Initial deadline for mailing exam withdrawal refund requests early July Candidates receive exam admission tickets and site information 15 July Final deadline for mailing exam withdrawal refund requests last Monday in July EXAM DATE (27 July 2009; 26 July 2010 etc) mid October Exam results, score reports, etc., are mailed (in June we will advise you of the exact date); coded pass/fail lists placed on the website on the same day Please note: as well as this Candidate Information Guide and Application Form, you also need the Application Supplement specific to the exam year and your country, which will tell you: • specific current information about exam sites, fees, and the address to which your application should be sent • any other up-to-date information you need to know up-to- 2 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 4. ABOUT THE IBLCE and IBCLCs Certification as an International Board Certified Lactation Consultant (IBCLC) is the credential that brings together those who share a common knowledge base in human lactation. The IBCLC credential is the gold standard in lactation consultant certification. It is the only professional credential for lactation consultants recognised by the International Lactation Consultant Association (ILCA), and throughout the world by national professional associations for lactation consultants. The designation IBCLC identifies members of the health care team who can provide substantive breastfeeding assistance and skilled technical management of breastfeeding problems. Experience has shown that lactation consultants contribute to improved breastfeeding practices and success rates and that that they have the ideal qualifications to help their hospitals become Baby Friendly. By supporting and educating their colleagues, the overall standard of breastfeeding care is improved amongst all staff. Whether you are a health professional or an administrator, you will appreciate that optimal practice and quality of care are as important in lactation management as they are in other health care fields. The IBLCE examination is an objective and independent measure of knowledge, skill, and experience. Board certification is quality assurance. WHAT IS THE IBLCE? WHAT IS AN IBCLC? IBLCE stands for International Board of Lactation IBCLCs—International Board Certified Lactation Consultant Examiners, the organisation that administers Consultants are health care providers who, by meeting the world’s first truly international certification program. eligibility requirements and by passing an independent examination, are certified to possess the necessary skills, The annual exam to credential IBCLCs has been offered in knowledge and attitudes to provide quality breastfeeding eighteen languages and at numerous sites all over the assistance to babies and mothers. world, building bridges across language and geographical borders. IBCLCs are valuable members of the health care team who find recognition and career opportunities that may not The IBLCE is a non-profit organisation with a policy- be available to others who have studied lactation, but are making Board of Directors with broad professional, not board certified. There are now many designated organisational and geographic representation. IBLCE has positions for IBCLCs. They work in hospitals, maternal and its headquarters in the USA, regional offices in Australia child health, the community and private practice. and Austria, and honorary local coordinators in countries where there are groups of IBCLCs and regular exam sites. As more health care facilities make a commitment to improving their breastfeeding practices and success rates, IBLCE’s primary purpose is to certify individuals who education of staff has been identified as a crucial step in provide quality care to babies and mothers worldwide. this procedure. There are around 20.000 currently certified IBCLCs worldwide, in 68 countries; IBLCE provides verification of Health facilities that encourage and support their staff to certified individuals. become board certified find that the exam provides them with a strong incentive to extend their study and skills. IBLCE’s certification program is accredited by the US Some hospitals now require all clinical staff who help National Commission for Certifying Agencies (NCCA), mothers with breastfeeding to work towards IBCLC which sets stringent guidelines for health certifying certification. organisations. INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS The IBLCE mission is to develop the internationally recognized certification standard and award credentials to individuals who demonstrate competence in providing breastfeeding assistance to mothers and children worldwide. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 3
  • 5. ELIGIBILITY REQUIREMENTS To be eligible to be a candidate for the exam, you must: • be an appropriately qualified health professional (see below) OR have completed background education in certain disciplines (see below); • have completed professional continuing education in lactation (see below); and • have had extensive practical experience providing breastfeeding counselling (see below). To apply to be a candidate, you must: lodge a complete application, accompanied by all required supporting documentation including professional references, and pay the appropriate fee, by one of the specified deadlines (see page 5). What qualification or background How much experience providing in health disciplines must I have? breastfeeding counselling must I have? You must either provide evidence that you have a degree The amount of post-secondary education you have com- or registration to practise clinically in one of the health pro- pleted, in any field, determines how many hours of experi- fessions or you must document completion of “background” ence providing breastfeeding counselling (BC hours) you education in each of the are required to have completed before you are eligible to following: be a candidate for the IBLCE exam. IBLCE has collected • anatomy and physiology data over many years showing that candidates with more • Sociology and cultural diversity education, and in some cases candidates with specific • counselling and communication skills backgrounds, require less experience (fewer BC hours) to • child development pass the exam and be ready to practise competently as • nutrition an IBCLC. This information has enabled IBLCE to group • medical terminology applicants with certain backgrounds together in pathways, and determine how much prior experience (BC hours) is “Background” is defined as a minimum of four hours of edu- required for each pathway. Your pathway is just one com- cation in each of the six disciplines above, and is further ponent of exam eligibility, and relates only to BC hours. defined as basic or introductory in content and not as ap- plied to lactation. It should be taught by someone who is qualified to teach that subject at the lowest post-secondary You should determine which of the six standard path- level, at least. ways A, B, C, D , E or F is applicable to you. You must also read the information about BC hours on This requirement must be completed before you send in p. 6. See also p. 18 about how to calculate your hours. your exam application. For maximum benefit, you are strongly encouraged to complete it before starting your lac- Pathway A – 2500 BC hours required. This pathway is tation education; there is no time limit for the period be- available if you have a bachelor or higher degree (in any tween when you do these courses and when you do the field), OR you are a registered nurse, a registered mater- exam. Please contact the IBLCE Office in Europe for further nal and child health nurse or a registered midwife. information specific to your country. Pathway B – 4000 BC hours required. This pathway is available if your education is lower as described in Path- What professional education way A. in lactation must I undertake? Pathway C – 900 precepted clinical hours in human lactation required. This pathway is available only if you You must have completed a minimum of 45 hours of have a bachelor or higher degree with a concentration in professional education in lactation reflecting the exam human lactation from an accredited institution. blueprint, within the three years immediately prior to sitting for the exam. Pathway D – 900 BC hours required. This pathway is However, if you will be doing the exam in a language other available only if you are a registered medical practitioner than English, you must have completed a minimum of (doctor). 80 hours of professional education in lactation. (This is be- cause most textbooks and journals are in English; Pathway E – Exceptions — 6000 BC hours required. candidates who are not able to study these materials have Please contact the IBLCE Office in Europe. been shown to need significantly more pre-exam education hours to achieve a similar standard of exam performance.) IBLCE further recommends that all candidates select and Pathway F – a pre-approved program covering all the participate in a comprehensive education program which Clinical Competencies (pages 9-11) over at least addresses all areas of the IBLCE Blueprint of knowledge 500 directly supervised clinical hours. Stringent condi- and skills for IBCLCs. tions apply. You must contact IBLCE for further information. Further, detailed information about the education requirement is on page 6. See also pages 19 and 23. Private study – many hours over a one to three year period – is also a major component of exam preparation for all candidates. 4 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 6. ELIGIBILITY REQUIREMENTS (continued) Recertification by exam I’d like to be a lactation consultant . . . If you are an IBCLC whose certification is still current IBLCE frequently receives enquiries from people who have and who is recertifying by exam, you are not required met an inspiring lactation consultant, often in relation to to provide references, information on BC hours or their own breastfeeding experience, and now they are CERPS, or documentation of qualifications. The fee is interested in becoming an IBCLC themselves. If this the same whether you are recertifying by exam or by describes your situation, you should read the following CERPs. Please read the Recertification Application information carefully and you should appreciate that your Supplement. As a recertifying IBCLC, you must use dream will be challenging to achieve. the buff coloured Application to Recertify form, rather Passing IBLCE’s international certification exam is the only than the standard exam application form. recognised pathway to becoming a lactation consultant. To be accepted as a candidate, an applicant must first meet eligibility pre-requisites. These include participation in Breastfeeding counselling experience lactation education as well as achieving the required clinical competencies through extensive prior experience (continued from page 4) providing breastfeeding counselling in a setting which has supervision appropriate for their training in this field. Supplementary Pathways Most candidates acquire this experience working as health professionals in a hospital or community setting. Others If your standard pathway requires 2500 BC hours or have served for many years as accredited mother support more (pathways A, B or E), you may reduce the counsellors, working within a supervised structure such as required number of BC hours by meeting the LLL or ABA. Personal breastfeeding experience, as requirements of one or both of the following wonderful as it is, does not meet this requirement; nor supplementary pathways G and H. The maximum does unsupervised practice counselling mothers outside reduction is a total of 1000 BC hours if both pathways the healthcare system, such as a doula or in a similar are used. private capacity. IBCLCs are the specialists that mothers (and other health Pathways G and H should be used only if you would professionals) turn to, usually when standard measures not otherwise have enough BC hours for the standard have not solved the problem. The skills and knowledge pathway applicable to you. required to pass the exam cannot be solely learnt from books, which is why clinical experience is necessary. Pathway G. You may reduce by 500 the number of BC For pre-exam BC hours, the IBLCE cannot recognise hours required for your standard pathway if you have unsupervised practice by someone who is not otherwise completed 150 hours of comprehensive education in registered or licensed to practise independently in this field lactation, i.e. 105 more than the 45 hours otherwise without supervision. If IBLCE were to do so, it could required (or 110 more if 80 hours is required). The encourage practice that is not necessarily in the best education must address the breadth of the exam interests of mothers and babies. The IBLCE is also not in a blueprint; it must be within the three-year period position to link would-be candidates with supervisors, immediately prior to sitting for the exam. An ILEAC mentors or settings where they could get supervised accredited program is encouraged (see p.23). practice. Pathway H. You may reduce by up to 500 the number The candidate eligibility requirements are based on data, of BC hours required for your standard pathway if you collected and progressively updated over the past have completed at least 10 and up to 100 hours of 20 years, that indicate the minimum requirements for a planned, directly supervised clinical practice in a candidate to have a reasonable likelihood of passing the setting other than your usual experience setting and exam and being competent to enter the profession. with an IBCLC who has been certified for at least five full years and has been recertified at least once. The What about documentation, references, reduction is at a ratio of 1:5, to a maximum reduction of 500 BC hours: e.g. 10 supervised hours equals a fees and deadlines? reduction of 50 BC hours. This pathway does not include generalised supervised experience and the Please read the detailed instructions on pages 17-20 plan must be approved in advance by IBLCE. Further about how to complete the application form, and what information is available from IBLCE. documents to enclose, including professional references. Full information about fees and deadlines Pathway L for lapsed IBCLCs is on pages 21-22. For the fees payable, you must also If you were previously an IBCLC and your certification lapsed more than one year ago, you must meet all requirements and pay refer to the Application Supplement specific to the the normal fees. If your certification lapsed less than one year ago, exam year and your country. Applications must be you are eligible for the “Repeat” fee discount rate and you are postmarked by: exempt from having to provide information on BC hours, a qualification certificate, references or lactation education hours. It is Early exam fee deadline 28 February your choice how you prepare for the exam and whether you Standard exam fee deadline 31 March participate in education programs. Please note that your certification period will not be continuous, as you are not Late exam fee deadline 30 April eligible to “recertify”. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 5
  • 7. EXPERIENCE AND EDUCATION BC EXPERIENCE LACTATION EDUCATION Breastfeeding counselling (BC) hours are defined as the Professional education in lactation is an important part of time you spend helping mothers and babies with breast- your preparation and eligibility for the exam. It needs to be feeding, usually in one-to-one consultations in person or recent (with the three year period immediately prior to on the phone. Group consultations may also be included. sitting for the exam), relevant (to the exam blueprint), and Your BC hours can be accumulated over any period of reliable (based on current information and relevant years, but it is important that you also have recent research). experience. Certification boards are required to be independent of pre- You are to provide self-documentation of your BC hours of exam education. IBLCE does not itself conduct education, experience, as follows: nor does it endorse or recommend any particular program. • at least 50%, and up to 100%, of your total required BC IBLCE CERPs allocation does not indicate the quality or hours must be in person through one-to-one suitability of a pre-exam program. consultations and follow-up, usually in a hospital, clinic, Your total education should reflect all disciplines and community setting; or through accredited volunteer chronological periods on the exam blueprint (page 7). counselling. Ideally, candidates participate in a comprehensive lactation • you may also include telephone/email consultations, education program, especially one accredited by ILEAC but only up to 25% of your total required BC hours (see page 23), covering all or most of the blueprint. Typically • you may also include consumer education or group such a program will be much longer than the minimum of consultations such as breastfeeding classes or the 45 hours because it is impossible to cover the entire exam breastfeeding component of antenatal groups, blueprint, at the depth required, in the minimum time. childbirth education classes, new parent groups, etc, If your education program has not covered the blueprint, you but only up to 25% of your total required BC hours. will need to make up the deficits by specifically focussing BC hours may only be included for periods when you were your private study. The Suggested Reading List (pages 14- working in an accredited capacity and/or under appropriate 15) will help you identify relevant publications. You should supervision, as IBLCE will recognise only experience be able to explain, if required, how your exam preparation hours that protect the best interests of mothers and has addressed all the areas on the exam blueprint. babies. Accredited means you were appropriately trained Please note that clinical work and classes for mothers are and qualified for the type of work you were doing and the not professional education for you, and do not count setting in which you were practising. Supervised means towards your lactation education hours. that you were practising within an appropriately monitored structure or setting where, if your advice or practice had Definition of lactation education been inappropriate or outside your scope of practice, it Lactation education hours can be earned from professional would easily have come to the attention of your education that is Lactation-specific, meaning that the topic: “supervisor” and/or the client’s primary health care • provides information about breastfeeding and/or human provider. The level of supervision should be appropriate for lactation; or your training to practise in this field. • addresses skills used by lactation consultants in their You may include BC hours from counselling mothers in a work with breastfeeding mothers and babies; and volunteer support group only while you were formally accredited as a counsellor/leader and practising under • is based on scientific principles, and on current appropriate supervision. If you can show that you have information and relevant research in the field of lactation been an active, accredited mother support counsellor, you can claim 10 BC hours per week or 500 BC hours per year CERPs Certificates without further documentation. If you believe you have CERPs are Continuing Education Recognition Points done more hours than this, you must provide allocated by IBLCE to programs that meet the learning documentation for those periods. requirements of IBCLCs after they have passed the exam. They are not an endorsement of a program by IBLCE. Not BC hours. When calculating your BC hours, do not Education hours for exam applicants do not have to be include: administrative or planning time; supervision time; approved for CERPs. However, some of your attendance commuting time; personal breastfeeding experience; lay certificates may show that “x L (or E or R) CERPs were counselling to friends or family; caring for babies in a allocated by IBLCE: Approval No. Cxxxxx”. One CERP is normal newborn nursery; or time spent on general support equivalent to one hour of education time. or promotional activities which help more mothers to L CERPs are for Lactation topics; E CERPs are for Ethics breastfeed. topics; R CERPs are for Related topics. You may go back as many years as necessary to retrieve Please note that some areas on the blueprint are not lactation your BC hours. However, do not include any of your specific; even though sessions on these areas are relevant to student practice hours, e.g. your midwifery training, as exam preparation, they would be classified as R CERPs or these have already been allowed for when determining the E CERPs. eligibility pathways related to education. Exception: if you For the purposes of pre-exam education, you may count only already had some BC hours as a midwife, and you then lactation topics (L CERPs) towards your required hours of pre- did additional training such as in maternal and child health, exam education. you can include the BC hours during that further training. Please note that clinical work and classes for mothers are not professional education for you, and do not count towards your lactation education hours. 6 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 8. IBLCE EXAM BLUEPRINT All exam questions have both discipline and chronological parameters. This blueprint gives you an indication of the breadth of information you need to know for the International Board Certified Lactation Consultant (IBCLC) certification exam. The possible number of questions on the exam that will be related to each topic appears in parentheses as a range. The examples given under each discipline are for guidance only; they are not inclusive of all aspects covered under each learning discipline. The Disciplines are expanded into chapters in ILCA’s Core Curriculum for Lactation Consultant Practice, www.ilca.org DISCIPLINES H. GROWTH PARAMETERS and DEVELOPMENTAL MILESTONES (10-16 questions.) A. Maternal and infant ANATOMY (19-33 questions) e.g. foetal and preterm growth; breastfed and e.g. breast and nipple structure and development; artificially fed growth patterns; recognition of normal blood, lymph, innervation, mammary tissue; infant and delayed physical, psychological and cognitive oral anatomy and reflexes; assessment; anatomical developmental markers; breastfeeding behaviours to variations 12 months and beyond; weaning B. Maternal and infant normal PHYSIOLOGY and I. INTERPRETATION OF RESEARCH (4-8 questions) ENDOCRINOLOGY (19-33 questions) skills required to critically appraise and interpret e.g. hormones; lactogenesis; endocrine/autocrine research literature, lactation consultant educational control of milk supply; induced lactation; fertility; infant material, and consumer literature; understanding hepatic, pancreatic and renal function; metabolism; terminology used in research and basic statistics; effect of complementary feeds; digestion and GI tract; reading tables and graphs; surveys and data collection voiding and stooling patterns J. ETHICAL and LEGAL ISSUES (4-8 questions) C. Maternal and infant normal NUTRITION and e.g. IBLCE Code of Ethics; ILCA Standards of BIOCHEMISTRY (10-16 questions) Practice; practising within scope of practice; referrals e.g. breast milk synthesis and composition; milk and interdisciplinary relationships; confidentiality; components, function and effect on baby; comparison medical-legal responsibilities; charting and report with other products/milks; feeding patterns and intake writing skills; record keeping; informed consent; over time; variations of maternal diet; ritual and battery; maternal/infant neglect and abuse; conflict of traditional foods; introduction of solids interest; ethics of equipment rental and sales D. Maternal and infant IMMUNOLOGY and INFECTIOUS K. BREASTFEEDING EQUIPMENT and TECHNOLOGY DISEASE (10-16 questions) (6-12 questions) e.g. antibodies and other immune factors; cross- e.g. identification of breastfeeding devices and infection; bacteria and viruses in milk; allergies and equipment, their appropriate use, and technical food sensitivity; long term protective factors expertise to use them properly; handling and storing human milk, including human milk banking protocols E. Maternal and infant PATHOLOGY (19-33 questions) e.g. acute/chronic abnormalities and diseases, both L. TECHNIQUES (19-33 questions) local and systemic; breast and nipple problems and e.g. breastfeeding techniques, including positioning, pathology; endocrine pathology; mother/child physical attachment and assessing milk transfer; breastfeeding and neurological disabilities; congenital abnormalities; management; normal feeding patterns; milk oral pathology; neurological immaturity; failure to expression thrive; hyperbilirubinemia and hypoglycaemia M. PUBLIC HEALTH (4-8 questions) F. Maternal and infant PHARMACOLOGY and e.g. breastfeeding promotion and community TOXICOLOGY (10-16 questions) education; working with groups with low breast-feeding e.g. environmental contaminants; maternal use of rates; creating and implementing clinical protocols; medication, OTC preparations, social or recreational international tools and documents; WHO Code; BFHI drugs and their effect on the infant, on milk implementation; prevalence, surveys and data composition, and on lactation; galactagogues/ collection for research purposes suppressants; effects of medications used in labour; contraceptives; complementary therapies CHRONOLOGICAL PERIODS G. PSYCHOLOGY, SOCIOLOGY, and 1. Preconception (2-7 questions) ANTHROPOLOGY (14-20 questions) 2. Prenatal (9-17 questions) e.g. counselling and adult education skills; grief, 3. Labour/birth (perinatal) (9-17 questions) postnatal depression and psychosis; effect of socio- 4. Prematurity (9-17 questions) economic, lifestyle, and employment issues on 5. 0 - 2 days (19-31 questions) breastfeeding; maternal-infant relationship; 6. 3 - 14 days (19-31 questions) maternal role adaptation; parenting skills; sleep 7. 15 - 28 days (19-31 questions) patterns; 8. 1 - 3 months (9-17 questions) cultural beliefs and practices; family; support 9. 4 - 6 months (9-17 questions) systems; domestic violence; mothers with special 10. 7 - 12 months (2-7 questions) needs, e.g. adolescents, migrants 11. Beyond 12 months (2-7 questions) 12. General principles (40-53 questions) IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 7
  • 9. CODE OF ETHICS FOR IBCLCs Preamble 16. Refuse any gift, favour or hospitality from patients or clients currently in her/his care which might be interpreted as seeking It is in the best interests of the lactation consultant profession and BACKGROUND INFORMATION to exert influence to obtain preferential consideration. of the public it serves that there be a Code of Ethics to provide guidance to lactation consultants in their professional practice 17. Disclose any financial or other conflicts of interest in relevant The International Board of Lactation Consultant Examiners and conduct. These ethical principles guide the profession and organisations providing goods or services. Ensure that outline commitments and obligations ofestablished to develop to (IBLCE) is a non-profit corporation the lactation consultant professional judgment is not influenced by any commercial self, administer a voluntary certification program for lactation and client, colleagues, society, and the profession. considerations. consultants. Founded in 1985, it has administered annual 18. Present substantiated information and interpret controversial The purpose of in several languages, at numerous Consultant examinations, the International Board of Lactation sites around information without personal bias, recognising that legitimate Examiners (IBLCE) is to assist in the protection of the health, differences of opinion exist. the world. safety and welfare of the public by establishing and enforcing 19. Withdraw voluntarily from professional practice if she/he has qualifications of certification and for scientific studiescredentials Over the past twenty years many issuing voluntary have engaged in any substance abuse that could affect her/his to individuals who have attained those qualifications. The IBLCE practice; has been adjudged by a court to be mentally validated the benefits of breastfeeding. At the same time, has adopted this Code to apply to all individuals who hold the incompetent; or has an emotional or mental disability that credential of International Boardwere developing a Consultant mother support organisations Certified Lactation significant affects her/his practice in a manner that could harm the client. (IBCLC).breastfeeding management skills. From this body of knowledge, in the 1980s a new allied health care provider 20. Obtain maternal consent to photograph, audio-tape or videotape a mother and/or her infant(s) for educational or Principles of Ethical Practice no competency began to emerge. However, there were professional purposes. The International Board role. standards for this new Certified Lactation Consultant shall act in 21. Submit to disciplinary action under the following a manner that safeguards the interests of individual clients, As an international leader in providing guidelines for circumstances: if convicted of a crime under the laws of the justifies public trust in her/his competence, and enhances the breastfeeding and mother-to-mother support, La Leche practitioner’s country which is a felony or a misdemeanour, an reputation of the profession. essential element of which is dishonesty, and which is related League International (LLLI) made a commitment to facilitate to the practice of lactation consulting; if disciplined by a ThedevelopmentBoard Certified Lactation Consultant panel of the International of standards for this new field. A is national, state, province or local government or authority, and personally accountable for her/his practice and, in the exercise of sixty experts representing a variety of health professions, at least one of the grounds for the discipline is the same or professional accountability, must: backgrounds, and geographic locations were involved in substantially equivalent to these principles; if committed an 1. Provide professional services with objectivity and with respect act of misfeasance or malfeasance which is directly related to developing the standards out of which the competencies and for the unique needs and values of individuals. the practice of the profession as determined by a court of scope of practice for lactation consultants was developed. competent jurisdiction, a licensing board, or an agency of a 2. Avoid discrimination against other individuals on the basis of Therace, creed, religion, gender,the International Board and constitutional meeting of sexual orientation, age, of governmental body; or if violated a Principle set forth in the national origin. Code of Ethics for International Board Certified Lactation Lactation Consultant Examiners (IBLCE) was held in March Consultants which was in force at the time of the violation. 3. Fulfil professional commitments inNursing Mothers' 1985. Canada, El Salvador and the good faith. 4. Conduct herself/himself with honesty, sent representatives 22. Accept the obligation to protect society and the profession by Association of Australia (NMAA) had integrity and fairness. upholding the Code of Ethics for International Board Certified 5. Remain freeplanning stages and attention wasthe objectives from the early of conflict of interest while fulfilling given to the Lactation Consultants and by reporting alleged violations of international need for mothers of the lactation be protected by and maintaining the integrity and babies to consultant the Code through the defined review process of the IBLCE. profession. competency standards. 23. Require and obtain consent to share clinical concerns and 6. Maintain confidentiality. information with the medical practitioner or other primary TheBaseNational Commission for Certifying Agencies 7. US her/his practice on scientific principles, and on current health care provider before initiating a consultation. (NCCA) is responsible for developing stringent guidelines research and information. 24. Adhere to those provisions of the International Code of for health certifying organisations, and to accredit those 8. Take responsibility and accept accountability for personal Marketing of Breast-milk Substitutes, and subsequent WHA which meet the in practice. International Board of Lactation competence criteria. The resolutions, which pertain to health workers. 9. Recognise, and exercise professional judgmentNCCA's Consultant Examiners (IBLCE) has utilised the within, the 25. Understand, recognise, respect, and acknowledge intellectual guidelines since its inception. AtThisinitial accreditation it limits of her/his qualifications. its principle includes seeking property rights, including but not limited to copyrights (which apply to written material, photographs, slides, illustrations, wascounsel onlymaking referrals to appropriate providers. one of and two organisations accredited by the etc.), trademarks, service marks, and patents. 10. Inform the on first application. of his/her services by using Commission public and colleagues factual information. An International Board Certified Lactation Implementation date: 1 December 2004 NCCA guidelines require that certification organisations be Consultant shall not advertise in a false or misleading manner. administratively, financially, and corporately independent, To lodge a complaint 11. Provide sufficient information control. IBLCE is a and thus not subject to outside to enable clients to make informed decisions. IBCLCs shall act in a manner that justifies public trust in their completely independent organisation, quite separate from competence, enhances the reputation of the profession, and ILCA, LLLI, NMAA, etc. 12. Provide information about appropriate products in a manner safeguards the interests of individual clients. that is neither false nor misleading. To protect the credential and to assure responsible practice by its The IBLCE was initially accredited by the NCCA in 1988, 13. Permit use of her/his name for the purpose of certifying that certificants, the IBLCE depends on IBCLCs, members of the after having consultant services have been rendered only if she/ lactation conducted the three examination administrations coordinating and supervising health professions, employers, and he provided criterion for eligibility. In 1993, the IBLCE required as onethose services. the public to report incidents that may require action by the IBLCE was reaccredited for an additional five year period. As part of 14. Present professional qualifications and credentials accurately, Discipline Committee. thisusing “IBCLC”IBLCE periodically conducts a Role process, the only when certification is current and Only signed, written complaints will be considered. Anonymous Delineation Study. All IBCLCs complying with all requirements authorised by the IBLCE, and worldwide are surveyed for correspondence will be discarded. The IBLCE will become involved only in matters that can be factually determined, and will details ofseeking initial or continued certification from the IBLCE. when their practice and the knowledge base they require. provide the accused party with every opportunity to respond in a The lactation consultant is also subject to disciplinary action Thefor aiding another is basedin violating any IBLCE requirements exam blueprint person on this Study. professional and legally defensible manner. or aiding another person in representing herself/himself as an Complaints that appear to fit the scope of the Discipline IBCLC when she/he is not. Committee’s responsibilities should be sent to: 15. Report to an appropriate person or authority when it appears that the health or safety of colleagues is at risk, as such IBLCE, Chair of the Discipline Committee circumstances may compromise standards of practice and 7245 Arlington Boulevard, Suite 200 care. Falls Church VA 22042-3217 USA 8 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 10. CLINICAL COMPETENCIES CHECKLIST COMPETENCIES CHECKLIST Much of the clinical practice of the International Board Certified Lactation Consultant (IBCLC) consists of systematic problem solving in collaboration with breastfeeding mothers and other members of the health care team. This checklist includes most of the clinical/practical skills that an entry level IBCLC needs in order to be satisfactorily proficient to provide safe and effective care for breastfeeding mothers and babies. The list is designed to encompass common breastfeeding situations and the challenges that are encountered most frequently by lactation consultants. This checklist can help you identify areas where you have less experience or knowledge, and you are encouraged to try to focus your professional education on these aspects. Clinical instructors can use this checklist as an appropriate guide in providing individualised education. The checklist is also the basis of eligibility pathway F, a pre-approved program covering all the Clinical Competencies over at least 500 directly supervised clinical hours by an IBCLC with at least 5 years experience. Stringent conditions apply. You must contact IBLCE for further information. IBLCE thanks ILCA and the IBCLCs from all over the world who worked on developing these Clinical Competencies. COMMUNICATION AND COUNSELLING SKILLS DOCUMENTATION AND COMMUNICATION SKILLS In all interactions with mothers, families, health care WITH HEALTH PROFESSIONALS professionals and peers, the student will demonstrate The student will: effective communication skills to maintain collaborative and Communicate effectively with other members of the supportive relationships. health care team, using written documents appropriate The student will: to the location, facility and culture in which the Identify factors that might affect communication (i.e., student is being trained, such as: consent forms, care age, cultural/language differences, hearing or visual plans, charting forms/clinical notes, pathways/care impairment, mental ability, etc.) maps, and feeding assessment forms Demonstrate appropriate body language Use appropriate resources for research to provide (i.e., position in relation to the other person, information to the health care team on conditions and comfortable eye contact, appropriate tone of voice for medications that affect breastfeeding and lactation the setting, etc.) Write referrals and follow-up documentation/ letters to Demonstrate knowledge of and sensitivity to cultural referring and/or primary health care providers that differences illustrate the student’s ability to identify: Elicit information using effective counselling The mother’s concerns or problems, planned techniques (i.e., asking open-ended questions, interventions, evaluation of outcomes and follow- summarising the discussion, and providing emotional up support) Situations in which immediate verbal Make appropriate referrals to other health care communication with the health care provider is professionals and community resources necessary, such as serious illness in the infant, child, or mother The student will provide individualised breastfeeding care Report instances of child abuse or neglect to specific with an emphasis on the mother’s ability to make informed decisions. agencies as appropriate or legally required The student will: SKILLS FOR THE FIRST TWO HOURS AFTER BIRTH Assess mother’s psychological state and provide The student will: information appropriate to her situation Identify events that occurred during the labour and Include those family members or friends the mother birth process that may adversely affect breastfeeding identifies as significant to her Identify and discourage practices that may interfere Obtain the mother’s permission for providing care to with breastfeeding her or her baby Promote continuous skin-to-skin contact of the term Ascertain mother’s knowledge about and goals for newborn and mother until the first breastfeed breastfeeding Assist the mother and family to identify newborn Use adult education principles to provide instruction feeding cues to the mother that will meet her needs Help the mother and infant to find a comfortable Select appropriate written information and other position for latching-on/attachment during the first teaching aids breastfeed after birth Identify correct attachment HISTORY TAKING AND ASSESSMENT SKILLS Reinforce to mother and family the importance of: The student will be able to: Keeping the mother and baby together Obtain a pertinent history Feeding the baby on cue - but at least 8 times Perform a breast evaluation related to lactation in each 24 hour period Develop a breastfeeding risk assessment Assess and evaluate the infant’s ability to breastfeed (continued) Assess effective milk transfer IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 9
  • 11. CLINICAL COMPETENCIES CHECKLIST (continued) COMPETENCIES CHECKLIST POSTPARTUM SKILLS Adolescent mother Prior to discharge from care, the student will observe a Strategies for returning to school breastfeed and effectively instruct the mother about: Maintaining milk production Assessment of adequate milk intake by the baby Nipple pain and damage Normal infant sucking patterns Engorgement How milk is produced and supply maintained, including discussion of growth/appetite spurts Blocked duct and/or nipple pore Normal newborn behaviour, including why, Mastitis when and how to wake a sleepy newborn Breast surgery/trauma Avoidance of early use of a dummy/pacifier Overproduction of milk and bottle teat Postpartum psychological issues including transient Importance of exclusive breast milk feeds and sadness (“baby blues”) and postpartum depression possible consequences of mixed feedings with Appropriate referrals cow milk or soy Medications compatible with breastfeeding Prevention and treatment of sore nipples Insufficient milk supply, differentiating between Prevention and treatment of engorgement perceived and real SIDS prevention behaviours Weaning issues Family planning methods and their relationship to Safe formula preparation and feeding techniques breastfeeding Care of breasts Education regarding drugs (such as nicotine, alcohol, caffeine and illicit drugs) and SKILLS FOR INFANT BREASTFEEDING CHALLENGES complementary remedies (such as herbal teas) The student will be able to assist mothers who have infants Plans for follow-up care for breastfeeding with the following challenges: questions, infant’s medical and mother’s Traumatic birth postpartum examinations 35-38 weeks gestation Community resources for breastfeeding assistance Small for gestational age (SGA) or large for gestational age (LGA) PROBLEM-SOLVING SKILLS PROBLEM- The student will be able to: Multiple births Identify problems Preterm birth, including the benefits of kangaroo care Assess contributing factors and cause High risk for hypoglycaemia Develop an appropriate breastfeeding plan in consultation with the mother Sleepy infant Assist the mother to implement the plan Excessive weight loss, slow/poor weight gain Evaluate effectiveness of the plan Hyperbilirubinemia (jaundice) Ankyloglossia (short frenulum) SKILLS FOR MATERNAL BREASTFEEDING CHALLENGES Thrush infection The student will be able to assist mothers with the following Colic/fussiness challenges: Gastric reflux Caesarean birth Lactose overload Flat/inverted nipples Food intolerances Thrush infections of breast, nipple, areola, and milk Neuro developmental problems ducts Teething and biting Continuation of breastfeeding when mother is Breast refusal/early baby led weaning separated from her baby Breastfeeding a toddler Milk expression techniques Breastfeeding through pregnancy Maintaining milk production Tandem feeding Collection, storage and transportation of milk Cultural beliefs that are not evidence-based and may MANAGEMENT SKILLS interfere with breastfeeding, (i.e., discarding The student will demonstrate the ability to: colostrum, rigidly scheduled feedings, necessity of Perform a comprehensive breastfeeding assessment formula after every breastfeeding, etc.) Assess milk transfer Medical conditions that may impact on Calculate an infant’s kilojoule and volume breastfeeding requirements Increase milk production (continued) 10 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9 EU
  • 12. CLINICAL COMPETENCIES CHECKLIST (continued) COMPETENCIES CHECKLIST SKILLS FOR USE OF TECHNOLOGY AND DEVICES SKILLS FOR MEETING PROFESSIONAL RESPONSIBILITIES The student will have up-to-date knowledge about The student will demonstrate the following professional breastfeeding-related equipment and demonstrate responsibilities: appropriate use and understanding of potential Conduct herself or himself in a professional manner, disadvantages or risks of the following: by complying with the IBLCE Code of Ethics for A device to evert nipples International Board Certified Lactation Consultants Nipple creams/ointments and the ILCA Standards of Practice; and by adhering Breast shells to the International Code of Marketing of Breast-milk Substitutes and its subsequent World Health Assembly Breast pumps resolutions. Alternative feeding techniques Practice within the laws of the setting in which s/he Tube feeding at the breast works, showing respect for confidentiality and Cup feeding privacy. Spoon feeding Use current research findings to provide a strong Eyedropper feeding evidence base for clinical practice, and obtain Finger feeding continuing education to enhance skills and Bottles and artificial teats obtain/maintain IBCLC certification. Nipple shields Advocate for breastfeeding families, mothers, infants Dummies/pacifiers and children in the workplace, community and within the health care system. Infant scales Use breastfeeding equipment appropriately and Use of herbal supplements for mother and/or infant provide information about risks as well as benefits of SKILLS FOR BREASTFEEDING CHALLENGES products, maintaining an awareness of conflict of WHICH ARE ENCOUNTERED INFREQUENTLY interest if profiting from the rental or sale of The following issues are encountered relatively infrequently, breastfeeding equipment. and may not be seen during the student’s training. The entry- SITES FOR ACQUISTION OF SKILLS level lactation consultant would not be expected to be proficient in these situations, but should have the basic skills The student may acquire clinical/practical skills in the to assist the mother and infant while seeking guidance from a following settings: more experienced IBCLC. Private practice IBCLC office Private practice, obstetric, paediatric, family or Infant: midwifery practice Infant with tonic bite/ineffective/dysfunctional suck Child health clinics and domiciliary services Cranial-facial abnormalities, such as micronathia Hospital (receding lower jaw) and cleft lip and/or palate Lactation services Down Syndrome Birthing centre Cardiac problems Postpartum unit Chronic medical conditions, such as cystic fibrosis, Mother-Baby unit PKU, etc. Level II and Level III nurseries: Special Care Mother: Nursery, Neonatal Intensive Care Nursery Induced lactation and relactation Paediatric unit Coping with the death of an infant Community nursing services Chronic medical conditions, such as Multiple Out-patient follow-up breastfeeding clinics Sclerosis, lupus, seizures, etc. Breastfeeding telephone counselling services Disabilities which may limit mother’s ability to handle Antenatal and postnatal breastfeeding classes the baby easily, such as, rheumatoid arthritis, carpal Home births (if legally permitted) tunnel syndrome, cerebral palsy, etc. Volunteer community support group meetings HIV/AIDS: understanding of current recommendations IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 11
  • 13. ILCA STANDARDS OF PRACTICE 2.2 Clearly state applicable fees prior to providing care International Lactation Consultant Association 2.3 Obtain informed consent from all clients prior to: Standards of Practice for International Board • assessing or intervening Certified Lactation Consultants • reporting relevant information to other health care professional(s) • taking photographs for any purpose Preface • seeking publication of information associated with the This is the third edition of Standards of Practice for IBCLC consultation Lactation Consultants published by the International Lactation 2.4 Protect client confidentiality at all times Consultant Association (ILCA). 2.5 Maintain records according to legal and ethical practices within the work setting All individuals practising as a currently certified IBCLC should adhere to ILCA’s Standards of Practice and the International Board Standard 3. Clinical Practice of Lactation Consultant Examiner’s (IBLCE) Code of Ethics for International Board Certified Lactation Consultants in all The clinical practice of the IBCLC focuses on providing lactation interactions with clients, families and other health care care and management. This is best accomplished by promoting professionals. ILCA recognises the certification conferred by the optimal health, through collaboration and problem-solving with the IBLCE as the worldwide professional credential for lactation client and other members of the health care team. The role of the consultants. IBCLC includes: • assessment, planning, intervention, and evaluation of care in Quality practice and service constitute the core responsibilities of a a variety of situations profession to the public. Standards of practice are stated measures or • anticipatory guidance and prevention of problems levels of quality that are models for the conduct and evaluation of • complete, accurate, and timely documentation of care practice. Standards of practice: • communication and collaboration with other health care • promote consistency by encouraging a common systematic professionals approach 3.1 Assessment • are sufficiently specific in content to guide daily practice 3.1.1 Obtain and document an appropriate history of the • Provide a recommended framework for the development of breastfeeding mother and child. policies and protocols, educational programs, and quality 3.1.2 Systematically collect objective and subjective information improvement efforts 3.1.3 Discuss with the mother and document as appropriate all assessment information • are intended for use in diverse practice settings and cultural contexts 3.2 Plan 3.2.1 Analyse assessment information to identify issues and/or Standard 1. Professional Responsibilities problems 3.2.2 Develop a plan of care based on identified issues The IBCLC has a responsibility to maintain professional conduct 3.2.3 Arrange for follow-up evaluation where indicated and to practice in an ethical manner, accountable for professional actions and legal responsibilities. 3.3 Implementation 1.1 Adhere to these ILCA Standards of Practice and the IBLCE 3.3.1 Implement the plan of care in a manner appropriate to the Code of Ethics situation and acceptable to the mother 1.2 Practice within the scope of the International Code of 3.3.2 Utilize translators as needed Marketing of Breast-milk Substitutes and all subsequent World 3.3.3 Exercise principles of optimal health, safety and universal Health Assembly resolutions precautions 1.3 Maintain an awareness of conflict of interest in all aspects of 3.3.4 Provide appropriate oral and written instructions and/or work, especially when profiting from the rental or sale of demonstration of interventions, procedures and techniques breastfeeding equipment and services 3.3.5 Facilitate referral to other health professionals, community 1.4 Act as an advocate for breastfeeding women, infants, and services, and support groups as needed children 3.3.6 use equipment appropriately: 1.5 Assist the mother in maintaining a breastfeeding relationship • refrain from unnecessary or excessive use with her child • assure cleanliness and good operating condition • assuring cleanliness and good operating condition • discuss the risks and benefits of recommended 1.6 Maintain and expand knowledge and skills for lactation equipment including financial considerations consultant practice by participating in continuing education • demonstrate the correct use and care of equipment 1.7 Undertake periodic and systematic evaluation of one’s clinical • evaluate safety and effectiveness of use practice 3.3.7 Document and communicate to health care providers as 1.8 Support and promote well-designed research in human appropriate: lactation and breastfeeding, and base clinical practice, • assessment information whenever possible, on such research • suggested interventions • instructions provided Standard 2. Legal Considerations • evaluations of outcomes • modifications of the plan of care The IBCLC is obligated to practise within the laws of the geopolitical region and setting in which she/he works. The IBCLC • follow-up strategies must practise with consideration for rights of privacy and with 3.4 Evaluation respect for matters of a confidential nature. 3.4.1 Evaluate outcomes of planned interventions 2.1 Work within the policies and procedures of the institution 3.4.2 Modify the plan based on the evaluation of outcomes where employed, or if self-employed, have identifiable . . . continued next page policies and procedures to follow 12 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 14. ILCA STANDARDS OF PRACTICE (continued) continued from previous page IBLCE Statement on International Code Standard 4. Breastfeeding Education and Counselling Health workers have a responsibility to be familiar with the Breastfeeding education and counselling are integral parts of the International Code of Marketing of Breast-Milk Substitutes care provided by the IBCLC. and to understand their responsibilities in relation to it (Ref: 4.1 Educate parents and families to encourage informed decision- Article 7.1). making about infant and child feeding 4.2 Utilise a pragmatic problem-solving approach, sensitive to the The IBLCE Code of Ethics requires IBCLCs to abide by the learner’s culture, questions and concerns provisions of the Code and subsequent World Health 4.3 Provide anticipatory guidance (teaching) to: Assembly (WHA) resolutions that apply to health workers. • promote optimal breastfeeding practices If a health worker receives a contribution from a company • minimise the potential for breastfeeding problems or that markets or distributes products within the scope of the complications International Code, e.g. exam fees, textbooks, or pre-exam 4.4 Provide positive feedback and emotional support for education, the Code requires that both the company and continued breastfeeding, especially in difficult or complicated circumstances recipient must disclose this to any institution with which the 4.5 Share current evidence-based information and clinical skills in recipient is affiliated. This also applies to contributions made collaboration with other health care providers to a third party on the health worker’s behalf (Ref: Article 7.5). Approved by the ILCA Board of Directors, October 2005. Copyright Financial contributions can create a conflict of interest, © 2005 International Lactation Consultant Association. Copies of especially in regard to the Baby Friendly Hospital Initiative. this document may be freely made, so long as the content remains (Ref: WHA 49.15) unchanged, and they are distributed free-of-charge. IBLCE COMPETENCY STATEMENTS The following competency statements identify and summarise the special knowledge and skills included in the role of an International Board Certified Lactation Consultant (IBCLC). The International Board Certified Lactation Consultant will: 1. Possess the skills, knowledge, and attitudes to provide competent comprehensive consultation and education in routine and special circumstance lactation, from preconception to beyond twelve months. 2. Integrate additional knowledge from the following disciplines in providing care for breastfeeding families: Maternal and Infant Anatomy; Physiology and Endocrinology; Nutrition and Biochemistry; Immunology and Infectious Disease; Pathology; Pharmacology and Toxicology; Psychology, Sociology, and Anthropology; Growth Parameters and Developmental Milestones; Interpretation of Research; Ethical and Legal Issues; Breastfeeding Equipment and Technology; Techniques; and Public Health. 3. Utilise knowledge of personality, counselling skills, and family and group theory when providing breastfeeding support. 4. Integrate cultural, psychosocial, nutritional, and pharmacological aspects of breastfeeding into lactation consultant practice. 5. Utilise appropriate communication skills in interactions with clients and health care providers. 6. Maintain a collaborative, supportive relationship with clients, emphasising individualised family care, client autonomy, informed decision making, and optimal health care. 7. Act as an advocate for breastfeeding in the community, workplace, and within the health care professions. 8. Utilise adult learning principles when providing educational experiences for clients, health care providers, and the community. 9. Interpret current research findings to determine appropriateness for application to practice. 10. Function and contribute as a member of the health care team, provide follow-up plans, and make appropriate referrals to other health care providers and community support resources. 11. Maintain comprehensive client records. 12. Follow a professional Code of Ethics, local laws and codes, and maintain appropriate standards of hygiene. 13. Observe the guidelines for health workers outlined in the WHO International Code of Marketing of Breast- milk Substitutes. 14. Maintain and enhance knowledge and skills with appropriate and regular continuing education. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 13
  • 15. SUGGESTED READING LIST Since individual study is a major component of exam ADDITIONAL READING preparation, this reading list is included to aid you in your AAP & ACOG. Breastfeeding Handbook for Physicians. 2006 preparation. This Suggested Reading List is not all-inclusive, (primarily for candidates who are physicians) nor does it cover all exam items. The IBLCE recommends Allain A and Chetley A. Protecting Infant Health: A that candidates become familiar with a wide range of Healthworker’s Guide to the International Code of Marketing of literature, scientific studies and journals, including material Breast-milk Substitutes. IBFAN, 2003. [J,M] published outside their own countries. In addition to the listed Bornmann, P. A Legal Primer for Lactation Consultants. Chapter in books, it is useful to review good basic texts on child ILCA Core Curriculum for Lactation Consultant Practice. Walker development, neonatology, prematurity, research (ed), Jones & Bartlett, 2001. [J] methodology and statistics. Candidates should also be Greenhalgh, Tricia How to read a paper: the basics of evidence familiar with books written for mothers, particularly the based medicine. BMJ Publishing Group. mother-support literature which covers normal behaviour, Relevant full text extracts available as articles at: older babies and breastfeeding management in a range of http://www.bmj.com/ [I] situations. Inclusion on this list does not constitute an Hale, Thomas. Medications and Mothers’ Milk Pharmasoft endorsement by IBLCE. Publishing, 2006 or biennial new edition. [F] Hale, T and Berens P. Clinical Therapy in Breastfeeding Patients. NOTE: The letters in brackets after a title in the alphabetical Pharmasoft Publishing. [F] listing refer to those Disciplines in the Exam Blueprint which Hale, T and Ilett K. Drug Therapy and Breastfeeding. Pharmasoft are well covered in that book or series. General lactation texts Publishing, 2002. [F] and practical breastfeeding management texts do not have Hanson, Lars. Immunobiology of Human Milk: How Breast-feeding Discipline references after them, since they cover a broad Protects Infants. Pharmasoft Publishing, 2004. [D] spectrum of topics. Ivey AE and Ivey MB. Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society. 5th GENERAL LACTATION TEXTS TEXTS edition. Wadsworth: 2003. [G] Lawrence, Ruth and Lawrence, Robert. Breastfeeding: A Lang, S. Breastfeeding Special Care Babies. Bailliére Tindall, 2002. Guide for the Medical Profession: Elsevier Mosby, 2005. [most disciplines; chronological period: 2] Merewood A and Phillip B. Breastfeeding Conditions and Diseases. Riordan, J. Breastfeeding and Human Lactation. Jones & Pharmasoft Publishing, 2001. [E] Bartlett, 2004. Morris, SE and Klein, MD. Pre-Feeding Skills — A Comprehensive Resource for Mealtime Development. Therapy Skill Builders, 2nd PRACTICAL BREASTFEEDING BREASTFEEDING edition, 2000. [A,C,E,G,H,L] MANAGEMENT TEXTS NHMRC. Dietary Guidelines for Children and Adolescents in Biancuzzo, M. Breastfeeding the Newborn: Clinical Australia incorporating the Infant Feeding Guidelines for Health Workers. Australian Government Printer, 2003. [M] Strategies for Nurses. Mosby, 2003. Polit, D and Beck, C. Essentials of Nursing Research: Methods, Brodribb, W. (ed) Breastfeeding Management. Australian Appraisal, and Utilization. 6th edition. [I] Breastfeeding Association, 2004. Roberts, K and Taylor B. Nursing Research Processes: An Lauwers, J, and Swisher A. Counseling the Nursing Mother. Australian Perspective. Nelson, 2002. [I] Jones & Bartlett, 4th Edition 2003. Scott, J. The Code of Ethics for International Board Certified Lactation Consultants: Ethical Practice. Chapter in ILCA’s Core Mohrbacher, N, and Stock J. The Breastfeeding Answer Curriculum for Lactation Consultant Practice. Walker (ed), Jones & Book. La Leche League International, 2003. Bartlett, 2001. [J] The Royal College of Midwives, UK. Successful Schaefer, CH., Spielmann, H. Drugs during Pregnancy and Breastfeeding. Churchill Livingstone, 2003. Lactation, Elsevier, Amsterdam, The Netherlands Shealy K, Li R, Benton-Davis s, Grummer-Strawn LM. The CDC Walker. Breastfeeding Management for the Clinician. Guide to Breastfeeding Interventions. US Dept of Health and Harcourt Brace, Canada Human Services, CDC, 2005. [M] Shelov, S. Caring for Your Baby and Young Child: Birth to Five PROFESSIONAL TEXTS Years. AAP. Bantam Books, 2004. [H] ILCA Core Curriculum for Lactation Consultant Practice. Stuart-Macadam P and Dettwyler K, Breastfeeding: Biocultural Walker, M (ed), Jones & Bartlett, 2001. Perspectives. Hawthorne, NY: 1995. [G] Tappero, EP and Honeyfield ME. Physical Assessment of the Newborn. NICU Ink, 2003. [chron. periods: 5&6] BOOKS OF CLINICAL PHOTOGRAPHS WHO. The International Code of Marketing of Breast-Milk Auerbach K., and J. Riordan. Clinical Lactation: a visual Substitutes: frequently asked questions. 2006 guide. Jones & Bartlett, 2000. http://www.who.int/child-adolescent-health/ [M] Wilson-Clay, B., and Hoover K. The Breastfeeding Atlas 3rd Wolf, LS and Glass RP. Feeding and Swallowing Disorders in edition. Lactnews Press, Austin Texas, 2005. Infancy: Assessment and Management. Psych Corp, 1992. [A,E,H,L] 14 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 16. READING LIST (continued) MOTHER SUPPORT JOURNALS AND OTHER GROUPS PROFESSIONAL PUBLICATIONS Academy of Breastfeeding Medicine www.bfmed.org Dear Mother Support Group Counsellor Clinical Protocols open access on website As an accredited counsellor or leader of your Breastfeeding Medicine (quarterly professional journal) organisation, please read the information below ABM News and Views. Quarterly newsletter by subscription. and complete the information relevant to your Australian Breastfeeding Association (ABA) meeting on the other side of this sheet. Return it www.breastfeeding.asn.au to the bearer so that s/he may submit it with Breastfeeding Review. Professional journal published twice her/his application for the IBLCE exam. each year, available by subscription from ABA. Thank you for your cooperation. Lactation Resource Centre. An annual subscription to ABA’s LRC provides quarterly listings of the latest published research and journal articles, vouchers for database searches Earning education hours and photocopying of articles; phone enquiry and referral service; Topics in Breastfeeding papers; plus a subscription by attending mother-to-mother to Breastfeeding Review. support group meetings Topics in Breastfeeding. A set has been published by ABA’s The International Board of Lactation Consultant LRC each year since 1991. Back copies of sets still available Examiners feels strongly that candidates for the IBLCE and useful. Check titles with ABA. exam should understand the importance of mother-to- ILCA www.ilca.org mother support and community resources, and learn more Journal of Human Lactation. Quarterly professional journal about “normal” breastfeeding. available by joining the International Lactation Consultant Applicants for the IBLCE examination who are not Association. counsellors/leaders of such an organisation can Evidence-Based Guidelines for Breastfeeding Management therefore earn 1 education hour per meeting session during the First Fourteen Days. (to a maximum of 4 hours; i.e. 4 meetings) towards their required minimum 45 (or 80) hours of education by International Breastfeeding Journal attending a discussion meeting of a breastfeeding mother- IBJ is an open-access peer-reviewed online journal: to-mother support group. Examples include, but are not http://www.internationalbreastfeedingjournal.com/ limited to La Leche League or the Australian Breastfeeding Association. La Leche League International www.lalecheleague.org Breastfeeding Abstracts Quarterly annotated summary of Candidates are asked to phone before attending a meeting important new research - by subscription from LLLI. to check that it is appropriate for them to attend that particular meeting (there may already be other observers World Health Organisation, Geneva www.who.int and attending or it may be a social meeting without a http://www.who.int/nutrition/publications/en/ discussion topic) and to confirm the time and place. Complementary Feeding: family foods for breastfed children. Before the meeting commences the counsellor leading the WHO 2000 [H] discussion may wish to talk with the candidate about how Evidence for the Ten Steps to Successful Breastfeeding. s/he is to be introduced, how s/he can participate in the Geneva, WHO 1998 [M] discussion, the support group’s Code of Ethics and any Global Strategy for Infant and Young Child Feeding. Geneva, other concerns or questions either party may have. The WHO 2003 [M] candidate is there in an observer capacity, not as a health HIV and Infant Feeding. A guide for health care managers professional, and should not be giving advice to mothers and supervisors and Guidelines for decision makers. Geneva, or asked to consult in a professional capacity. WHO 1998 [D, M] The counsellor or group leader is required to sign a form Hypoglycaemia of the Newborn: Review of the Literature. to confirm that the candidate attended. If there are Geneva, WHO 1998 [B] concerns about the candidate (e.g. unethical behaviour), International Code of Marketing of Breast-milk Substitutes. please contact the IBLCE Regional Director at Geneva, WHO 1981 [M] office@iblce-europe.org, or the local IBLCE Coordinator. Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During The First Six Months of Life. 2002 [C, H] Cut this half page off along the dashed Protecting, Promoting and Supporting Breastfeeding: The line and use the form on the other side Special Role of Maternity Services. WHO/UNICEF Statement, 1989. [M] as your record of attendance Relactation: Review of experience and recommendations for at mother-to-mother support group practice. Geneva, WHO 1998 [B] discussion meetings. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 15
  • 17. __________________________________________________ SENDING YOUR APPLICATION Name of Observer (IBLCE Exam Candidate) MEETING 1: Please follow carefully the instructions on pages 17-20 for completing your application form, and the fees and deadlines ______________________________ __________________ information on pages 21-22. Check that every section of your Name of Counsellor or Group Leader Phone application is complete and that you have signed and dated it. Also check that you have enclosed all required accompanying ____________________________ ____________________ materials with the form. Please do not fold or staple your Date of Meeting Name of Organisation application or the documentation enclosed in it. __________________________________________________ Keep a photocopy of your application for your records, along Topic of Discussion Meeting with your Candidate Information Guide and Application Supplement. I certify that the above-named observer attended this discussion meeting of my breastfeeding support group. Mail your application to the address shown on your Application Supplement. If you are mailing close to a fee ___________________________________________ deadline, you are advised to ensure the envelope is clearly Signature of Counsellor/Leader postmarked. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Applications are processed in the order in which they are MEETING 2: received. In busy periods, it may take three to four weeks before your application is processed. We will contact you if ______________________________ __________________ there is any problem with your application and we will notify Name of Counsellor or Group Leader Phone ineligible applicants. End of June candidates with complete files who meet eligibility requirements will receive the ____________________________ ____________________ admission package, confirming eligibility, acceptance, exam Date of Meeting Name of Organisation site allocation and a receipt for exam fees received. However __________________________________________________ please feel free to contact us any time before end of June if Topic of Discussion Meeting you have questions. I certify that the above-named observer attended this discussion Avoid additional fees by including all meeting of my breastfeeding support group. required information and documents ___________________________________________ with your application form. Keep a copy Signature of Counsellor/Leader _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ of your application, and keep this Guide and your Application Supplement for MEETING 3: reference. ______________________________ __________________ Name of Counsellor or Group Leader Phone ____________________________ ____________________ MILCC FINANCIAL ASSISTANCE Date of Meeting Name of Organisation Monetary Investment for Lactation Consultant Certification (MILCC) is an international body which __________________________________________________ provides financial assistance to IBLCE exam or Topic of Discussion Meeting recertification applicants who demonstrate financial I certify that the above-named observer attended this discussion need, with priority given to applicants who work with meeting of my breastfeeding support group. under-served or disadvantaged families. A MILCC application form is available from IBLCE ___________________________________________ Signature of Counsellor/Leader on request or can be downloaded from the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ website. It must be submitted with a completed exam application, and mailed MEETING 4: to IBLCE by the end of January. ______________________________ __________________ Please note that all eligibility requirements, Name of Counsellor or Group Leader Phone including all education hours, must have been completed by the time of application. ____________________________ ____________________ Date of Meeting Name of Organisation The JoAnne W. Scott scholarship is also available through MILCC for applicants from a __________________________________________________ mother-to-mother support background. Topic of Discussion Meeting IBCLCs recertifying by exam or by CERPs may also I certify that the above-named observer attended this discussion apply for MILCC financial assistance. If recertifying by meeting of my breastfeeding support group. CERPs, the completed recertification application and MILCC application must be mailed to IBLCE by the end ___________________________________________ of January. Signature of Counsellor/Leader 16 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 18. APPLYING TO BE AN IBLCE EXAM CANDIDATE This section provides important information undertake, and whether evidence of any exceptional about applying to be an IBLCE exam circumstances is provided. Our security requirements also affect the decision. candidate and tells you how to fill in the Application Form (version 2.9EU). The Additional sites cannot always be justified but, if a small additional site is arranged, the extra local costs are the numbers refer to the items on the form. responsibility of the candidates who take advantage of it. Please note that sites for one or a few candidates are 1. IDENTIFICATION DETAILS: considered only in exceptional circumstances. Enter your given names and family or surname. Print clearly You will be notified of your allocated exam site with your and enter one letter in each square. application package. If your allocated site must be cancelled, Please tell us your preferred title and also state any other you will be contacted earlier and given the option to move to surname that you use or are known by. another site or to accept a full refund of fees. Enter the exam year, your date of birth (dd/mm/yy) and your If an additional site is added closer to your home, you will be country of citizenship. notified. You will have the option of changing to the new location or remaining at your original site. A site change may be requested at any time, but may not be 2. ADDRESS AND CONTACT DETAILS: possible after the end of June. Contact IBLCE with your Print your home postal address clearly. Use the customary request as early as possible. format for your country, and the appropriate number of lines. We want to be sure that your admission packet and exam results reach you quickly, without having to be redirected. (We prefer that you do not use a work address, as we have 4. EXAM FEES: had too many problems with mail not getting through to Your full exam fee (credit card details, copy of bank transfer candidates at their work addresses.) receipt or cheque) must be included with your application. We may need to contact you for further information. The details of how you can pay your exam fees are described Therefore, please provide your phone numbers, including the on page 21 of this Guide. Be sure to enclose your correct area code, and your email address (please print very clearly). exam fee. Fees are based on We usually prefer to communicate with you by email when • the deadline by which your complete application is appropriate and convenient. postmarked If you change your address or any of your other contact • your country of residence, and details, you must advise us immediately. We will send you your exam admission packet about four weeks before the • the fee schedule for which you are eligible. exam. Also, during the last few weeks before the exam, we Please make cheques payable to IBLCE and send to IBLCE may need to contact you with important information. as registered mail. Therefore, please make sure we have your contact details, Application fees and deadlines are shown in the Application especially if you will be away from your usual address. Supplement specific to the exam year and your country. Deadlines are strictly adhered to and postmarks are checked. 3. EXAM SITE CITY: See your Application Supplement for the anticipated exam 5. ELIGIBILITY PATHWAYS: site cities in your country, normally a capital or main city. The actual location of the exam venue may be in the city or The requirements for all the eligibility pathways are in the surrounding metropolitan area. described on pages 4 and 5 of this Candidate Information Guide. Please circle one letter only for the Standard pathway Write the name of a city referred to in your Application for which you believe you are eligible. You may also circle Supplement. You may also write the name of a city, not one or both Supplementary pathways, but only if you meet mentioned in the Application Supplement, where you would the requirements and need one or both of these pathways to prefer to sit for the exam. Such a request for an additional site be eligible to sit for the exam. If you have been a candidate will be considered after applications close and you will be before, please indicate the year/s. If you have ever been an advised if your request is successful. IBCLC, but your certification has lapsed, please circle only L as your pathway. We try to make the location of exam sites as convenient as possible for as many candidates as possible. However, when we make decisions about exam sites, we must take into account our overall costs and administrative requirements, the numbers of candidates in the areas served by each site, the reasonableness of the travel that candidates need to IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 17
  • 19. APPLYING TO BE AN IBLCE EXAM CANDIDATE (continued) 6. ACCOMPANYING MATERIALS: 7. CALCULATING YOUR BC HOURS All the required accompanying materials must be submitted To determine your eligibility, we need you to tell us your with your application form. Tick the boxes on the form to total number of breastfeeding counselling hours (BC hours) confirm that you have included these materials. and how you have made this calculation. Your application is not complete and will not meet fee BC Hours are explained on page 6 of this Guide. deadlines unless all accompanying materials are sent by the Using the table provided in the application form (attach an due date. Please include: additional sheet, if necessary), fill in a new line for each Payment: Your full exam fee – complete credit card details position in which you have worked or had experience given on the Application Form or copy of bank transfer providing breastfeeding counselling. Also use a new line for receipt, cheque or money order. the same position if a change in your responsibilities affected Qualification: A photocopy of the relevant degree, diploma, your BC hours. For concurrent work experience, list each practising certificate, etc that verifies your eligibility separately; for example, if you are employed in the daytime, pathway. Please do not send more documents than but teach breastfeeding/parenting classes for another necessary; one is often enough. For instance, if you are a organisation in the evening, use a separate line for each. midwife, a copy of your registration card or a copy of Please list your experience chronologically. your degree is sufficient. Column 1: Place of Work/Experience Lactation education certificates: Photocopies of Write the name of your employer/organisation and the certificates of attendance or similar verification for location of your work/experience. education hours already completed, as listed by you in item 8 of the form. Where these are not available, provide Column 2: Title / Position full details or a copy of the program. Fill in your job title or the name of your position. If you have not yet completed all the education hours Column 3: Area / Nature of Work / Experience required, you may lodge your application now, but in Briefly describe the nature of your work/experience. section 8 of the form you must provide a list of completed Column 4: Month/Year Started and Ended education, and/or education for which you are signed up Fill in the month and year you started and the month and year to undertake, that totals at least 45 hours (80 hours if you you finished in this position. are doing the exam in a language other than English) and that covers the exam blueprint. All this education must be Column 5: Total Weeks, Excluding Leave completed before the exam. The photocopies of these Looking at the dates in Column 4, translate this period of further education hours must be sent to us when time into the total number of weeks for this position, completed, preferably before the exam, but in any case excluding recreational leave periods (usually at least 6 weeks within two weeks after the exam. per year, including public holidays) and sick leave. References: TWO recent original professional references Column 6: Average Hours Per Week from supervisors or colleagues. For convenience, these Fill in the usual number of hours per week you worked in this may be on the reference forms provided with the position. Part-time, relief or shift work employees may application form but, if the referee prefers to write a average the number of hours per week. letter, it must cover all the areas addressed on the form. References may not be from fellow exam applicants Column 7: Total Hours Worked (unless they are recertifying IBCLCs), nor can one letter Figure out your total number of work hours by multiplying signed by two people count as two references. Do not the total number of hours per week by the number of weeks send unsigned references or photocopies. in the position. Your employer may be able to provide this figure for you. A full-time job is generally about 38 hours per Name change document: If any of the above materials are week times 46 weeks per year or approximately 1700 hours in a name that you use or used, but different from the per year worked. name in which you have applied, enclose a photocopy of the documentation of your name change. It is accepted that an active, accredited volunteer mother support counsellor averages 10 BC hours per week or 500 BC Please remember that, if you overlook any of the required hours per year. You can claim this, and no further documents, you are liable for substantial additional fees. documentation is required. However, If you believe you have done more hours than this, please provide documentation for those periods. Column 8: Percentage of time providing Breastfeeding Counselling Figure out the number of hours per week you spend on breastfeeding counselling. If your BC hours in any one position varied widely from week to week, it may be necessary to average the different totals. In your current position you may find it helpful to keep a record of your hours for a few weeks. 18 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 20. APPLYING TO BE AN IBLCE EXAM CANDIDATE (continued) Divide the number of hours per week that you spend on • distance education (check with the organisers for the breastfeeding counselling by the total number of hours you contact hour equivalent) work per week. If you figured 16 hours a week for BC hours • formal coursework specific to breastfeeding. within a 38-hour work week, your percentage is 16 divided You cannot count practice exams as part of your education. by 38, multiplied by 100, which equals 42%. For further information about lactation education and pre- As a general guide, midwives on postnatal wards (where 75% exam training courses, see pages 6 and 23 of this Guide. or more of mothers are breastfeeding) commonly average 40% or more of their time providing breastfeeding To be eligible for the exam, you must document at least 45 counselling, depending on the size of the hospital, staffing hours of professional education specific to lactation and levels and other duties. Some midwives with particular reflecting the exam blueprint. (The minimum is 80 hours if responsibilities for breastfeeding may do significantly more. you are doing the exam in a language other than English.) Where breastfeeding rates are lower, percentages tend to be If you are doing, or have completed, a comprehensive lower. lactation education course, you do not need to list each Columns 9 to 12: session, just list the total number of hours awarded. Total Hours providing Breastfeeding Counselling Sessions with essentially the same content can be counted Multiply your BC percentage in Column 8 by the total only once. Private study is not included, nor are audio or number of hours you worked (Column 7). This is your total video tapes except as part of a structured learning program. BC hours for a single job/work experience. For each line, Attending or conducting education sessions for parents write the total BC hours in Column 9, then give the are not professional education for you. breakdown of one-to-one in person, telephone/email and Sessions or programs do not have to have been formally consumer education (groups/classes) hours, in Columns 10, approved for CERPs (see page 6). If CERPs have been 11 and 12 respectively. allocated, 1 CERP equals 1 hour. You can only count L Total BC Hours: (lactation) CERPs towards pre-exam education. If a program Then add up the BC hours in Column 9 to give you your total has R (related) CERPs or E (ethics) CERPs allocated, these BC hours. For you to be eligible, this overall total figure must sessions may be useful exam preparation but they can not be be equal to or greater than the minimum number of BC hours included in the required 45 (or 80) hours. required for your Eligibility Pathway. Ensure that the total of Attach photocopies of any attendance certificates or CERPs each of Columns 11 and 12 is less than 25% of the total of certificates you have received. Where you do not attach Column 9; if not, you must reduce the number of hours you certificates for proof of program attendance, you must have included in Columns 11 and 12. provide detailed self-documentation for each session, or Too few BC hours? If necessary, you may include hours you attach a copy of the program. To calculate the hours, count are certain you will complete between the date of your only the actual session time programmed, including application and the exam date. Show these hours on a questions. Panel sessions relevant to lactation may be separate line on your application. Before the exam, you will included, but do not include breaks or opening/administrative be required to send verification that you have completed the sessions. Generally, a one day lactation seminar will be no outstanding hours. Please be aware you will not be eligible to more than 5 to 6 education hours. receive your exam results if you do not complete these hours If necessary, you may include sessions you are signed up to before the exam date. If you find yourself in this situation, attend between the date of your application and the exam you should withdraw before the exam (see the Application date. Show these uncompleted hours on separate lines on the Supplement for withdrawal deadlines). form. You can be accepted as a candidate while completion Too many BC hours? If you are very experienced, you may of your education hours is still pending, but you must send find you have many hours in excess of your eligibility documentation of at least the required minimum hours to requirement. You should provide full details of your most IBLCE as soon as they have been completed. This should recent hours, up to your eligibility requirement, and then you preferably be before the exam, but in any case no later than 2 can summarise your earlier experience. However, please weeks after the exam (or your results may be delayed). Please estimate your total hours, for data purposes. be aware you will not be eligible to receive your exam results at all if you do not complete these hours before the exam date. If you find you will be unable to complete these 8. PROFESSIONAL LACTATION outstanding hours you should withdraw before the exam. See EDUCATION HOURS: the Fees section of this Guide for withdrawal deadlines, and your Application Supplement for refund information. Using the table in the application form (attach an additional sheet, if necessary), provide details of the professional If you are an applicant who is not an appropriately education specific to lactation or breastfeeding management qualified health professional, you must not include your that you have attended, or are signed up to attend, during the “background” education in this section of the form. Please three-year period prior to the date of the exam. You can enclose a separate sheet showing how you have met this include relevant education from: requirement and attach attendance certificates. • courses, conferences, seminars, and workshops • in-service study days for health professionals IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 19
  • 21. APPLYING TO BE AN IBLCE EXAM CANDIDATE (continued) 9. PRINCIPAL CURRENT EMPLOYMENT Pregnant candidates SETTING: A candidate who will be in the last trimester of pregnancy or This information is sought for IBLCE’s statistical purposes. recently delivered at the time of the exam, should provide her Please tick one box which best indicates your principal due date. Special consideration can be given to seating for current employment setting, or describe your situation beside pregnant candidates. Parents of young babies will need to the box marked “Other”. If you regularly work in more than make their own arrangements for care of the baby during the one setting, you may tick a second setting if it involves a two exam sessions. Babies are not allowed in the exam room. significant proportion of your time. Exam translations Each year the exam is translated into several languages 10. WORKPLACE: according to demand and availability of suitable translators. For a translation where there is typically only a small number Please complete the information requested about your of candidates, or for a translation language new to IBLCE, at workplace name and address. least 15 eligible candidates must have applied and paid their exam fees before 31 December for the translation to be 11. BIOGRAPHICAL DETAILS: considered. At the time of application a candidate should indicate in Tick all the boxes that correspond to your qualification/s which language other than English s/he wishes to do the or registration/s. If you have relevant qualification/s or exam, if it were to be made available. If there are not enough registration/s in the health care field that are not included on applicants wishing to do the exam in this language, there will the list, please fill in the “Other” line. not be a translation offered, and applicants will be entitled to Tick one box to indicate the highest level of post-secondary a full refund or may elect to do the exam in English. education that you have successfully completed. Do not tick a Translations in previous years have included Arabic, Dutch, qualification not yet completed. French, German, Icelandic, Italian, Japanese, Korean, Polish, Tick the box for your gender. We need to know this Portuguese, Spanish, Hungarian, Slovenian and Swedish. A information for selection of exam supervisors. candidate may have access to exam materials in only one language version. It is not permitted to have two exam booklets in different languages. 12. INDIVIDUAL CONSIDERATIONS: It is IBLCE policy that no individual shall be excluded from Use of a bilingual dictionary certification on the basis of race, national origin, religion, A candidate may be given permission to use her/his own gender, age, or physical disability. unmarked non-electronic bilingual dictionary during the If you have reason to require individual consideration when exam. An unmarked non-electronic bilingual medical you sit for the exam, mark the appropriate box/es in this dictionary is also permissible, as long as it contains only section of the application form, and provide accompanying translations of words and has no definitions. documentation where requested. These requests should be The use of dictionaries can be requested on the application made at the time of your application as they may require form and IBLCE will communicate the local arrangements to special arrangements. If a problem requiring individual you. At sites where many candidates are using them, you may consideration arises closer to the exam date, please advise be required to submit your dictionary to the Chief Proctor or IBLCE as soon as possible. a designated assistant prior to the exam date. Please include The time that is allowed for the exam in generous, and allows your name, address, and telephone number inside the front for candidates who are slow test takers or doing the exam in a cover. You will not be permitted to use any dictionary that language other than their primary language. has not been submitted for checking. Electronic dictionaries, computers, calculators, etc. are not Candidates with disabilities permitted in the exam room. A candidate with a disability may request individual consideration by providing written notice, with an original signature and appropriate documentation, including: 13. SIGNED STATEMENT: • an official letter which clearly states the nature and extent of the disability; and Please read the Statement carefully. Be sure to circle the • details of any appropriate modifications to the exam appropriate response to each of the five questions. If you procedure which are requested; and answer “Yes” to any of the questions, you should provide • details of any appropriate auxiliary aids that the candidate information with your application. If necessary, IBLCE will may need to sit for the exam. confidentially seek further information from you. A “Yes” response will not necessarily mean you will not be permitted Where possible, individual arrangements at the exam site for to sit for the exam, especially if you are otherwise able to be candidates with disabilities will be provided by IBLCE. employed in the health care system without restriction. There will be no additional charge to the candidate. It may not be possible to meet requests received after the final You must sign and date your application, or it will be classed application deadline. For more information contact IBLCE. as incomplete and additional fees will be charged. 20 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 22. FEES AND DEADLINES EXAM FEES INELIGIBLE APPLICANT FEE Fees are set according to country of residence and take into An applicant whose application does not meet the account central and local administrative costs. The fees are requirements to sit for the exam will receive a refund of set out in the table in the Application Supplement specific to her/his exam fee minus the processing fee listed in table in the exam year and your country. your Application Supplement. All fees must be paid in EURO and may be paid by: Credit card authorisation: INCOMPLETE APPLICATIONS by completing the section on the Application Form, using If any item of required information or documentation is not only Visa or MasterCard. included with your application, your application will be classed as incomplete and therefore it will not have met the fee deadline. We will contact you about what is missing. Bank transfer from a bank account to IBLCE’s bank account in Austria: Incomplete applications will be treated as meeting the For a European Standard Transfer: next deadline. There will therefore be an additional charge, being the difference between the fee you have IBAN: AT55 2020 5012 0000 3067 paid and the fee for the next deadline. BIC: SPBDAT21XXX This policy has been instituted because of the extra For bank transfers from the Middle East and North Africa: administrative time and costs involved, and so as to be fair to other applicants who have delayed their applications till a later Account in the name of: IBLCE in Europe, Steinfeldgasse 11 deadline to ensure that their applications included all the 2511 Pfaffstaetten, Austria required information and documents. Account no: 1200-003067 Do not send your application unless all sections are Name and address of bank: Sparkasse Baden, Stiftgasse 1 completed, full payment and all accompanying materials 2511 Pfaffstaetten, Austria are enclosed, and it is signed. To avoid further fees, check it very carefully before sending. SWIFT/BIC: SPBDAT21XXX Examples that would make your application incomplete: Please make this bank transfer before you post your application, and enclose a photocopy of the bank transfer receipt with your • not enclosing two references* [section 6] application form so that we can match your payment to our bank • not enclosing your qualification certificate/s [section 6] statement. • not enclosing a name change document if required [section 6] We cannot accept payment of fees by cheque or • not listing the required BC hours [section 7] money order! • not listing at least 45 (80 if applicable) completed education hours (or not naming the comprehensive Please note that banking of your payment does not constitute course ) [section 8] an acknowledgment of eligibility. • not providing your biographical details [section 11] • not completing the signed statement or not answering all Your fee depends on when your complete application (with 4 questions or not signing the statement [section 13] all accompanying materials) is postmarked. Please check the three levels of fees listed in the table in your Application *If a referee is sending a reference directly to us, please Supplement, and ensure that the fee you are paying is correct include a note with your application stating the name and for the date of posting. Deadlines are strictly adhered to. contact details of that referee. Such a reference must reach us before, or within 10 days after, your application is received, otherwise your application will be classed as incomplete. APPLICATION DEADLINES HAND-SCORING FEE HAND- Applications must be postmarked by the following dates to A request for hand-scoring of exam answer sheets (see qualify for the respective fee level: page 30) must be accompanied by the fee listed in the table in your Application Supplement. Early exam fee deadline 28 February Standard exam fee deadline 31 March Late exam fee deadline 30 April IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 21
  • 23. FEES AND DEADLINES (continued) RE-ISSUE OF CERTIFICATE FEE RE- IS YOUR EMPLOYER PAYING? Requests may be made in writing for a certificate to be re- We welcome the fact that many employing institutions show issued, due to name change, damage to your certificate, etc. their support for their staff by paying fees on behalf of Please enclose your old certificate with your request. The fee candidates. We appreciate the need of those institutions to be listed in the table in the Application Supplement is required supplied with a complying tax invoice. As a not–for-profit- for processing and mailing. Certificates damaged when they organisation we will issue a “Confirmation of Exam Fees” are mailed out will be replaced at no cost if IBLCE is notified for this purpose on request. immediately. We very much prefer that payment accompany the same time as sending the candidate’s application form, as we cannot WITHDRAWAL DEADLINES process an application unless and until the appropriate fee has been paid. A “Confirmation of Exam Fees” is available on Examination fees are partially refundable. A candidate who request. Exam fees and associated administration charges, are decides to withdraw from sitting for the exam, for any reason, VAT-free. A receipt will be provided with the admission must send a written request for a partial refund by mail, fax package or earlier on request. or email by 20 June (for the higher level of refund) or 15 July (for the lower level of refund). The levels of these We kindly ask you to understand that in terms of fairness to refunds are shown in the table in your Application all candidates, deadlines will be monitored strictly. In order Supplement. If you have already received your exam to be valid for a certain deadline we will need your complete admission ticket, return it with your request. documentation and proof of payment of exam fees sent within the specified deadline. If the transfer of fees falls into You do not need to provide a reason or supporting the next deadline or if an application is not complete, we will documentation to request a withdrawal refund. Only the have to ask you to pay the difference to the next level of fees. candidate can request the withdrawal. If the exam fees were paid by a third party, the partial refund will be made to that Alternatively to an employer paying for exam fees, the staff party. An alternative candidate is not permitted to sit for the member may pay the fee and be reimbursed by the employer. exam by using your exam fee. We strongly recommend the latter method, as that way the staff member keeps control over the date of payment and A candidate whose application is accepted subject to the avoids the liability for the additional cost of a higher fee level eligibility requirements being completed, and who later finds if the employer’s finance department is slow in generating that s/he will not be able to complete all the requirements payment and the intended deadline is missed. prior to the exam date, cannot be certified and should withdraw, sending the written request for a partial refund by the dates specified. EXAM FEES AND PROFESSIONAL ETHICS Except in the following limited circumstances, no applications or exam fees may be held over or transferred Health workers have a responsibility to be familiar with the from one year to the next. In extreme circumstances IBLCE International Code of Marketing of Breast-milk Substitutes will consider allowing a candidate to defer to the following and to understand their responsibilities in relation to it year, but only if a case is presented outlining the unusual and (Article 7.1). The IBLCE Code of Ethics requires IBCLCs to exceptional circumstances that would justify deferral, abide by the provisions of the Code, and subsequent World accompanied by appropriate medical certificates and other Health Assembly (WHA) resolutions, which apply to health documentation, and then only if an additional administrative workers. If a health worker receives a contribution from a fee is paid the following year. Such a deferred candidate must company which markets or distributes products within the lodge the next year’s application by the early closing date, scope of the International Code, for example-exam fees, and all eligibility requirements (including education hours) textbooks, or pre-exam education, the Code requires that both must already have been met by that date. A candidate the company and recipient must disclose this to any wishing to request consideration of a deferral must contact institution with which the recipient is affiliated. This also applies to contributions made to a third party on the health IBLCE as soon as possible. worker’s behalf (Article 7.5). Financial contributions should Please understand that IBLCE needs to set strict rules about not create a conflict of interest, especially in regard to the deadlines, and limitations on refunds, because it incurs costs Baby Friendly Hospital Initiative. (WHA 49.15) and financial obligations at certain stages of the period leading up to the exam date. For instance, as well as administrative and printing costs incurred per candidate, “Repeat” DISCOUNT exam room bookings and engagement of proctors have to be This special rate is available to an exam candidate who was organised in advance; these costs are related to the numbers unsuccessful and is applying again in the immediately of candidates at each site. following year. Eligibility must still be current; the IBLCE Office will provide further information. The fees payable are Avoid additional fees by including all required shown in the “Repeat” column in the table in your information and documents with your application Application Supplement. This special rate is also allowed to a form. Keep a copy of your application, and keep this former IBCLC whose certification lapsed in the immediately Guide and your Application Supplement for reference. preceding year. 22 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 24. PREPARING FOR THE EXAM STUDY STRATEGIES Because each candidate’s background and experience is We strongly suggest that you check off the Exam Blueprint different, you are expected to determine your own strengths and the Clinical Competencies and be sure you have and weaknesses in the relevant Disciplines and addressed all areas. Typically, candidates’ exam scores are Chronological Periods, and to organise your own program of lower in the disciplines that are less clinical (G, H, I, J & M), study. The following information may help you organise your and yet practising lactation consultants consider that these are study, and may be used in conjunction with other sections of important aspects of their work. To gain a better this booklet: Exam Blueprint, Clinical Competencies, the understanding of the roles and skills required, try to spend Suggested Reading List, and ILCA’s Standards of Practice. time with experienced IBCLCs working in various settings. Plan your study program ahead and determine how you study Allow time to integrate your new knowledge and skills into best. Do you learn better on your own or when you can your practice. Two-thirds of the exam questions will test discuss material with colleagues? You may want to organise application of knowledge. a study group or find a study partner, then take turns in preparing and presenting topics. Some people learn well from In determining how deeply to study a subject area, you need working through a textbook cover-to-cover; others prefer to to asking yourself what a lactation consultant might need to choose a topic and study different sources of information. know. As you study each topic, ask yourself how the information might fit into the broad scope of an IBCLC’s Identify areas where your background has given you little practice. Application of your knowledge is the ultimate experience and ensure you cover these areas in your purpose of your study. preparation. For example, if you have worked only in a hospital postnatal area, you may have little experience with breastfeeding beyond the early period. Use the Suggested Activities in this booklet as a checklist to see how well prepared you are. LACTATION AND EXAM PREPARATION COURSES The IBLCE exam is a certification exam, which means that it covered in other ways. Courses may also be basic or is a standardised independent assessment of knowledge and advanced. Some are conducted over several weeks or competency. This is recognised as a higher standard than months; some are short and intensive; and some are on-line courses with internal exams, which may teach to their or by distance education. Some simply require attendance; assessment or assess to their teaching. some encourage pre-reading on specified topics; and some As well as meeting the pre-exam eligibility requirements, you have written work to be submitted for assessment. Some may must take responsibility for preparing yourself for the exam. also include clinical hours. Some include a practice exam, but Most candidates find that the simplest way to ensure their please note that, while practice exams and the associated education reflects the exam blueprint, and is at the discussion may help you to better understand exam questions, appropriate level, is to participate in a comprehensive they are not an optimal way to learn about lactation and lactation course which is designed for this purpose. It is very breastfeeding management, and you cannot count them as difficult to prepare adequately for the exam and cover the part of your lactation education hours. exam blueprint by putting together only sessions from No course can possibly teach you everything you need to conferences, in-service education and chat nights. know for the exam; that’s why you need both private study Evaluate available courses to determine whether there is and clinical experience in a setting where your practice is one that will best meet your needs as a candidate. The IBLCE based on the application of scientific principles and on in Europe website has got a list of available pre-exam- current research and information. education programs in Europe and the Middle East. See section “Pre-Exam-Edu”. Please note that the IBLCE does not provide any educational materials or conduct any courses, and is On the website of the International Lactation Consultant completely independent of the many private lactation Association (ILCA) http://www.ilca.org/accredi.html you and exam preparation courses, practice exams and other will find information about pre-exam-education programs materials that candidates use to prepare for the exam. which have been accredited by ARCC, an international body The content of the courses and their practice exams may established to provide a reliable indicator of the educational be quite different from the IBLCE exam. “CERPs” quality of courses. approval by IBLCE is not an endorsement of a presenter’s content or opinions, nor does it necessarily It is important that you assess the degree and depth to which indicate whether a program is of suitable standard or a course addresses all the Disciplines and Chronological content for exam preparation. Periods which the exam blueprint covers. This assessment will enable you to identify aspects that will need to be IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 23
  • 25. CHECKLIST OF SUGGESTED ACTIVITIES The IBLCE Exam Blueprint covers many Disciplines Study the interactions of newborns with their and Chronological Periods. The experiences in each mothers. candidate’s background may not address all areas listed. For example, someone who works on a postpartum Attend a variety of mother-support meetings to ward may have little experience with older observe mothers and babies and to learn breast- breastfeeding babies. An accredited mother support feeding techniques. Note how counsellors listen, ask counsellor may have little experience with premature or questions, practise ethics, etc. special care babies. A candidate with children of her or Observe the developmental milestones of babies and his own may have a better knowledge of child young children in a casual setting. You might spend development. time at a playground, a playgroup or a mother It is vital that lactation consultants are thoroughly support gathering watching the inter-actions of familiar with normal breastfeeding. This puts abnormal mothers and babies/toddlers. Try to guess the ages of situations and experiences into perspective. babies/toddlers by observing their developmental activity level. Ask the mother her child’s age to see The following suggested activities may help broaden if you have determined correctly. the scope of your professional development. You should seek to observe areas that are not part of your Study the normal growth, development and everyday work experience. Although most of these breastfeeding behaviour of a single baby over a six activities will not be applicable toward your clinical month period. Describe the first few days, weeks. practice hours, they will help to make you aware of How do these differ from breastfeeding at six deficiencies in your background and increase the months? efficiency of your preparation. This list is in no Have an IBCLC observe your consultations or particular order and is a starting point only; you may interactions with mothers. Ask her or him to critique think of other activities that will augment your general different things at different times - your counselling breastfeeding consultant experience. skills, your problem solving skills, your practical skills, or your breastfeeding knowledge in the As you prepare for the exam, tick the boxes on this clinical situation. checklist to measure the breadth of your experiences. Become a mother-support group newsletter Work with or observe a lactation consultant to study subscriber. These publications are generally full of her or his experiences and client interactions. mothers’ personal experiences. Expand your professional education to a broad Sit with a lactation consultant who is staffing a spectrum of programs. Consider attending a breastfeeding phone counselling line. Listen to her/ childbirth conference, a seminar conducted by a his counselling techniques. professional association, or sessions presented by a Attend a Baby Friendly Hospital Initiative course. lawyer, a dietician, or a human relations counsellor. Review hospital practices to see how breastfeeding- Although only lactation topics meet the exam friendly they are. What types of breastfeeding eligibility requirement, other professional education problems might poor hospital practices generate? opportunities are also valuable. How might these be prevented? Study the anatomy and physiology of the breast in Seek out a professional lactation consultant detail, including how milk is synthesised. A course organisation for support, information and may help. Learn about infant oral anatomy and educational opportunities. development. While these suggestions are not mandatory, they will Offer to present a session to your colleagues on the help you to broaden your perspective, enhance your biochemistry of human milk, or a similar skills, and focus your studies in this multi-disciplinary challenging topic. Presenting a topic usually requires field. You may think you are going to use the credential you to develop a real understanding of the subject only in your current practice setting, but IBCLCs are matter you are talking about. qualified and accountable for competence in all practice Observe the interaction of a mother and baby settings. continuously for the first two hours after birth. Compare the baby of a mother who used no medication during labour with the baby of a mother who used pain relief medication. 24 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 26. EXAM INFORMATION EXAM CONTENT EXAM QUESTION REFERENCING The exam is composed of 200 multiple choice All examination questions are referenced to the questions. The degree of difficulty is set at technical/medical literature, usually to literature postgraduate university level. Since effective lactation published within the last five years. Older scientific consultation requires assessment and decision-making studies may be used if they are still quoted as reputable skills, the questions are primarily designed to test the references in current texts. Each exam question is application of knowledge, rather than the pure recall of referenced to printed materials, not to statements made facts. Application questions are more realistic and at conferences. Anecdotal material, controversial enhance the validity of the exam. information, authors’ opinions and areas where the The exam is administered in two sessions of 100 major texts give conflicting information are all avoided. questions each. Of the 200 questions, 125 are cognitive, References are current to the end of the calendar year based on word scenarios, and 75 are based on photos. prior to the exam. They are all combined for classification into Disciplines and Chronological Periods. IBLCE EXAM COMMITTEE COMMITTEE The Exam Blueprint in this Guide gives more The Exam Committee, chaired by a Director of the information about the Disciplines and Chronological IBLCE Board, works under the direction of a PhD in Periods, with the number of anticipated exam questions Psychometrics, who is a Health Professions for each shown in brackets. This outline helps you Certification Examination Consultant. The following determine the relative emphasis of the exam and groups will typically be represented on the Exam reflects average lactation consultant practice, based on Committee to give a range of professional expertise: an extensive role delineation survey. For example, IBCLCs in hospital and in community practice, Pathology (19-33) means that there will be a minimum lactation educators, IBCLCs trained primarily through of 19 questions and a maximum of 33 questions which the mother support system, IBCLCs who trained address infant and maternal pathological conditions through traditional health professions, medical relevant to lactation consultant practice. practitioners experienced in supporting mothers and Checking your knowledge and skills off against the babies, a PhD level researcher in lactation, and the Exam Blueprint will help you to identify areas you highest scorer from the previous year’s exam. As far as need to address, and help you focus your study. possible, the Committee reflects the geographic distribution of IBCLCs, including Europe and the Asia/ The sample test questions in this booklet were selected Pacific region. as examples of the type of multiple choice questions that may be expected on the cognitive portion of the The Exam Committee meets over several days to exam. Since they are limited in scope, they should not prepare, review, edit, and select test items which are be regarded as representative of the full range of then compiled into a draft exam based on the blueprint. material that will be tested, or the degree of difficulty. The Committee draws from previously-used questions and from new questions submitted by IBCLCs and The photo section has 75 questions based on colour other experts worldwide. All questions are written in a photographs which illustrate various situations and sophisticated multiple choice format. The final exam clinical conditions relevant to lactation consultant goes through several editing and approval stages before practice. Typically, candidates are asked to evaluate being translated into other languages, according to whether or not a problem is present, the nature of the demand. problem, or how it should be managed. Each candidate will be provided with a booklet of colour pictures to use for this part of the exam. EXAM CONFIDENTIALITY Although the exam is administered in two sessions, the Each year, the IBLCE uses a percentage of previously scores for the both sessions are added together to used questions on the current exam, for validity testing. determine each candidate’s overall score and pass/fail It is therefore considered unethical to divulge any designation. Candidates pass or fail the examination as questions on the IBLCE exam or to request information a whole. A higher score in one area can compensate for from previous candidates. If a candidate who had a lower score in another area, so the candidate passes received inside information were to pass the exam the overall exam. unfairly, it would be to the detriment of breastfeeding babies and mothers and to the profession itself. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 25
  • 27. EXAM INFORMATION (continued) EXAM QUESTIONS HOW THE EXAM IS SCORED SCORED Each question in the exam has an introductory sentence or The pass/fail cut-off score is determined according to the paragraph (stem). All the information necessary to answer Nedelsky-Gross technique which measures the degree of the question is given in the stem or the accompanying difficulty of each question, based on the number of picture. Candidates can be assured there are no additional sophisticated responses which might distract candidates from complicating circumstances if they are not mentioned. the correct response. The level of difficulty of the overall Many items refer to a clinical situation involving the mother exam is, therefore, based on averaging a myriad of individual and/or baby and ask what “you” should do. In these items, analyses of each question. The more difficult the exam, the “you” means you in your role as a lactation consultant. If you lower the pass/fail cut-off score, and vice-versa. have another professional role which authorises you to The Nedelsky-Gross technique ensures that there is no perform additional functions (such as a doctor with arbitrary number or percentage of candidates who pass the prescribing rights), do not include these functions in the role exam each year, and that candidates are not competing of the lactation consultant for the purposes of this exam. See against each other. It also ensures that variations in the ILCA’s Standards of Practice for Lactation Consultants to degree of difficulty of the exam from one year to another will better understand the LC role. not affect an individual candidate’s likelihood of passing or Each item contains a specific question which you should failing the exam. Over the years, the pass/fail cut-off has read carefully to know what is being asked. The key word is ranged between 61% and 68%. capitalised. Some questions may ask for “the MOST All answer sheets are computer-scanned and scored by a appropriate intervention” or “which of the following would consultant psychometrician. Each sheet is checked for stray NOT be appropriate to recommend”. The purpose of these marks and possible double counting where a response has questions is not to mislead or “trick” you, but to represent the been erased and replaced. Every year, a number of answer types of decisions that lactation consultants often face. sheets are hand scored to check accuracy. For example, a mother may benefit from any of several There is only one correct answer to each question. Each item interventions, but the lactation consultant should know the receives one point if correct, zero if incorrect. Points are not intervention that is MOST likely to be effective in her deducted for incorrect answers, so candidates should attempt situation and why other interventions might not be as all questions. effective. At other times, there are several interventions After all answer sheets have been initially scored, each which may be effective, but there is one that should NOT be question is individually analysed in the post-exam review recommended. process, using performance data from all (approx. 2500) There may also be questions which ask for “the MOST (or candidates. This identifies any questions which did not LEAST) likely cause or explanation”. These questions test perform as expected or were ambiguous. If there were to be a knowledge of the general principles which apply to clinical faulty question, this post-exam review is most likely to practice, which candidates acquire through their experience. identify it. Questions are also reviewed on the basis of Each item has three to five responses, most commonly four. comments that candidates have made on their critique forms. There is only ONE correct answer, and knowledgeable Questions determined to have been flawed, e.g. two correct candidates will be able to identify why the other answers are answers, are deleted from scoring for all candidates so no-one not correct. IBLCE does not use true/false questions or such is disadvantaged. All candidates’ scores are then recomputed. options as “all of the above”, “none of the above”, “a and This quality control procedure enhances reliability, validity, c”, etc. because these types of questions are not and fairness. psychometrically valid. Each year, a number of previously used questions are Common misconceptions and outdated ideas are often included in the current exam, and the performance of the included among the incorrect responses. Candidates should current candidates on those questions is compared with how not worry that these responses are intended to be correct. The the question performed when it was previously used. This exam has been checked by experts. procedure enhances validity by providing a check on whether the competence level of the candidate body has changed. The IBLCE exam has a low failure rate, yet the highest The Critique Form scores are typically in the mid-80% range and the mean IBLCE is unusual in that we give you a Critique Form to scores in the low to mid-70% range. This result demonstrates use during the exam. Comments on individual questions a well prepared, well screened candidate body and a should be restricted to those which you have good reason challenging exam. to believe may be faulty and must include an explanation or they will not be collated and considered by the Post- Exam Review Committee. You should also state which answer you chose - many comments merely tell us why an incorrect answer is incorrect. Your comments are entirely optional and will not affect your individual score in any way. 26 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 28. SAMPLE EXAM QUESTIONS These sample questions are indicative of the types of questions you can expect in the exam. They are not representative of the overall degree of difficulty, so “passing” this exam is not an indication that you are ready to pass the IBLCE exam. These questions are from old exams and more likely to be easier because they are testing more basic knowledge. The number and letter in brackets after each question indicates the Chronological Period and the Discipline on the Exam Blueprint. The answers are shown in a box at the end. 1. A woman interrupts your breastfeeding class to ask you 5. The definitive symptom of incorrect positioning of a baby about breastfeeding an anticipated adopted baby. She has at the breast is: been using an electric pump and has generated a a. nipple pain. 30 ml (1-oz) per day supply. What should you do b. irritated, inflamed nipple epithelium. FIRST? c. stabbing pain when the baby latches on. a. Praise her for her interest and offer to meet with her d. a compression stripe across the nipple. later to discuss it further. e. blanching of the whole nipple after feeding. [6-L] b. Ask how she plans to provide nutrition for the baby 6. You are a lactation consultant in private practice. A beyond her own 30 ml (1-oz) per day production. mother reports that she feels rejected by her 2-week old c. Thank her for attending and ease her out the door as infant's refusal to breastfeed, and she wants to hit him. quickly as possible. How should this conversation be handled for d. Inform her that it is unlikely she will bring in more documentation purposes? milk. [1-G] a. Do not write any notes, since they can be subpoenaed. b. Write her statement as a quote and urgently phone her 2. A pregnant woman contacts you after attending a prenatal doctor or an appropriate social service agency. class on infant feeding. The instructor has been very c. Contact a lawyer. positive about breastfeeding, but emphasised that d. Take written notes and require that the mother initial lactation hormones may affect sexual functioning. You them. [12-J] should tell her that lactation hormones usually: 7. A mother had been expressing to maintain her milk a. reduce libido. supply for her very sick baby. You have been seeing her b. increase libido. weekly and her son is now 4 months old and has been c. reduce vaginal lubrication. hospitalised since birth . When told three days ago that d. increase vaginal lubrication. her son would be in hospital for a year, she stopped e. do not affect libido or vaginal lubrication. [2-B] expressing. You should: a. begin intensive counselling to convince her to 3. Which of the following techniques minimises the risk of relactate. causing nipple trauma? b. discontinue meeting with her. a. Position the infant on his back in his mother’s arms c. meet with her a final time to explain how to dry up her and elicit the rooting reflex; when the infant turns his milk. head, place the nipple in his mouth. d. send her a leaflet on breastfeeding, bringing her b. Support the breast using the first and second fingers attention to drying up one's milk. on either side of the areola. e. continue to meet with her until both of you feel c. Prevent the nipple from coming in contact with the comfortable with ending the appointments. [9-G] infant’s soft palate to decrease the incidence of tongue 8. A mother contacts you complaining of overall aching and thrusting. fatigue and has a fever of 39.4oC (103oF). Her breast is d. Position the infant so that his entire body faces the sore and has red streaks. Her baby refuses to breastfeed. mother, and much of the areolar tissue is in the infant's The MOST important thing you should advise her to do mouth. [5-L] is: a. go to bed and get plenty of rest, arranging for the 4. The MOST advantageous moment for the first breastfeed father to give the baby a bottle of formula at night. of a premature infant is when the baby is: b. breastfeed frequently, offering the affected side first. a. awake and in an alert state. c. see her doctor to discuss antibiotic treatment. d. offer the unaffected breast only. [12-E] b. crying from a recently performed procedure and needing comfort. 9. For babies, objects and people do not exist when out of c. relaxed, peaceful, and drowsy. sight. In which of the following age ranges is this d. in a deep sleep and unable to resist an attempt to put perception most likely to change? the breast into his mouth. [4-L] a. 3-5 months b. 6-9 months c. 10-13 months d. 14-17 months [10-H] IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 27
  • 29. SAMPLE EXAM QUESTIONS (continued) 10. A mother is found to be HIV positive as a result of NEGATIVE STEM artificial insemination. She breastfed her baby, who is now 6 months old, for the first 6 weeks. The child will QUESTION CONSTRUCTION MOST likely have: The following questions are samples of certain kinds of a. no symptoms of AIDS and no HIV antibodies. construction forms with which some candidates may be b. no symptoms of AIDS but may have HIV antibodies. unfamiliar. Because this type of question requires a c. symptoms of AIDS and no HIV antibodies. “mental shift” to think in negative terms after d. symptoms of AIDS and HIV antibodies. [9-D] answering a series of positive questions, candidates sometimes interpret them as ambiguous or tricky. However, in spite of these concerns, the construction 11. The mother of a 19-month-old baby is concerned because forms below are psychometrically valid and they he wants to breastfeed at naptime and bedtime, and he represent skills that lactation consultants use. As appears to have little appetite for other foods. The doctor familiarity and practice may help allay candidate considered him to be very healthy at his concerns, these questions are grouped according to 18-month check-up, but the mother still worries that his three common construction types. Work through them continued breastfeeding is preventing him from eating carefully and the interpretation shift will become enough solid foods. Your BEST response is that: evident. You will be alerted to the groups of negative a. toddlers who drink too much milk and do not eat stem questions on the exam and you should take special enough solid foods can develop “milk anaemia.” care to make the mental shift. b. many toddlers have small appetites, whether they are weaned or not. c. human milk is all he needs. The “NOT” Construction d. human milk has very little nutritional value for a 13. A 9-day-old infant with cleft palate defects should NOT 19-month-old child. [11-H] be positioned for feedings with its body: a. in the cradle or across the front position 12. You are working with an obstetrician in conducting a b. semi-upright or upright study of pregnant women who have inverted nipples. The c. in the clutch/underarm position study requires photo documentation of the women's d. prone [6-E] breasts. What is the MOST appropriate legal and ethical procedure in taking these photographs? 14. Which of the following is NOT a developmental indicator a. Obtain written release from the women before for introducing solid foods? photographing them. a. baby shows interest in table foods b. Obtain written release from the women after b. baby has the fine motor skills to grasp food with the photographing them. thumb and fingers c. Obtain written release from the women only if the c. baby swallows without tongue protrusion photographs are to be submitted for publication. d. baby can hold and drink from a cup with few d. Offer written assurance to share any royalties from the spills [9-H] use of the photographs. [2-J] 15. Which of the following is NOT a part of normal sucking technique? a. tongue darting in and out b. tongue covering the gum line A Statistical Report on the most recent c. tongue curved around the breast exam is published each year d jaws rhythmically compressing the areola e. lips flanged [5-L] by IBLCE’s psychometrician, Dr. Leon Gross. 16. Which of the following foods is NOT a good source of calcium? The report can be read on the IBLCE a. natural cheese web site and is updated each year, b. red meat c. almonds usually in early December. d. dark green, leafy vegetables [12-C] www.iblce-europe.org 28 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 30. SAMPLE EXAM QUESTIONS (continued) The “LEAST likely” Construction The “EXCEPT” Construction 17. A mother contacts you because she is concerned that her 21. Actual drug passage to breast milk is dependent upon all 3-month-old baby is suddenly waking up more frequently of the following EXCEPT: at night, in spite of being breastfed at least every 3 hours a. milk pH during the day. Which of the following would be the b. drug teratogenicity LEAST appropriate response? c. drug solubility a. “The baby may be experiencing a growth spurt.” d. drug ionisation e. lipid solubility [12-F] b. “The baby may be experiencing the discomforts of early teething.” 22. You should expect breastfeeding problems with a baby c. “The baby may have a chronic or low-grade who has a cleft defect to include all of the following infection and should be examined by the doctor.” EXCEPT: d. “The baby does not need feedings at night at this a. forming a seal age, and is using you as a pacifier.” [8-G] b. maintaining a vacuum c. positioning his tongue over his gum line 18. After several years of planning, a hospital will be d. preventing aspiration [6-E] implementing a new breastfeeding protocol. Which of the 23. All of the following can be responsible for suboptimal following components of the protocol is LEAST likely to milk production EXCEPT: promote breastfeeding success? a. short frequent feedings a. early initiation of breastfeeding b. insufficient mammary glandular tissue b. progressive lengthening of time at the breast c. lower than normal prolactin level c. night-time breastfeeding d. retained placental fragment. [12-B] d. supplements only when medically indicated [5-M] 19. A mother, 4 months postpartum, has a large lump at the 12:00 position on the areola. She can express a yellowish, EXAM STRATEGIES thick fluid from the corresponding nipple pore. The LEAST likely cause of this lump is: Both the morning and afternoon sections are three hours each. This is sufficient for even slow test takers and a. a plugged milk duct candidates doing a the exam in a second language to b. a galactocele finish. During the afternoon session there will be c. a neoplasm 75 questions that correspond to clinical photographs d. an abscess [9-E] in the exam booklet. There are no penalties for incorrect answers, so attempt 20. A woman is ready to be discharged from the hospital. She every question, even those of which you are not sure. will be returning to work when her baby is 8 weeks old. This strategy will increase your chance of passing and She wants to express milk at work and have her milk fed prevent mismatching subsequent questions with the to her baby by her childcare provider. She asks you what wrong numbers on your answer sheet. You may mark in she can do during those first few weeks to promote a your test booklet the questions you wish to reconsider smooth transition back to work. Which of the following and return to them later. If you change an answer, be suggestions is LEAST likely to help her? sure to erase your original answer completely. a. Try to arrange a longer maternity leave. Questions with a negative stem construction (see b. Be sure that she has a childcare provider who is samples on this page) are grouped together on the exam supportive of breastfeeding, and that she freezes with a note advising you when they start. These are not some extra breast milk for the first few days when trick questions, but they need careful attention. her return to work will likely cause her milk Questions are not arranged in order of difficulty or supply to diminish. subject matter. Therefore, you can work out how many c. Breastfeed the baby exclusively for 4-6 weeks questions you should complete within a chosen time and then start bottle-feeding expressed breast milk interval and pace yourself accordingly. several times per week, so that the baby will take a bottle when she leaves. d. Introduce the bottle during the first week in order 23. a 22. c 21. b 20. d 19. c to accustom the baby to it. [5-H] 18. b 17. d 16. b 15. a 14. d 13. d 12. a 11. b 10. b 9. b 8. c 7. e 6. b 5. a 4. a 3. d 2. c 1. a ANSWERS TO SAMPLE QUESTIONS ANSWERS TO SAMPLE QUESTIONS ANSWERS TO SAMPLE QUESTIONS ANSWERS TO SAMPLE QUESTIONS IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 29
  • 31. AFTER THE EXAM NOTIFICATION OF RESULTS RETEST POLICY FOR UNSUCCESSFUL Your official exam result will be mailed to you in mid- CANDIDATES October. When we send your Candidate Admission Ticket, There is no limit to the number of times an unsuccessful we will tell you the exact date on which the results will be candidate may apply to retake the IBLCE certification exam. sent out. On this date we will also place a pass-fail list on the To be eligible to do the exam again, a candidate needs to website, with your own result identifiable only by a personal meet current eligibility requirements, submit another code we issue to you. application, and pay the relevant exam fee. If the supporting No exam results are available before this date, nor can documentation is still up-to-date it will not need to be they be provided at any time in response to phone resubmitted. enquiries. All results are mailed on the same day, although they will inevitably be received over a period of days. FUTURE EXAM DATES Exam results for any candidate with an incomplete file The IBLCE exam is held annually, always on the last (e.g. documentation not submitted) will not be released Monday in July, concurrently at multiple sites worldwide. until the file is complete. With your official exam results, you will receive information MAINTENANCE OF CERTIFICATION CERTIFICATION on your performances in each of the Disciplines and If you pass the exam, you may use the title “International Chronological Periods. This information may help you to Board Certified Lactation Consultant” or the letters “IBCLC” identify your strengths and weaknesses and to focus future for a period of five years after you pass the examination. study. If you pass, you will also be sent your IBCLC Make an effort to learn these letters correctly and to use them certificate and The IBCLC Handbook, which includes as your title and after your name. You may see reference to information about recertification. the designation RLC (Registered Lactation Consultant); this is applicable only in North America. IBLCE keeps lists of currently certified IBCLCs and reserves the right to provide verification of certified individuals. Initial certification is effective from the date of notification Scores, and the names of candidates who fail, are strictly until the end of October in the fifth calendar year following confidential to IBLCE and will not be released to anyone certification. else. Before the end of this five-year period, you must recertify either by passing the exam again, or through a recertification application showing 75 Continuing Education Recognition APPEALS POLICY Points (CERPs). All appeals against the IBLCE examination must be sent to Ten years after you last passed the exam (and five years after IBLCE in written form, and with supporting documentation, CERP recertification), you are required to do the exam again postmarked no later than 10 November in the same year. A for recertification. The IBLCE has determined that this is the signed critique form, lodged at the time of the examination, is best way to ensure continued competence of IBCLCs, and the sole basis for appeals against exam content and will be hence to protect consumers. considered during the post-exam analysis, before final scoring of the exam. About a year before your certification is due to expire, we will send you current information and application materials - Candidates can not review their exam materials under any if we have your current address. The IBLCE also publishes a circumstances. The IBLCE cannot delete a question for an newsletter The IBCLICK! to keep IBCLCs informed and individual candidate without deleting it for everyone and re- posts regular updates on the www.iblce-europe.org website. scoring the exam, and individual scores cannot be adjusted because of hardship or other circumstances. However, a Please note: updating your address with your professional candidate whose exam performance was genuinely association will not update it with IBLCE. You need to disadvantaged by circumstances outside her/his control advise us directly of any change of address, by phone, mail or should make the relevant IBLCE office aware of the email. situation, preferably soon after the exam, but no later than JOIN YOUR PROFESSIONAL 10 November in the same year. ASSOCIATIONS If a candidate fails the exam she/he may request that her/his answer sheets be hand scored for the fee advised in the The IBLCE urges IBCLCs to join ILCA (The International applicable candidate materials. If an error was made in Lactation Consultant Association), VELB (The European machine scoring the candidate’s exam, the candidate’s score Association for Lactation Consultants) and the appropriate will be corrected and the fee for hand scoring will be professional association/s in your country. By becoming an refunded. All requests for hand scoring must be postmarked IBCLC, you become part of a local, a national and a global on or before 10 November in the same year. community. The IBCLC is the one credential that is recognised by all national and international professional (Appeals against CERPs recertification decisions must be associations. You can meet and communicate with others sent to IBLCE in written form, and with supporting who share your credential and your interests. And, as part of documentation, postmarked no later than 30 days after your continuing professional education at conferences, notification was mailed to the IBCLC.) seminars and meetings you can share your passion about this wonderful field. 30 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU
  • 32. SUMMARY OF IBLCE EXAM ADMINISTRATION PROCEDURES 1. INQUIRY: You make an initial inquiry about the IBLCE exam. We send you the Candidate Information Guide and the Application Supplement specific to the exam year and your country. If you decide to do the exam in another year, you will need to request the Application Supplement for that year. 2. APPLICATION: You complete all pages of the application form and enclose photocopies of the necessary documentation. You send it to us with the appropriate exam fee, postmarked by the early, standard, or late deadlines. Closing dates are strictly adhered to. You keep a photocopy of your application. We check that your application is complete, establish your file on the database, and determine your eligibility. We confirm information on request. Incomplete applications are followed up and additional fees charged. Applications are processed in the order in which they are received. In busy periods, it may take three to four weeks before your application is processed. We will contact you if there is any problem with your application and we will notify ineligible applicants. In early July candidates with complete files who meet eligibility requirements will receive the admission package, confirming eligibility, acceptance, exam site allocation and a receipt for exam fees received. However please feel free to contact us any time before early July if you have questions. 3. CHANGES/ERRORS: Check the accuracy of your name and address on correspondence you receive from us. Be sure the spelling and presentation of your name are as you wish them to appear on your certificate, and that the address is correct for receiving your exam results. Please notify us in writing of any changes or corrections. We update your entry on the database, if there are changes or corrections. Candidate details in the database are used to coordinate administration and organisation of the exam. They are confidential to IBLCE and are never released to any other organisation. 4. SITE ALLOCATION: Your site allocation is noted in your admission ticket. In case a change of site becomes necessary, we will contact you as soon as your application is assessed. If you want a site change, please inform us immediately. Candidate numbers at each site determine the size of the exam room, the number of proctors contracted, and the number of exam materials dispatched. If you request a site change after the end of June, we may not be able to accommodate you. Initially, we place each candidate at the exam site stated on her/his application form, but we note any preference for a more convenient site. Once candidate numbers are finalised, decisions are made about which sites, if any, must be cancelled or moved and whether we will offer additional sites. If your choice is affected by a cancellation, or if a site closer to you is offered (even if you did not request it), we send you notification of the proposed change. 5. ADMISSION PACKET: Early in July, you should receive your exam admission packet containing your admission ticket, information about the exam site and its location, including transport and parking details, exam rules and arrangements for the day and a receipt for fees. 6. SEND OUTSTANDING DOCUMENTATION: If you had incomplete BC or education hours at the time of your application, you must complete these hours before the exam. You send us the documentation of completion, preferably before the exam, but in any case no later than 2 weeks after the exam (or your results may be delayed). 7. EXAM ADMINISTRATION AND SCORING: You sit for the exam. We send your answer sheets to be computer scored by IBLCE’s psychometrician. This process is time consuming, since the validity of each question is checked by a number of procedures. The Exam Review Committee meets and some questions are deleted from scoring before all answer sheets are re-scored. The exam as a whole is also validated. 8. EXAM RESULTS: We mail your exam results to you in mid October. We mail all pass and fail letters on the same day, but experience has shown that some candidates receive their letters on a different day to other candidates, even in the same city. If you did not complete your BC or education hours before the exam, or if you did not send the documentation to us, your exam results will not be issued. If you have failed the exam, we send you your score report; your details remain confidential to IBLCE. If you have passed the exam, we send you your certificate, score report, and your copy of The IBCLC Handbook. We will also send you your IBCLC ID card when produced and a copy of The IBCLCK! newsletter. IBLCE Exam - Candidate Information Guide, version 2.9EU www.iblce-europe.org 31
  • 33. IBLCE DISCIPLINE PROCEDURES PREAMBLE Privilege to Practice. An IBLCE Certificate is a conditional privilege which is revocable for cause. It confers no vested right to the holder thereof. Generally. The IBLCE Board has the inherent authority and duty to prescribe a Code of Ethics for its Certificants, to determine what constitutes grounds for discipline of its Certificants and those persons applying to take any IBLCE examination, to discipline its Certificants and Applicants for cause, and to limit, suspend or revoke the certification of every IBLCE Certificant or the eligibility for certification of every IBLCE Applicant whose unfitness to practice as a lactation consultant has been duly established. These procedures apply to: (1) any and all persons currently certified by the IBLCE; (2) any and all persons who were certified by the IBLCE at the time of the acts or omissions complained of, whether or not they remain certified when the procedures are applied; (3) any and all Applicants for any IBLCE Examination (provided they were Applicants at the time of the acts complained of); and (4) any and all IBLCE Certificants and Applicants in relation to acts or omissions complained of which occurred prior to their becoming IBLCE Applicants or Certificants provided the Complaint alleges: (a) conviction of a crime; (b) misconduct that reflects on the Respondent’s honesty or trustworthiness, such as in cases alleging conduct involving dishonesty, fraud, deceit or misrepresentation; (c) misconduct due to disability (Article XXIII); or (d) any other misconduct which would warrant suspension or revocation of certification of an IBLCE’s certification pursuant to the Guidelines for Imposing Sanctions set forth in Article VIII of the IBLCE Procedures for Discipline in effect at the time of the misconduct which is the subject of the Complaint. (Effective: 1 January 2007) www.iblce-europe.org www.iblce- This is the address for the regional IBLCE website. ... where you can find further information about the IBLCE, the exam, recertification and CERPs, and where you can download this Guide and the Application Form. … where you can find out about some of the programs, courses, modules and discussion meetings where you can earn CERPs. … where you can find out more about the IBLCE administrative team, and see photos to help you put faces to names. ... where you can find the number of currently certified IBCLCs in each country. ... where you can find the latest information in the news section. … where you can read the most recently published Statistical Report on the IBLCE exam. ... where you will find links to the lactation consultant professional associations. IBLCE Recognition Statement about Mother-to-Mother Support Organisations Mother-to- The International Board of Lactation Consultant Examiners recognises the critical role served by mother-to-mother support organisations such as La Leche League and the Australian Breastfeeding Association in support of mothers and babies in the initiation and duration of breastfeeding. These organisations also serve a vital role in providing the experiential base for developing the breastfeeding expertise of mother-to-mother support group leaders/counsellors and lactation consultants. In addition, these organisations provide essential continuing education for leaders/ counsellors/lactation consultants and others, disseminating knowledge and information based upon empirical research and clinical experience. 32 www.iblce-europe.org IBLCE Exam - Candidate Information Guide, version 2.9EU