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Certified Breastfeeding Counselor CBC
Questions and Answers, 2025 Update.
Where does breast tissue normally develop? - Correct answer Along the breast line
- located from under the arms down to the groin What are the 3 stages of early breast development? - Correct answer 1. In utero
- First 2 months of life
- Puberty Breast development during menstruation - Correct answer - Estrogen: Induces Ductal System development
- Progesterone: Induces Lobular-Alveolar development What is Lactogenesis? - Correct answer The initiation of milk production How many stages of Lactogensis are there? - Correct answer 4 What stages of Lactogenesis occur during pregnancy? - Correct answer 1 and 2 Lactogenesis 1 - Correct answer Ductal and Lobular-Alveolar systems grow at an accelerated rate (influenced by hormones)
- breasts enlarge
- high progesterone levels cause an increase in alveoli
- colostrum begins to produce in the alveoli When does Lactogenesis 1 occur? - Correct answer around 16 weeks
Lactogenesis 2 - Correct answer The placenta is released from the uterus and progesterone levels drop
- this causes the alveolar cells to begin to release milk and allows them to continue to produce more milk How long does Lactogenesis 2 last? - Correct answer 2-4 days What are the 5 main areas of the breast? - Correct answer - Upper Inner
- Lower Inner
- Upper Outer
- Lower Outer
- Tail of Spence What are the 2 types of breast tissue and what are they composed of? - Correct answer - Parenchyma: ductal and lobular- alveolar structures
- Strom: connective tissue (fat, vascular, nerve, lymphatic) What is an Alveolus - Correct answer Small cavity where milk is produced and stored
- made of epithelial cells What are Alveoli? - Correct answer multiple alveolus What is the Intra-lobular duct? - Correct answer Connects a lobule to the lactiferous ducts What is a Mammary Lobule? - Correct answer 10-100 alveoli combined together What are Lactiferous Ducts? - Correct answer connects mammary lobules/intra-lobular ducts to the nipple Breast Anatomy - Correct answer
- the resupply of mature milk that occurs when milk is removed from the breast When does Lactogenesis occur? - Correct answer day 10- postpartum
- when mature milk is established
- lasts until mom is ready to wean from breastfeeding Lactogenesis 4 - Correct answer involution
- milk production is decreased by apoptosis of the milk making epithelial cells What are the 2 main hormonal influences of breastfeeding? - Correct answer Prolactin and Oxytocin What is the job of Prolactin? - Correct answer Milk production Where is prolactin released? - Correct answer the anterior pituitary gland into the blood stream to the alveoli What is the main inhibitor of prolactin? - Correct answer progesterone When is prolactin released? - Correct answer When the placenta detaches, progesterone levels decrease and prolactin levels increase What are some other purposes of prolactin? - Correct answer - keeps alveoli glued together
- inhibits ovulation Remaining fragments of placenta can cause what problem in breastfeeding? - Correct answer delay/decrease the release of prolactin
What is the job of oxytocin? - Correct answer milk release (the let- down reflex)
- tells the myoepithelial cells (and the uterus) to contract and move milk to the ducts and out the breast Where is oxytocin released? - Correct answer the posterior pituitary gland via many stimuli Name some of the stimuli used to release both Oxytocin and Prolactin - Correct answer - nipple stretching
- massaging the breasts
- Seeing/Touching/Smelling/Hearing the infant How often does the let-down reflex occur? - Correct answer several times during a feeding What are some signs of Prolactin/Oxytocin release? - Correct answer cramping Thirst Leaking Pins and needles Increased bleeding Sleepy Sometimes, nothing Does stress play a role in hormone release? - Correct answer stress can inhibit hormonal release
- high levels of cortisol/catacholamines reduce oxytocin and prolactin levels List some ways to reduce stress for breastfeeding - Correct answer remove visitors Turn lights out Skin to skin Sleep
- milk synthesis works by supply/demand, most important regulatory mechanism is frequent thorough removal Baby is properly latched on when - Correct answer juncture of hard/soft palates Reasons for baby prefering one side - Correct answer clavicle fracture, cephallhematoma on one side, subtle positioning Most common cause of inadequate supply - Correct answer inadequate or infrequent milk removal
- persistent milk stasis suppresses lactation Diet of breastfeeding woman - Correct answer - do not need change, keep normal intake
- woman living under variety of circumstances can breast feed, most components are not related to mother's intake
- should eat enough calories, gain weight within same parameters as if you were not pregnant/breastfeeding Lump in breast not related to lactation - Correct answer if changes size before/after feeds (do not change related to milk flow) Prolonged elevated bilirubin - Correct answer - not pathological
- encourage 10-12 effective feeds per day Most contributing factor of breast abscess - Correct answer prolonged milk stasis Immature sucking patterns - Correct answer short bursts with pauses Mature sucking patterns - Correct answer rapid sucking followed by steady suck swallow Coordinated breathing
Moves smoothly from rooting to latched on 34 weeker struggling to latch - Correct answer due to sleepiness of prematurity and delayed lactogensis from premature delivery Restarting breastfeeding - Correct answer start with skin to skin several times a day PPD and breastfeeding - Correct answer most antidepressants are safe Drug that rapidly decreases in breastmilk after mother stops - Correct answer alcohol Mag sulfate - Correct answer can cause maternal lethargy, drowsiness, confusion and muscle relaxation Standard of practice for breastfeeding counselors - Correct answer clinical practice, breastfeeding and counseling, professional responsibilities, legal considerations AWHONN responsibilities of staff women working with breastfeeding mothers - Correct answer provide education, foster enviornment Support and implement practice, current EBP Preterm and vulnerable patient importance Support groups First organization to provide mother to mother support - Correct answer la leche league 10 steps to successful breastfeeding - Correct answer written policy, train all staff, inform pregnant woman about benefits, initiate breastfeeding (skin to skin early), show how to breast feed, give newborns only breast milk unless otherwise indicated,
Three signs let down has occurred - Correct answer tingling breasts, feeling warmth/fullness, dripping, release opposite nipple, uterine contractions, relief of discomfort Largest component of breast milk - Correct answer water When should initiation occur - Correct answer as soon as mom and baby ready, give uninterrupted skin to skin Last feeding cue - Correct answer crying Cluster feeding - Correct answer 24-48 hrs
- baby is waking up, feeding frequently for short amount of time Basic principle behind breast milk production - Correct answer supply and demand, hand express, do not supplement Growth spurt - Correct answer mother should not supplement, feed frequently on demand Time for newborn to regain birth weight - Correct answer 2- weeks Normal weight for healthy baby during 3-4 days of life - Correct answer 5-7 oz Minimal output - Correct answer one diaper per day of life until milk comes in Recommended caloric intake for breastfeeding woman - Correct answer 2700 calories, most consume 2200, min. Is 1800 Easy nutrition for lactation - Correct answer cheese, yogurt ,fresh fruit, raw veggies, nuts, hard boiled eggs, whole grains, fluids (helps w/ dehydration), 400 Vit D, no specific diet- well balanced
How many calories needed for milk production - Correct answer 500 calories Assessment considerations with vegan breastfeeding mother - Correct answer b12 needed, can cause muscle weakness/vomiting Ankyloglossis - Correct answer tongue tie- labial/lingual frenulum that restricts movement of lip and tongue Sore nipples - Correct answer feed on less tender first, warm moist compress before, cold after, hand express some and apply to nipple
- lanolin and gel compress also options Predisposing factors to abscess - Correct answer prior mastitis, delay in treatment, non compliance with abx or resistance, abrupt weaning or failure to drain/avoiding affected side Breast engorgement - Correct answer vascular dilation, congestion, accumulate milk, edema secondary to swelling Green cabbage for engorgement - Correct answer apply to decrease swelling, do not use if allergic to sulfa S/S of mastitis - Correct answer red patches on breast, low fever, hard lump (hot/red/tender), achy and run down Mammary candida - Correct answer painful condition (both MOB and baby use treatment) Nipple ointment (mupropion, nystatin, betamethasone) Infant with hyperbili - Correct answer latch on technique, quality, frequency of feeds
Contraindicated medications - Correct answer antimetabolites, radioisotopes, illicit substances Depo provera admin - Correct answer after 6 weeks Birth control methods most compatible - Correct answer progesterone, IUD, barriers Successful weaning - Correct answer mother: drop one pump/feed per week Baby: 6-9 mo, only breast feed when baby asks Most important criteria for milk transfer - Correct answer audible swallowing How many IU of vitamin D does infant need - Correct answer 400 IU daily Let down = - Correct answer milk ejection reflex Tube called which breast milk travels in breast - Correct answer milk duct At birth full term infant can digest - Correct answer `1-2 teaspoons Breast feeding mother lump in her breast, tender, no fever - Correct answer plugged duct Antiretroviral med for AIDS - Correct answer not safe, use donor breast milk Vegan diet - Correct answer b12 supplement Increase supply - Correct answer hand express after feeds
