CERTIFIED LACTATION COUNSELOR UPDATED EXAMS
SCRIPT QUESTIONS AND ANSWERS SURE A+
✔✔Alveoli - ✔✔Small glands in the breast that produce milk
✔✔At-Breast Supplementer - ✔✔a device that allows a supplement to be given while a
baby is actively nursing at the breast,
ex: Supplement Nursing System
✔✔Atopy - ✔✔hypersensitive or allergic state involving an inherited predisposition
✔✔What is the BFHI Baby Friendly Hospital Initiative - ✔✔Initiative by UNICEF and
WHO (1991) to support breastfeeding in hospitals and maternity centers. "The 10
Steps".
Unicef. Baby-Friendly Hospital Initiative. Available online:
http://www.unicef.org/programme/breastfeeding/baby.htm.
✔✔Bilirubin - ✔✔an orange-yellow pigment formed in the liver by the breakdown of
hemoglobin and excreted in bile.
✔✔CCK (cholecystokinin) - ✔✔Hormone that regulates the emptying of the gallbladder
and secretion of enzymes by the pancreas.
✔✔Colostrum - ✔✔Thick, milky fluid secreted by the breast during pregnancy and
during the first days after birth before lactation begins. Causes a laxative effect which
helps the baby pass meconium.
✔✔Coryllos type - ✔✔Classification system for anklyloglossia (tongue-tie)
✔✔Dancer Hand Position - ✔✔Technique used to support Baby's chin and mother's
breast. Use Thumb and index finger under chin, remaining 3 fingers to support breast.
✔✔Alveolar Cells - ✔✔found in the walls of the alveoli, simple squamous epithelial cells,
main sites of gas exchange
✔✔myoepithelial cells - ✔✔contract in response to stimulation by sympathetic nervous
system and squeeze milk up the duct
✔✔Montgomery glands - ✔✔Bumps on breasts (Look like goosebumps)
Produce a unique blend of milk and sebum (skin oil)
✔✔Modern study of the structure of the breast reveals what? - ✔✔-Fat is mixed
throughout the breast
-Uneven spacing of the ducts
,-3-5 functioning nipple pores (May have 5-9, but not all work)
-No lactiferous sinus
✔✔What are the 2 hormones pathways that control lactation? - ✔✔Prolactin and
Oxytocin
✔✔Prolactin (4 details related to milk production) - ✔✔1. is triggered by touch (pregnant
and non pregnant women). Higher levels when stimulating breast/nipples vs breast
alone.
2. Lengthening time between feeding leads to lower baseline levels. (Weaning)
3. levels go down between nursings and rise during nursing.
4. Infrequent nursing leads to lowering of this hormone
✔✔Average number of feeds in a day? - ✔✔8-12
✔✔What produces colostrum? - ✔✔Progesterone in the receptor sites
✔✔What produces more mature milk? - ✔✔Prolactin in the receptor sites
✔✔What happened when infants suckled in the first 2 hours of birth? - ✔✔Ingested
significantly more milk on day 4
✔✔What happened to mother of preemies who initiated milk expression within 1 hour of
birth? - ✔✔Had significantly more milk when measured on days 7 and 42. Better to
stimulate breasts throughout the day right after birth to continue to stimulate production.
✔✔Oxytocin - ✔✔A hormone released by the posterior pituitary that stimulates uterine
contractions during childbirth and milk ejection during breastfeeding.
✔✔What 3 things can trigger Oxytocin? - ✔✔1. Conditioned response
2. Nipple stretching
3. Hand massage
✔✔Conditioned Response from Milk Ejection (Let down) - ✔✔-Example- Mother lets
down when not near baby, but hears a baby cry.
-Conditioned over time
-Faster for women who have BF in the past
-To condition the response can use any sense-smell, touch, sound
✔✔Nipple stretching - ✔✔Only happens with a proper latch
✔✔Hand massage: Baby - ✔✔When we allow babies to be more hands on they can
help control flow rate by how they massage the breast.
,✔✔How many triggers does Oxytocin have? Can it be triggered by stress. - ✔✔3
triggers. Yes.
✔✔What is hormone is triggered by stimulation? - ✔✔Prolactin
✔✔What 3 emotional/behavioral function do the hormones of lactation have besides
making milk? - ✔✔1. Aggression
2. Protection
3. Bonding/trust
✔✔What is special about the composition of milk? - ✔✔1. Mammal species with higher
water content milk feed more frequently.
2. Prolactin triggers production of lactose in the mammary cells.
✔✔What are the different care patterns of mammalian mother's and their babies? -
✔✔1. Nest (eg. puppies, cats) OR cache (deer, rabbit)
2. Carry (monkey), follow (giraffe, bison), or hibernate (bear)
✔✔What kind of milk has the highest lactose of all mammalian milk? - ✔✔Human milk:
high in water, low in protein and fat.
✔✔When does paracellular transport occur? - ✔✔1. In the first few days after birth
2. Mother with low prolactin levels
✔✔When are cells not plump? - ✔✔During paracellular transport
✔✔Transcelluar pathway - ✔✔Substances must go through the milk cell to enter the
milk.
Cells are plump and can no longer go around.
✔✔Why is colostrum easier to suck/swallow - ✔✔Because it is thicker and takes longer
to express from the breast.
✔✔What are the 3 stages of milk making? - ✔✔1. Secretory Differentiation:
Lactogenesis I
2. Secretory Activation: Lactogensis II
3. Lactation: Lactogenesis III
✔✔What happens during Secretory Activation? Lactogensis II - ✔✔Rapid drop in
progesterone, mature milk making is activated
✔✔What happens during Secretory Differentiation? Lactogenesis I - ✔✔Cells grow and
expand
, ✔✔When does breast milk composition change? - ✔✔Can occur:
1. Within a feeding
2. Within a day
3. Over course of lactation
✔✔What happens during Lactation? Lactogensis III - ✔✔Mature milk is being made.
frequent expression of milk
✔✔Preterm milk composition is... - ✔✔Higher in protein, fat, and electrolytes than
mature milk
✔✔What is foremilk? - ✔✔first milk excreted at the beginning of feeding. Does not
always mean low fat.
✔✔What is hindmilk? - ✔✔Milk at the end of the feed. Not always higher in fat.
✔✔When is fat transfer high? - ✔✔When oxytocin levels are high.
✔✔Does a mother need to nurse both breasts in one feed? - ✔✔No. Some babies do
better on one breast per feeding.
✔✔Who regulates the fat intake when feeding? - ✔✔The baby can regulate his fat
intake quickly.
✔✔When is fat content higher? - ✔✔When the flow is faster.
✔✔Can milk fat be different if the baby is male or female? - ✔✔Yes.. Mother's seem to
produce milk that is 25% higher in fat content for males.
✔✔galactorrhea - ✔✔abnormal discharge of milk.
Ex: Men make milk, due to brain tumors or drug side effects (haldol, Thorazine).
✔✔Reasons why BF protects babies from diarrhea? - ✔✔1. pH of the gut is lower.
Bifidus factor promotes growth of friendly bacteria which maintains lower pH in the gut.
2. Low iron in the gut. Organisms need iron to survive! Lactoferrin deprives bacteria of
iron.
3. Hormones and growth factors stimulate growth, development, and motility of the gut.
4. Antibodies (e.g. Secretory IgA [SIgA] which bind to microbes in the digestive tract and
prevent them from being absorbed.
5. WBC kill microbes (e.g. B and T lymphocytes)
6. Cell wall disrupters that kill microbes by destroying the cell walls
7. B12 binding factor. Same result as iron.
8. Mucous also wall protectors which keep bacteria from attaching to the cell wall.
9. Microbes (bacteria from the mother's intestine) from the mother's skin transferred to
baby.
SCRIPT QUESTIONS AND ANSWERS SURE A+
✔✔Alveoli - ✔✔Small glands in the breast that produce milk
✔✔At-Breast Supplementer - ✔✔a device that allows a supplement to be given while a
baby is actively nursing at the breast,
ex: Supplement Nursing System
✔✔Atopy - ✔✔hypersensitive or allergic state involving an inherited predisposition
✔✔What is the BFHI Baby Friendly Hospital Initiative - ✔✔Initiative by UNICEF and
WHO (1991) to support breastfeeding in hospitals and maternity centers. "The 10
Steps".
Unicef. Baby-Friendly Hospital Initiative. Available online:
http://www.unicef.org/programme/breastfeeding/baby.htm.
✔✔Bilirubin - ✔✔an orange-yellow pigment formed in the liver by the breakdown of
hemoglobin and excreted in bile.
✔✔CCK (cholecystokinin) - ✔✔Hormone that regulates the emptying of the gallbladder
and secretion of enzymes by the pancreas.
✔✔Colostrum - ✔✔Thick, milky fluid secreted by the breast during pregnancy and
during the first days after birth before lactation begins. Causes a laxative effect which
helps the baby pass meconium.
✔✔Coryllos type - ✔✔Classification system for anklyloglossia (tongue-tie)
✔✔Dancer Hand Position - ✔✔Technique used to support Baby's chin and mother's
breast. Use Thumb and index finger under chin, remaining 3 fingers to support breast.
✔✔Alveolar Cells - ✔✔found in the walls of the alveoli, simple squamous epithelial cells,
main sites of gas exchange
✔✔myoepithelial cells - ✔✔contract in response to stimulation by sympathetic nervous
system and squeeze milk up the duct
✔✔Montgomery glands - ✔✔Bumps on breasts (Look like goosebumps)
Produce a unique blend of milk and sebum (skin oil)
✔✔Modern study of the structure of the breast reveals what? - ✔✔-Fat is mixed
throughout the breast
-Uneven spacing of the ducts
,-3-5 functioning nipple pores (May have 5-9, but not all work)
-No lactiferous sinus
✔✔What are the 2 hormones pathways that control lactation? - ✔✔Prolactin and
Oxytocin
✔✔Prolactin (4 details related to milk production) - ✔✔1. is triggered by touch (pregnant
and non pregnant women). Higher levels when stimulating breast/nipples vs breast
alone.
2. Lengthening time between feeding leads to lower baseline levels. (Weaning)
3. levels go down between nursings and rise during nursing.
4. Infrequent nursing leads to lowering of this hormone
✔✔Average number of feeds in a day? - ✔✔8-12
✔✔What produces colostrum? - ✔✔Progesterone in the receptor sites
✔✔What produces more mature milk? - ✔✔Prolactin in the receptor sites
✔✔What happened when infants suckled in the first 2 hours of birth? - ✔✔Ingested
significantly more milk on day 4
✔✔What happened to mother of preemies who initiated milk expression within 1 hour of
birth? - ✔✔Had significantly more milk when measured on days 7 and 42. Better to
stimulate breasts throughout the day right after birth to continue to stimulate production.
✔✔Oxytocin - ✔✔A hormone released by the posterior pituitary that stimulates uterine
contractions during childbirth and milk ejection during breastfeeding.
✔✔What 3 things can trigger Oxytocin? - ✔✔1. Conditioned response
2. Nipple stretching
3. Hand massage
✔✔Conditioned Response from Milk Ejection (Let down) - ✔✔-Example- Mother lets
down when not near baby, but hears a baby cry.
-Conditioned over time
-Faster for women who have BF in the past
-To condition the response can use any sense-smell, touch, sound
✔✔Nipple stretching - ✔✔Only happens with a proper latch
✔✔Hand massage: Baby - ✔✔When we allow babies to be more hands on they can
help control flow rate by how they massage the breast.
,✔✔How many triggers does Oxytocin have? Can it be triggered by stress. - ✔✔3
triggers. Yes.
✔✔What is hormone is triggered by stimulation? - ✔✔Prolactin
✔✔What 3 emotional/behavioral function do the hormones of lactation have besides
making milk? - ✔✔1. Aggression
2. Protection
3. Bonding/trust
✔✔What is special about the composition of milk? - ✔✔1. Mammal species with higher
water content milk feed more frequently.
2. Prolactin triggers production of lactose in the mammary cells.
✔✔What are the different care patterns of mammalian mother's and their babies? -
✔✔1. Nest (eg. puppies, cats) OR cache (deer, rabbit)
2. Carry (monkey), follow (giraffe, bison), or hibernate (bear)
✔✔What kind of milk has the highest lactose of all mammalian milk? - ✔✔Human milk:
high in water, low in protein and fat.
✔✔When does paracellular transport occur? - ✔✔1. In the first few days after birth
2. Mother with low prolactin levels
✔✔When are cells not plump? - ✔✔During paracellular transport
✔✔Transcelluar pathway - ✔✔Substances must go through the milk cell to enter the
milk.
Cells are plump and can no longer go around.
✔✔Why is colostrum easier to suck/swallow - ✔✔Because it is thicker and takes longer
to express from the breast.
✔✔What are the 3 stages of milk making? - ✔✔1. Secretory Differentiation:
Lactogenesis I
2. Secretory Activation: Lactogensis II
3. Lactation: Lactogenesis III
✔✔What happens during Secretory Activation? Lactogensis II - ✔✔Rapid drop in
progesterone, mature milk making is activated
✔✔What happens during Secretory Differentiation? Lactogenesis I - ✔✔Cells grow and
expand
, ✔✔When does breast milk composition change? - ✔✔Can occur:
1. Within a feeding
2. Within a day
3. Over course of lactation
✔✔What happens during Lactation? Lactogensis III - ✔✔Mature milk is being made.
frequent expression of milk
✔✔Preterm milk composition is... - ✔✔Higher in protein, fat, and electrolytes than
mature milk
✔✔What is foremilk? - ✔✔first milk excreted at the beginning of feeding. Does not
always mean low fat.
✔✔What is hindmilk? - ✔✔Milk at the end of the feed. Not always higher in fat.
✔✔When is fat transfer high? - ✔✔When oxytocin levels are high.
✔✔Does a mother need to nurse both breasts in one feed? - ✔✔No. Some babies do
better on one breast per feeding.
✔✔Who regulates the fat intake when feeding? - ✔✔The baby can regulate his fat
intake quickly.
✔✔When is fat content higher? - ✔✔When the flow is faster.
✔✔Can milk fat be different if the baby is male or female? - ✔✔Yes.. Mother's seem to
produce milk that is 25% higher in fat content for males.
✔✔galactorrhea - ✔✔abnormal discharge of milk.
Ex: Men make milk, due to brain tumors or drug side effects (haldol, Thorazine).
✔✔Reasons why BF protects babies from diarrhea? - ✔✔1. pH of the gut is lower.
Bifidus factor promotes growth of friendly bacteria which maintains lower pH in the gut.
2. Low iron in the gut. Organisms need iron to survive! Lactoferrin deprives bacteria of
iron.
3. Hormones and growth factors stimulate growth, development, and motility of the gut.
4. Antibodies (e.g. Secretory IgA [SIgA] which bind to microbes in the digestive tract and
prevent them from being absorbed.
5. WBC kill microbes (e.g. B and T lymphocytes)
6. Cell wall disrupters that kill microbes by destroying the cell walls
7. B12 binding factor. Same result as iron.
8. Mucous also wall protectors which keep bacteria from attaching to the cell wall.
9. Microbes (bacteria from the mother's intestine) from the mother's skin transferred to
baby.
