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How to Deal with Case “Studies” on the IBLCE Exam

How to deal with IBLCE Exam’s cases studies

Many frantic test-takers have heard about the IBLCE Exam’s case studies. They’ve heard there are very difficult questions attached to “case studies.” First, I believe these case “studies” would be better described as short case scenarios or case reports. Don’t worry about wading through a lengthy, detailed case study. But since seemingly everyone seems to call them case studies, I’ll stick with that term for the moment.

Whatever you call them, you should know how to prepare for them. Here are my suggestions.

Know the format

On my recent exam, I was presented with two case studies. Each had one “exhibit” which consisted of three components. (The test-taker can click on each component.)

  • First was a relatively brief history of the mother’s pregnancy and delivery. (I would estimate the “brief” description as fewer than 500 words or so.)
  • Second was a relatively brief history of the baby, since his birth.
  • The third component consisted of a few sentences describing where the IBCLC’s role fit into the situation.

Be prepared for various types of data collected by others

The IBLCE Exam’s cases studies provide information that has been collected by others on the healthcare team.

Anything you’ve ever seen as related to “history” is fair game on the clinical scenario. Be prepared to read and understand any and all data collected and recorded in the medical record as related to this birth. That might include labor/delivery details, Apgar score, vital signs, bilirubin level, body mass index, medications administered, and anything else you’ve ever read in a medical record.

Additionally, you should be prepared to read and understand interview data (e.g., the mother complains of “burning and itching”). Such interview data might be what you’ve learned from the client, or what has been recorded by others. Information on any or all past medical, surgical or psychosocial history, is, in my view, all “fair game” for these case studies.

Distinguish normal from abnormal data

In my view, the IBLCE Exam’s cases studies force the candidate to know what’s normal, and what’s not. For me, information that is NOT within normal limits (WNL) or parameters (WNP) immediately jumps out. So, I jot that information on my dry erase board. For example, perhaps I see that the mother had a normal spontaneous delivery and an estimated blood loss (EBL) of 750 ml after a vaginal delivery. That raises a red flag for me. I jot down:

  • NSD, EBL 750 ml

This data may or may not pertinent to the problem I may be asked to solve, but it would jump out at me, since the amount exceeds what I’ve seen hundreds or thousands of times.

(Full disclosure: I did NOT encounter the examples mentioned here when I took the real exam.)

Know normal parameters across time

Not only will you need to recognize normal data in IBLCE Exam’s cases studies, you’ll need to know what is normal at different times. What’s normal for a baby at 2 hours of age is not necessarily normal at 2 days, 2 weeks, 2 months, or 2 years of age. Normal intake, normal output, and various other data differs as the baby gets older. (Or, as the mother is further along postpartum.)

So, for example, a baby who has one wet diaper on the first day is probably just fine. But the baby who is 7 days old and has only one wet diaper in a day is not fine at all.

Distinguish pertinent from non-pertinent data

You know this from real life, right? Often, you find data that is interesting, either from the medical record or from the client herself, but not relevant to solving the problem at hand. The competent practitioner can distinguish between what’s relevant, and what’s extraneous.

You’d need to know the symptoms that would accompany the ailment

The IBLCE Exam’s cases studies will require you to know feeding-related stuff AND any other symptoms or relevant data. Let’s say the baby has a cleft defect. You might get a test item where you’d be required to know that clefts are often associated with otitis media.

Interpret the meaning of changing data

Not infrequently, what has occurred on the first day might be very different — better or worse — from what occurs on the third day. Therefore, how you might have managed the baby on Day 1 is not necessarily appropriate on Day 3.

Recognize risk factors

I honestly can’t recall one of the IBLCE Exam’s cases studies posing a question such as, “Which of these is a risk factor.” But in order to know how to manage the case, I might need to recognize that a risk factor was present, and that it has or has had an impact on the current situation.


You’ve heard me harp and harp on terminology! I can think of two ways in which IBLCE Exam’s cases studies could test your ability to know your terms. First, the medical term might be listed on the exhibit. Second, I could imagine that they might ask a question where you needed to translate medicalese into lay terms as you are counseling or teaching parents.

Let’s say that the mother has a history of luteal phase defect. If you don’t know what that is, and if you don’t know how it impacts breastfeeding and lactation, it’s unlikely that you’ll be able to answer the question.

Relate multiple observations to the whole situation

As the old saying goes, the whole is greater than the sum of its parts. That’s good advice when dealing with the IBLCE Exam’s case study  questions.. Let’s say the mother is experiencing flu-like symptoms. It’s flu season, and she says she feels like she’s coming down with the flu. Your first inclination might be to provide anticipatory guidance about breastfeeding while she has the flu. However, you then realize that the mother is a diabetic and is nursing twins. You realize that those two factors put her at increased risk for mastitis, so your priority is for further assessment of her breasts.

Be ready to figure out what’s going on in the photo

Anything is fair game here. Anything! You might need to recognize important data related to skin, muscle tone, equipment, latch, nipple damage, or just about anything else! The photo will in some way be related to the exam question. (And the answer!)

Final thoughts on IBLCE Exam’s case studies

I have two take-home messages for you.

First, try not to worry when people tell you that the case studies are so difficult. Although they are time-consuming, I found that the case study questions were easier than many of the other questions on the exam. I do better when I can see whole clinical picture. (Or, as I said earlier, “in context”.)

Second, be happy! If you’ve ever come to one of my courses, you’ve heard me harp on the criticality of the clinical “so-what?” No worries about memorizing this information, because this is where your clinical acumen will likely get you through.

How prepared do you feel to handle the IBLCE Exam’s case studies? Tell me in the comments below!

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