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Focusing on IBCLC Exam’s Global Perspective

Hand on globe

I’ve had candidates tell me, “Wait, Marie! That’s not how we do it in my hospital!” Nope, probably not. Nor in any hospital I’ve ever worked in. But be forewarned: being aware of the IBCLC® exam’s global perspective is a strong key to passing the exam.

What’s normal, what’s not

I can guarantee that your hospital has a newborn hypoglycemia policy or protocol. It specifies some magic number as signaling hypoglycemia.

Let’s say the IBLCE gives a question on hypoglycemia. You pick an answer based on a magic number — maybe 40 is what your hospital calls “normal.” But the IBCLC exam’s global perspective doesn’t assume that. Why so?

There is no research to confirm that 40 is normal. To the best of my knowledge, this “normal” question was first raised in Cornblath’s 1956 study. In 1997, the World Health Organization (WHO) came out with a massive review of the existing literature, and basically said, we don’t know a number for “normal”.

Then, more than 40 years after his original study, Cornblath published a compelling review of the literature emphasizing that since we don’t know a number that defines newborn euglycemia we therefore don’t have a number that defines hypoglycemia.

More recently, the Academy of Breastfeeding Medicine’s protocol says, “The definition of hypoglycemia in the newborn infant has remained controversial …” and “Current evidence does not support a specific blood concentration of glucose that correlates with signs or that can predict permanent neurologic damage in any given infant.”

What’s the “right” clinical management?

The discussion about hypoglycemia might help you to understand how the definition of “normal” informs clinical management.

So, for example, what about holding a baby NPO before a circumcision? (Check out the Academy of Breastfeeding Medicine’s protocol.) What about using human milk for non-feeding purposes? Any of this and much more is fair game for the IBLCE exam.

What about weaning recommendations? How we do it here in the United States has little or no scientific basis. Be prepared for questions about how much milk on older baby really needs. Breastfeeding in public continues to be an issue that makes headlines. And weaning, whether recommended by a doctor, or led by mother or baby is still a point of discussion from a global standpoint.  

What’s biological rather than social

Here in the United States, we presume that practices like artificial birth control are not only available, but also necessary, normal, and superior to other practices. But as you approach the test, you’ll need to adopt the IBCLC exam’s global perspective.

In non-US countries, natural practices such as the Lactational Amenorrhea Method (LAM), championed by the late, great Miriam Labbok, are the social norm. Here, LAM is often scoffed at and presumed to be ineffective. But research on thousands of women, including a 3-part series published by the WHO has shown otherwise.

Recommendations of Public Health Authorities

So you know this could be an all-day discussion, right?

Here’s the most glaring example I can think of. Having attended a US-based course only a few months prior to my first exam, I had learned that if the mother is HIV positive, she should not breastfeed. Period. End of story.

Imagine how stunned I was to find more than one test item on HIV. Worse still, it was the first item on the exam. My test-taking confidence was immediately shot. (And my confidence in the course I had taken was shot, too.)

In preparing my all-online 95-hour course, I made a big effort to help attendees look at differences in US-based recommendations versus global recommendations. Partly because I know that’s a key to passing the exam. But partly because I believe that public health recommendations here will change someday.

What about medications and technology?

Yeah, whether people are taking my all-online 95-hour course for exam eligibility or reviewing for a first-time or certification renewal, they worry about knowing some technology that rolled out of the factory yesterday or a medication the FDA approved last Tuesday.  

First, remember that the FDA is irrelevant, because of the IBCLC exam’s global perspective. Second, it’s likely that many countries do not yet have the new piece of equipment or the new drug.

Instead, I encourage test-takers to know generic names of drugs (because the trade name isn’t relevant in a global environment, right?) and to be prepared for exam items that address non-technological aspects like hand expression.

What about me?

I am entirely comfortable with the fact that I’m American. I’m a nurse. I’ve done the vast majority of my clinical work in a hospital. In short, I can only come being who I am.

But I’ve taught my courses to thousands of attendees on 6 continents. When I prepare a course, I make a concerted effort to continually address the IBCLC exam’s global perspective. I teach my students to think globally.

Have you taken steps to make sure your course gives you a global perspective? How are you preparing to think beyond your immediate surroundings? Tell me in the comments below!

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