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How to Deal with Case Studies on the IBCLC Exam

Black woman sitting at a laptop computer studying.

Many frantic test-takers have heard about case studies on the IBCLC exam and how tough the related questions are! Take a deep breath, this isn’t as daunting as it might seem. You can answer these by understanding just a few main principles.

Don’t be spooked by the term “case study”

First, if you adhere to the technical term of “case study,” as I do, you’re probably feeling spooked by all that might be addressed.

What’s actually on the exam is just a very brief synopsis of clinical events. I might even be willing to call them case reports. But what the exam presents to you does not fit the classic definition of a case study.

So, try not to worry about wading through a lengthy, detailed case study, because that’s not what you’ll need to deal with. But since seemingly everyone seems to call them case studies, I’ll stick with that term for the moment.

Know the format

I suspect the case studies on the IBCLC exam are formatted pretty much the same from one year to the next.

On my last 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.)

  1. First, there 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.)
  2. Second was a relatively brief history of the baby since birth.
  3. 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 case studies on the exam provide information that has been collected by others on the health care 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 birth-related data collected and recorded in the medical record as related. 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, as you approach case studies on the IBCLC exam, 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 (verbally or in writing) by others. Information on any or all past medical, surgical or psychosocial history, is, in my view, “fair game” for these case studies.

Distinguish normal from abnormal data

In general, expect the case studies on the IBCLC exam to force the test-taker 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 pull out the dry erase board they provided so that I could keep track of that. For example, perhaps I see that the mother had a normal spontaneous delivery and an estimated blood loss (EBL) of 750 ml.

That raises a red flag for me. It’s not screaming “danger” but it’s outside of normal limits. On the dry erase board, I scribble:

NSD, EBL 750 ml

These data may or may not be pertinent to the question they are about to pose, but such data would jump out at me, since the amount exceeds what I’ve seen hundreds or thousands of times in clinical practice.

(Full disclosure: I did NOT encounter the examples mentioned here when I’ve taken the real exams.)

Know normal parameters across time

Not only will you need to recognize normal data on case studies on the IBCLC exam, you’ll also need to know what’s 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 also happens in real life, right?

Often, you’ll find data that’s interesting, either from the medical record or directly from the client, 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

Case studies on the IBCLC exam will require you to know feeding-related stuff AND any other symptoms or relevant data.

For example, 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 lactation issues on Day 1 is not necessarily appropriate on Day 3.

Recognize risk factors

I honestly can’t recall one of the case studies on the IBCLC exam posing a question such as, “Which of these is a risk factor?”

But to know how to manage the case, I might need to recognize when a risk factor was present, and that it does have 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 case studies on the IBCLC exam 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 that requires you 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 (or if) it impacts breastfeeding and lactation, it’s unlikely that you’ll be able to answer the question that follows.

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 case studies on the IBCLC exam.

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 are risk factors for mastitis, and many women experiencing mastitis report having flu-like symptoms.

This is an excellent example of how you’ll need to make multiple observations within the context of the whole situation. And, 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!

Historically, people who don’t do well on the text-only part of the exam do worse on the photo items. So I’ve said a little about photo recognition.

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 case studies on the IBCLC exam

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! No worries about memorizing this information, because this is where your clinical acumen will likely get you through.

Are you confident you can handle case studies on the IBCLC exam? Or are you still uneasy about seeing the data, distinguishing normal from abnormal or changing data, photo recognition, risk factors, terminology, extraneous information, signs and symptoms? If so, buy my ever-popular, all Online Lactation Exam Review. There’s something for everyone and everyone’s budget!

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