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What Topics Should You Expect on the IBCLC Exam?

Woman sitting at a library writing while studying.

Are you taking the IBCLC exam for the first time? Or, are you recertifying by exam? In either case, you might be wondering what about what topics could appear on the exam, or if there are new answers to familiar topics. Here are some ideas for what to expect on the IBCLC exam.

Pump and feed

Here in the United States, there is seemingly an epidemic of full-time pumping for healthy, term infants who can suckle. I’d be stunned if pumping was not put on the IBCLC exam this year.

I’ve addressed details of “pump and feed” elsewhere. And I’ve interviewed a leading researcher for this topic on my podcast. I suspect this will break down into:

Truthfully, if I were testing this year (which I’m not!), I’d expect to be pummeled with questions about “pump and feed.”

Microbiobiome and gut hormones

Seemingly everyone these days is talking about the microbiome. I’ve addressed that in several places, including a post, an interview with Dr. Kirsty Le Doare, and an interview with author and filmmaker Toni Harman.

I continue to be surprised that this topic hasn’t shown up yet, so I’m guessing it’s a topic to expect on the IBCLC exam.

Even the phrase “gut hormones” wasn’t on my radar 10 years ago! But in the past few years, I’ve dedicated an entire page in the manual of my comprehensive Lactation Education Course about gut hormones. I cover gastrin, somatostatin, glucocorticoid, cholecystokinin (CCK), and more. Be prepared to have a general idea of what these hormones accomplish.

Bariatric surgery

I’ve never yet seen bariatric surgery on the IBCLC exam, but it’s a topic that could likely appear on the exam.

This goes along with the idea of body image. More than 80% of people who undergo bariatric surgery are women.

I wrote a post on this and conducted an interview with Dr. Allison Childress. I’m sure you would not have seen bariatric surgery on the IBCLC exam 10 years ago but I’d be willing to bet money that, sooner or later, it will show up as an exam item. Eating disorders might also be something to expect on the IBCLC exam.

Exercise and sports

Can’t believe it hasn’t shown up yet. At least not for me, and I’ve successfully taken the exam five times.

The American Heart Association now recommends that adults have at least 150 minutes of moderate exercise each week. Mothers are also adults — and those who try to comply with this recommendation have raised real-life questions to me. So, don’t be surprised if such questions are on the exam. Listen while I give you much more information on exercise before, during and after pregnancy.

Breast reduction and augmentation

Breast reduction surgery is nothing new. In fact, some 30 years ago I lived across from a neighbor who was a breast surgeon who had performed many of them.

Lately, however, it seems to me that there is an increasing need to counsel those who have had previous breast surgery, and then later, tried to lactate. One of my most popular blog posts addresses some of the big questions, and readers have added even more questions.

I think it’s a topic that you should expect on the IBCLC exam, so be fully prepared on the topic.


The World Health Organization came out and said, any breastfeeding is better than none and go ahead and breastfeed if in doubt (more elaborate than that, but that’s the gist of it).

In past years, that has not been their message. Check out my short course that offers CERPs on this topic.

Stay tuned for part two where I’ll highlight a few more topics I fully expect to see on the IBCLC exam.

What do you expect on the IBCLC exam this year? Below, share your thoughts with other test-takers!

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  1. Kimberly Cook

    The thing I was most surprised about was the communication questions. I work as an NFP nurse so open ended questions and MI are familiar to me but many questions seemed to be based on what would you say next to the patient? the easy answer, tell me more. Often as nurses, we want to get the facts, so start asking them questions. But the first statement should usually be a more open ended question. I took test in 2020. Also if you can take at a testing center, I recommend you do so. Remote testing was a nightmare for me and took 7 1/2 hours.

    • Marie Biancuzzo

      Kim, yes, I agree, there seems to be a heavy emphasis on Communication. I do offer a 5-hour communication course but many people aren’t interested because they think, “oh, I’m good at talking to people” so they seek a more “interesting” course. Trouble is, most of the communication test items I’ve encountered are more about listening, and not much about talking! I find that nurses have the toughest time with the communication questions because, as you say, we were all trained to get the facts, and solve the problem! I’d encourage test-takers to carefully read my post on this topic. On remote testing, yes, I wrote a post on that; let me know what you think of it!

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