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What’s the Most Difficult Part of the IBCLC Exam?

Brunette woman sitting at table in libary surrounded by books and laptop computer looking into distance.

Not surprisingly, IBCLC hopefuls often ask me, “What’s the most difficult part of the IBCLC exam?”

Here’s my answer: It all depends on how you look at it. I think it boils down to whether you look at it from the standpoint of content, age groups, or format.


The IBLCE Detailed Content Outline shows that the exam will cover 7 different disciplines. I think it’s fair to say that the “most difficult” discipline is the one that you know the least about.

Mind you, those 7 disciplines are further detailed into more than 100 subtopics. And yes, I’d understand if you ask yourself, What the heck does THAT mean? I understand, because I had to really do the deep dive to figure out some of that when I designed my 95-hour Lactation Education Course, because I wanted to make sure I included all of those subtopics.

So, if you’re still wondering which of those disciplines is the most difficult part of the IBCLC exam, here’s what I’d say.

First, I’ve helped thousands of IBCLC candidates on 6 continents to prepare for and pass the IBCLC exam. Many of them have been very verbal about their difficulties!

Second, many have taken my practice exams that give a personalized, computerized analysis of strengths and weaknesses. Many people have also sent me the results of their exams.

From these three sources, I’d say that my clients have had the most difficulty with the pharmacology/toxicology discipline and the pathology disciplines. Mind you, one instructor’s observations do not a research study make! Your areas of weakness might be very different.

Age groups

The IBCLC exam will cover several age groups:

  • Prenatal – maternal
  • Labor – maternal/birth – perinatal
  • Prematurity (including late preterm)
  • 0-2 days
  • 3-14 days
  • 15-28 days
  • 1-3 months
  • 4-6 months
  • 7-12 months
  • Beyond 12 months

This means that you need to know the typical and atypical capabilities and limitations of the baby and the changes that occur in the mother during those time periods.

There’s also a “general principles” category. That means that answers to a test item do not depend on the timeframe. So for example, the sequence in which you would assemble the part parts doesn’t matter if the baby is 2 days or 2 months or 2 years old. You’re expected to just know the “general principle” in order to get the test item right.

Again, this comes down to what areas you’ve had the least amount of exposure to. If you’ve worked primarily in a hospital with newborns aged 1-2 days, you’ll probably sail through questions on those areas, but struggle with those about older infants or children.


Basically, I’d say there are three formats on the exam:

Text only (i.e., no images)

Image-based (one image that directly relates to one test item)

Case studies


I can blow through these fairly easily and finish the text-only chunk long before the timer goes off. I’d say that most of the exam items in the text-only chunk are related to ethics, public health, research, communication, and psychology/sociology. I don’t know for sure; it just feels that way.


There are many clinical photos, but I’ve also seen graphs, weight charts, and research result tables, and more.

Most people have the most trouble with the images. Interpreting the clinical photos depends heavily on your physical assessment skills and your ability to recognize the approximate age of the baby. I think they’re tough, partly because sometimes the photo is of poor quality, or because I just can’t figure out what they’re asking. I’ve never finished with more than 2 minutes to spare, and often, I finish with only seconds to spare.

Case studies

First, I think the term “case study” is not a good description for what you’ll be facing. I’ve explained that in a different post.

Personally, I think the “case studies” are easier. I like context, I have a very broad base of clinical experience with pregnant mothers, breastfeeding mothers, well mothers, sick mothers, well babies, and sick babies.

This approach depends on the ability to look at what various healthcare professionals have observed and recorded, looking at graphs or lab results — all that sort of thing. That’s in my comfort zone, but for some people this is tough.

The most difficult part of the IBCLC exam is subjective and really comes down to your areas of experience, but preparing in your weak areas will give you confidence and the best shot at passing. My Guide to Decoding Lactation Photos Course will help you distinguish between similar but different conditions, and pass the photo portion of the exam with ease. If you’re looking to get an idea on what the exam will be like and test your skills, try my practice exams. And if you’re ready to commit to passing the exam on your first try, my Online Lactation Exam Review will provide structure, streamline your study, and demystify the exam. Choose from three packages to meet your budget and learning needs.

What do you think is the most difficult part of the IBCLC exam? How are you choosing to prepare? Be sure to share this post with fellow IBCLC exam-takers!

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