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What Should First-Time IBCLC Exam-Takers Expect?

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I’ve helped thousands of people on six continents to prepare for the IBCLC exam. In my experience, first-time IBCLC exam-takers don’t have a clue about what to expect on the exam. Read on for a few critical clues.


You’ll face a total of 175 multiple choice items. There will be 2 “chunks.”

The first chunk consists of text-only test items. Basically, that means there are no images. This will be about half of the total, give or take. When you close out of this chunk, you cannot go back to it.

The second chunk will consist of image-based items, including some clinical case studies. This might be photos, graphs, or various other images.


You may also skip some items and come back to them before the session ends (the software automatically flags the ones you skipped after you have seen the items on that chunk of the exam.) When you get to the end of that chunk, a screen presents the skipped questions to you.

Yes, you may change your answer.

No, there is no penalty for guessing.

Time Constraints

You will be given a total of four hours to complete the exam. But I find that a very misleading statement. First-time IBCLC exam-takers must keep that in mind.   

You’ll have two hours to complete the first chunk of the exam, which consists of text-only test items. I usually blow through this in about 100 minutes.

The second chunk is image-based, and you’ll have two hours to complete that chunk. I’ve successfully taken the exam five times, and I’ve never had more than about two minutes to spare before the timer runs out for the image-based chunk of the exam.


First-time IBCLC exam-takers must be aware of the breadth of information they’ll face. Overall, it comes down to seven main disciplines (with more than 100 subtopics) and 11 ages and stages. These include:

  • Development and nutrition
  • Physiology and endocrinology
  • Pathology
  • Pharmacology and toxicology
  • Psychology, sociology, and anthropology
  • Techniques
  • Clinical skills (which includes equipment, education, ethics, research, public health)

The age groups include:

  • 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
  • General principles (including preconception)

For much more in-depth information, download the Detailed Content Outline.

Most first-time IBCLC exam-takers don’t have a clue about what, exactly, this means. Read what I’d consider to be fair game, and what’s not fair game.

So, pause for a moment. Would you expect to find a test item on:

Maybe those topics hadn’t occurred to you — and maybe you won’t get any of them on your particular exam — but they are unquestionably possible topics for the IBCLC exam.

Or, maybe you expect to face questions on mastitis. Yep, I agree. But do you have any idea the depth of information you need to answer those questions? How many of these 29 facts do you already know?

Maybe you expect a question on let-down. Agree, totally. But how much do you really know about let-down?

You might also want to look at my predictions of topics you might see on the exam. I don’t have any crystal ball, so this isn’t “official” insight or information, it’s just my gut reaction.

Difficulty Level

In my experience, most (if not all!) first-time IBCLC exam-takers tend to massively underestimate the difficulty level of the exam. They tend to think it will be like an end-of-course exam where you just need to answer questions about the material that was presented in the course.

The IBCLC exam isn’t like that at all.

End-of-course test items are basically recall-only. That’s very different from the IBCLC exam where nearly all of the test items are at the application level.

Consider taking a review course to fully prepare. My Online Lactation Exam Review has helped many first-time IBCLC exam-takers pass the exam on the first try, and it can help you, too! Be sure to pass along to other first-time IBCLC exam-takers!

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