I am a nurse midwife. I have sat for RN boards, taken the GRE (the most
meaningless exam I have ever had to spend time on but very hard and
necessary to get into grad school), most recently the Boards necessary to
certify as a nurse-midwife, and five years ago, took the IBCLE exam.  Of
all the professional certification type exams I have taken, the IBCLE is
by far the most difficult in my opinion.  I think the test did cover a
reasonable base of knowledge though for someone who wishes to function as
a lactation consultant. What I am finding difficult at the present is
finding time to figure out how to get all the continuing ed requirements I
need as I must have a certain amount for ACNM, a certain amount to
maintain my prescriptive authority and additionally, more credits to
maintain my IBCLC. It adds up to alot of time and money! I do wish we
could get credit for our participation here.

Re estrogen patches for ppd: I don't prescribe low dose combined OC's for
breastfeeding mothers because estrogen has been well documented to both
decrease milk volume and to be one of the things that can indeed alter
milk quality.  I would think estrogen patches would be unacceptable for
the same reason.  While optimally, we don't have pregnant moms or
breastfeeding moms on medications like antidepressants if we can help it,
there are antidepressents that seem fairly acceptable to use, and
because I know of  no effect of antidepressents on milk quality or
quantity, I would be much more inclined to prescribe an antidepresent that
there was a good deal of experience with in breastfeeding moms than
estrogen (which may not even affect the depression) if it were really
needed (counselling and support seem the obvious first choices).

Ione Sims, CNM, IBCLC