I can understand the anxiety of those who have not taken the exam before
and want to have some more experience with slides beforehand.  Those of us
who have taken the exam once have some point of reference.  Those who have
never taken it don't really know WHAT to expect.  They may not realize that
their years of dealing with common problems and with growing babies and
children will stand them in good stead.  The exam is not all rare
situations.  The questions are not primarily trick questions trying to trap
you.

It's like preparing for the birth of a first baby.  You can take
preparation for childbirth classes and read lots of books and listen to
others' experiences, but you don't really know how much it will affect YOU
as a unique individual, and how well YOU will cope with the demands of
childbirth at the time.  The next time, you know you have been able to
handle it before and that you will be able to again, even though it will be
hard. But the first time, you don't know if what someone else says is
painful (or not) will feel like to you.

I can remember how worried I felt before taking the exam, not knowing quite
what would be asked of me.  I also remember one anxious candidate who ended
up seated in the back of the auditorium with a poor view of the slides who
became so unnerved that she burst into tears on the first one.  That
certainly did not help her evaluate the slides carefully in the one minute
allowed for each.  I believe that slides are no longer used, but that each
candidate receives a booklet with color photos, so that you can go through
them at your own pace and spend less time on the ones that are easier for
you and more time when you are unsure.  Another helpful thing is that you
can write out on a separate paper concerns you have on any question on the
exam (for example, if you think answer A is best because of this, but B is
equally correct because of that.)  The comments are reviewed and some
questions may actually not be used if they were ambiguous or had errors.

I agree that we need to have lots of hands-on experience, and that we don't
want to see candidates who care only about passing the test but don't
absorb the commitment and dedication to promoting, protecting and
supporting breastfeeding that we share.  But it is helpful, I think, to see
pictures of various clinical situations that we may not encounter
frequently.  I know that the photos inside the covers in Riordan and
Auerbach, the helpful slides I have seen in various breastfeeding workshops
and courses, and the photos in pamphlets such as Kay Hoover's thrush
handout or Sarah Danner's pamphlets on feeding babies with special needs
(the Dancer hand position) have been very helpful to me as a frame of
reference.  I can use them to review and to compare with situations I see
clinically.  And they are there to look at over and over again, whereas the
mother and baby you see with a problem may be a one-time encounter.

So, good luck to those of you facing the exam this summer.  You still have
time to do a lot of good preparation and learning in the days ahead, not
just for the exam, but for all the situations you will encounter in the
future while helping mothers and babies.  The exam is looking for entry
level competency.  You will continue to add to your knowledge afterwards,
too!  You are taking a good first step in you learning just by being on
Lactnet.

Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI
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