Jean writes:
<<Karin, I would have chosen A, mainly because ALL nipple pain needs to
evaluated. Certainly in my practice 99% of nipple pain I see is due
primarily to incorrect latch>>
However, the question wasn't about evaluating nipple pain. The question
was about something that all mothers experience with incorrect positioning
(not even incorrect latch -- and I would submit that you can have a great
latch with the baby on his back -- terrible positioning).
I will also tell you that the reason that it is offered up as a sample
question is because it was one that was thrown out of the question bank. If
it had been a great question, it would still be in the question bank.
So for all the reasons we are arguing about whether the answer is A or D
(and I felt D was more appropriate than A), that's the reason the IBLCE
dumped the question out of the bank.
I have a fabulous picture that I use in my lecture on painful nipples --
it's one of my moms (and I have permission to use the photo): third time
mom, baby flat on his back with his head screwed over to face the breast,
little teeny bird-like mouth on the nipple, baby's hand up between the baby and
the breast. It is a CLASSIC picture of awful positioning and latch. Mom
didn't have one iota of pain. You can see that the baby is a little
skinny, so he wasn't getting as much milk as he should have been, but she didn't
have any pain!
Jean -- I do agree with you that all nipple pain must be evaluated -- and
treated over the phone. But I would evaluate red, excoriated nipples, a
compression stripe, and whatever the other one was as well. Not all nipple
pain is due to incorrect latch/positioning, and not all incorrect
latch/positioning results in nipple pain.
Bottom line: terrible question.
As a writer of more questions and more exams than I care to think about
(for our course, for our practice exam book, etc etc), and as one who has
taken the IBLCE exam 4 times, and helped write it once, I will say that there
are occasions when a question and it's answers make PERFECT sense to the
writer at the time the question is being written. It is only when someone
questions it, and you have to re-think it that you realize that perhaps it
wasn't such a good question after all. There are no perfect exams, and no
perfect exam committees, and no perfect exam writers. The IBLCE exam is one
of the best written exams I know of, and they have psychometricians who help
them keep the exam fair, honest, and NOT tricky.
There is a reason that a certain number of questions are eliminated each
year. That's because even with a large committee writing the questions,
they aren't perfect, and it takes the cohort who is taking the exam to help
them realize it. The banner year (not the year I helped write the exam, I'll
have you know) is the year they eliminated 22 questions!! Last year I
think it was 6. I promise you, there will be questions in which you hate all
the responses. Pick the one you think is the best -- and write a "whine"
about it. (No cheese with that whine, though).
Good luck to everyone. You are all gonna do great!
Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants
_www.lactationeducation.com_ (http://www.lactationeducation.com/)
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