1. The FIRST thing I want to tell you about today's lactation consultant certification exam is that:
a) Nigella Lawson showed up to give me a Domestic Goddess apron and ask me to correct Saturday's post: she does acknowledge that the odds of finding halloumi and Thai basil at the supermarket are low
b) Her grocer came along to thank me for the publicity because he's been doing land-office business since that last post
c) The hospital cafeteria was serving Slut-Red Raspberries in Chardonnay Jelly
d) I am cautiously optimistic
2. The MOST useful outcome of my marathon Saturday cram-avoid-cram-avoid-fest was:
a) I confidently answered every question about making shortcrust pastry
b) I included the recipe for Molten Chocolate Babycakes on my comment sheet because I figured they'd have to give me extra credit for it
c) Turns out The Breastfeeding Atlas, in which I immersed myself for most of Saturday afternoon, proved extremely helpful
d) At stressful moments I could console myself with the prospect of Spiced Pink Soup. (Which will actually be Spiced Orange Soup because I have orange beets in the fridge. It's delicious: blend baked beets, stock, cumin and coriander, salt and pepper and lime juice; add sour cream and leave it to chill with split green onions steeping in it.)
3. The MOST worrisome prospect for me is:
a) answer sheets being carried off to England by Nigella Lawson's absent-minded grocer (really, if he can't remember to order Thai basil, how far can you trust him?)
b) ignominious failure
c) my pencils were actually not #2 and my answers will not scan
d) I might have missed a bunch of questions because I ruled out the right answer
Let me explain.
The first of the sample exam questions provided by IBLCE asks for the MOST important recommendation you'd give a mother with a high fever and a red streak on her breast. Two of the answers were easy to dismiss. Suppose it was something like this:
a) apply a poultice of chayote pulp and shredded boomslang skin while invoking the aid of Nuestra Senora de Buen Parto y La Leche
b) nurse frequently
c) see a doctor or midwife to discuss antibiotic treatment
d) wean immediately to formula, and ever after heap imprecations on the heads of happy breastfeeders
I went back and forth briefly between b and c, but in the end b seemed like the clear winner to me. Here is my suggested protocol for mothers dealing with high fevers and red streaky breasts:
1) Go to bed. Go directly to bed. Do not pass go; do not collect $200. Rest.
2) Take baby with you and nurse at every squeak. If she rejects the affected breast (the milk may taste saltier to her), pump or hand-express. Keep the milk moving or the misery will multiply. If you're up for it, you can try warm compresses on the affected spot. You might not be up for it right now.
3) Get some help (and I say this as a person who hates asking for help) -- someone to hold the baby if she gets tired of hanging out in bed and to bring you large glasses of water and regular doses of an OTC pain-reliever and fever-reducer.
4) When you call your HCP about the best OTC medication choice, ask about antibiotics. Some HCPs will suggest that you start taking an antibiotic immediately. Some will suggest that you wait a bit and see if the fever begins to come down on its own.
IBLCE says that the correct answer is c -- she should see her doctor or midwife. This baffles me. She should drag herself to the doctor's office? So her HCP can say, "Yep, that's a fever. Yep, that's a red streak"? I have only had two bouts of infectious mastitis, but I remember clearly that dialing the phone seemed too effortful at the time. And in that state I needed to go and see my HCP more than I needed to rest and nurse? I am not convinced.
I am also not the one grading the exam, though, and I wonder how many questions I missed today for similar reasons. So let us return to this exam, in which I am the one with all the right answers--
4. My approximate cup size after ten hours without nursing was:
a) D
b) DD
c) H
d) V
e) I don't really want that on the web, do I?
4. With the remainder of my evening I am going to do all of the following EXCEPT:
a) put on comfortable pajamas
b) fix myself a giant bowl of ice cream
c) curl up on the couch with Perelandra
d) look up all my guesses from today and torture myself with thoughts of being the lowest-scoring candidate in the world. Lower, even, than Nigella Lawson's grocer.
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