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Colette's Thoughts on the NABBLM Board Exam

October 27, 2023

NABBLM Board Exam Thoughts


Study tools I found most useful

  • ABM protocols and position statements (2 separate pages on the ABM website)

  • Katrina Mitchell’s website and photos, especially on breast masses and management. Great pics!

  • Stanford newborn nursery photos

  • IABLE lactfacts – only did a few but useful for random topics I couldn’t find elsewhere.

  • NABBLM exam blueprint


Topics not covered on exam but I think we should know:

  • Milk composition

  • Legal rights of BF moms in workplace

Topics very minimally covered on exam but I think we should know:

  • Hormonal regulation of milk supply

  • Normal breast anatomy and milk production e.g. ductal anatomy, cellular level of milk production

  • Pumping

  • Breast cancer during lactation/pregnancy

Exam taking notes

  • No images or video.

  • Font is quite small, I tried to zoom in but then couldn’t see “next” button.

  • Google Meet was fine but a little tricky to position phone to keep it charging and not falling over.

  • I logged in around 9:10 am, got the space setup and connected to proctor, started exam around 9:25 am.  Finished by 10:45 am (1 hour 20 minutes) including 2x 5-10 minute breaks, so total of about 60-65 minutes to do the 150 questions, not including breaks.  Note I am a fast reader and test-taker.  I'd guess most people will want maybe twice this amount of time and if you want longer breaks the whole test will take longer obviously. 

  • The questions are in 50 question blocks, but within those blocks there are sections that you can’t go back to – for example after the first 10 questions I was informed I could not go back to these questions, was I sure I wanted to proceed. It was ok but a bit surprising since I expected to be able to review each 50 question block at the end if I had time.


Topics covered

  • Breast masses and management/referral: lactational adenoma, abscess (analysis of ultrasound result and what to do – when to refer for drainage?); when to get an US vs give abx; intraductal papilloma eval/ref for imaging; Montgomery gland blockage management (salicylic acid?).

  • Inducing lactation – medication protocols, counseling of lactating parent about realistic expectations of process and results.

  • Early postpartum counseling, when to give supplement, telling mom what is normal.

  • WHO code.  Ethical questions – which types of materials or foods does it apply to and how should we proceed so that we are in compliance.

  • Engorgement in first week – management, counseling

  • Hand expression technique

  • Lymphatic massage –various indications, technique

  • Hyperlactation diagnosis and management, when to block feed

  • Evaluation of abnormal breast development such as tubular breasts, IGT, asymmetry

  • Nipple vasospasm – evaluation, stages of management (warmth vs nifedipine)

  • Mastitis diagnosis, treatment protocols, when to switch abx and type of abx, how long to wait before abx, when to refer for imaging.

  • Medications – commonly used ones that are ok or contraindicated with BF, including topicals applied to breast.

  • Pumping: Pumping pressures for stimulation/expression.  Proper flange fitting. Proper pump settings and timing.

  • Management of IGM

  • Nipple shields  - a lot of questions! Know evidence on what they do, if they decrease milk supply, if they help pain, if moms tend to stay on them, how to fit them (turn half inside out?) or if different size needed.

  • Weaning, support for work pumping or down-regulating before starting work, if not planning to pump.

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