Behind the Latch

Rethinking the Lactating Breast with Dr. Donna Geddes

What if some of what we still teach about breast anatomy, milk supply, pumping, and milk ejection is based on an outdated understanding of how the lactating breast actually works? In this episode of Behind the Latch, Margaret sits down with internationally recognized human lactation researcher Dr. Donna Geddes to explore what more than two decades of imaging the living, lactating breast has taught us. Dr. Geddes’s groundbreaking ultrasound research challenged anatomical models that had remained largely unchanged for more than 160 years. Her work has helped demonstrate that the lactating breast is far more variable—and far more complex—than the simplified diagrams many clinicians were originally taught. Together, Margaret and Dr. Geddes discuss how these discoveries translate into real clinical practice. Margaret and Dr. Geddes discuss: How Dr. Geddes went from radiography and ultrasound to human lactation research The history behind the traditional anatomical models of the lactating breast What ultrasound revealed that older breast anatomy diagrams got wrong Why the concept of large “lactiferous sinuses” does not match what we see in the living breast How widely milk duct anatomy can vary between individuals Why some people can hand express milk easily while others struggle Whether having fewer lobes necessarily means a person will have low milk production What we currently understand—and still don't understand—about mammary hypoplasia Why breast size alone tells us very little about milk-making capacity Breast changes during pregnancy and what clinicians should be asking about prenatally The relationship between blood flow to the breast and milk production Pregnancy complications such as gestational diabetes, preeclampsia, and fetal growth restriction as potential clues to later lactation challenges Metabolic health, inflammation, and their possible relationship to milk production Why identifying risk does not mean predicting failure The importance of anticipatory guidance for families at increased risk for low milk production Why intensive feeding plans such as triple feeding should have clear goals and endpoints What ultrasound has taught us about the milk ejection reflex Why many people do not actually feel their milk ejections Why watching milk flow—or watching the baby—may tell us more than asking whether a parent “felt a letdown” Why some babies choke, sputter, or struggle with fast milk flow The difference between anatomy-driven fast flow and true oversupply Why automatically trying to decrease milk production can sometimes create a new problem How milk storage capacity differs dramatically from one person to another Why frequent feeding does not automatically indicate low milk supply Why infant growth, behavior, milk transfer, maternal experience, and the whole clinical picture matter more than feeding frequency alone Why the right and left breast should not necessarily be expected to function identically How researchers estimate the percentage of available milk removed from the breast Why simply comparing pumping volumes between people can be misleading A Bigger Lesson for Lactation Professionals Throughout the conversation, one theme keeps returning: Human lactation does not fit neatly into a checklist. Breasts vary between people. The two breasts of the same person can behave differently. Milk production is influenced by anatomy, development, metabolic health, blood flow, hormones, inflammation, infant behavior, milk removal, and many other interacting factors. Understanding the science should help us individualize care—not create another rigid set of rules. What’s Coming Next? Dr. Geddes also shares some of the research underway within her team, including work examining: Flange and breast shield sizing Infant body composition Biomarkers associated with low milk production Proteomics and metabolomics Clinical measures that could help identify low milk production earlier Antenatal and early postpartum screening tools Gestational diabetes and lactation outcomes Bundled-care interventions Ultrasound phenotyping AI-supported prediction tools that may eventually help clinicians identify patterns and risk factors The goal is not simply to understand lactation better—it is to translate that science into tools clinicians can actually use. About Dr. Donna Geddes Dr. Donna Geddes is a leading researcher in human lactation based at The University of Western Australia in Perth, Western Australia. Her research has used technologies including ultrasound, Doppler imaging, human milk analysis, and other advanced laboratory techniques to investigate breast anatomy, milk production, milk ejection, infant feeding, and lactation physiology. Her work has played a major role in reshaping our understanding of the anatomy and function of the lactating breast. Learn More Donna Geddes — University of Western Australia profile: UWA Research Profile This is a great primary link because it includes her biography, research projects, publications, affiliations, and other professional links. UWA Centre for Human Lactation Research and Translation: Centre for Human Lactation Research and Translation This is the Centre Dr. Geddes directs and is probably the best link for listeners who want to learn about the broader research program. Geddes Hartmann Human Lactation Research Group: Human Lactation Research Group This is especially useful for clinicians because it highlights the group's research and current projects. Professor Donna Geddes website: Professor Donna Geddes Her UWA profile lists this as her personal professional website. Donna Geddes ORCID: Donna Geddes ORCID Profile Useful for listeners who want to track her scholarly publications. ABREAST Conference: ABREAST Conference This is the conference she mentioned during your interview, featuring lactation research, clinicians, families, and live ultrasound demonstrations. Your Next Steps: Learn with Me: https://margaretsalty.com/courses Read the Blog: https://margaretsalty.com/blog Email Me: hello@margaretsalty.com LinkedIn: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/ Instagram: https://www.instagram.com/margaretsalty/ Facebook: https://www.facebook.com/profile.php?id=61550829710885 Music: The Magnifiers — "My Time Traveling Machine"

It's Not Magic, It's Skill: Therapeutic Breast Massage with Maya Bolman, IBCLC

We were taught to keep our hands in our pockets. Maya Bolman was taught the opposite — by her great-aunt, a midwife in Belarus, who could take an engorged, aching breast and leave it soft in an hour. In this episode, I sit down with Maya to talk about the skill most of us were never trained in: what to actually do with our hands. Maya Bolman is an IBCLC in Cleveland, Ohio, with 26 years in hospital lactation care and a second home at Breastfeeding Medicine of Northeast Ohio, where she works alongside Dr. Ann Witt. She's the clinician who named Therapeutic Breast Massage in Lactation (TBML), published the research behind it, and travels the world teaching manual skills to lactation professionals. In this conversation, she breaks down the physiology of engorgement (hint: it's not just milk), why we massage milk down but swelling up, and the deceptively simple technique she calls breast gymnastics. If you've ever felt underprepared the second a parent's breast is hard, painful, and stuck, this one is going to change how you practice. What You'll Learn: Why engorgement is really "lymphodynamic edema" — and why that one distinction changes how you use your hands The moment Maya realized massage therapists move the breast up while lactation consultants are taught to move milk down (and why both are right) What breast gymnastics actually is, why it takes 20 seconds, and why she tells every parent to start it today How to know when you're "done" — the outcome to feel for instead of a number to hit Why the 2022 mastitis protocol's silence on milk expression is, in Maya's words, "a big minus" The difference between overstimulating a working duct and actually moving milk from the one that's stuck Why she calls herself a lactation therapist, not a consultant — and what that reframe unlocks How mindful latching flips the script: the parent doesn't latch the baby, she positions so the baby can latch Where to find milk you're missing (it's closer to the nipple than you were taught) The case for demonstrating instead of explaining — and what mirror neurons have to do with breastfeeding success Resources Mentioned in This Episode: Maya Bolman's website (workshops, free breast gymnastics & massage video, BreastKindness LLC): https://www.mayabolman.com Bolman, M., Saju, L., Oganesyan, K., Kondrashova, T., & Witt, A. M. (2013). Recapturing the art of therapeutic breast massage during breastfeeding. Journal of Human Lactation, 29(3), 328–331. https://doi.org/10.1177/0890334413475527 Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation, 32(1), 123–131. https://doi.org/10.1177/0890334415619439 Witt, A. M., Bolman, M., & Kredit, S. (2016). Mothers value and utilize early outpatient education on breast massage and hand expression in their self-management of engorgement. Breastfeeding Medicine, 11(8), 433–439. https://doi.org/10.1089/bfm.2016.0100 Your Next Steps: Learn with Me: https://margaretsalty.com/courses Read the Blog: https://margaretsalty.com/blog Email Me: hello@margaretsalty.com LinkedIn: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/ Instagram: https://www.instagram.com/margaretsalty/ Facebook: https://www.facebook.com/profile.php?id=61550829710885 Music: The Magnifiers — "My Time Traveling Machine"

What Counts as Low Milk Supply? Measurement, Biomarkers, and What's Next with Dr. Katie Kivlighan

Low milk supply might be the most common concern we field—and one of the hardest things in lactation to actually measure. In this episode I sit down with researcher Dr. Katie Kivlighan to separate what we can quantify from what we're guessing at, and to look at the tools and technologies that are about to change how we assess it. Episode Summary "Low milk supply" gets used as a catch-all, but it isn't one thing—and treating it like one thing is part of why families get the wrong support. Dr. Katie Kivlighan, co-author of Measuring Low Milk Supply: Methods and Implications for Lactation Research and Clinical Practice (Journal of Human Lactation, 2026), joins me to walk through the difference between primary, secondary, and perceived low supply, and why our measurement methods have never fully caught up with the problem. We get into what the evidence actually supports right now: test weights, milk transfer, and biomarkers like sodium and conductance—plus the emerging technologies (bioimpedance, at-home milk sodium testing) that could give us objective data we've never had at the bedside. We also talk honestly about the flip side: how devices and social media can feed parental anxiety, how normal infant behavior gets misread as a supply problem, and where clinical judgment still has to lead. If you support families navigating supply concerns, this one is about sharpening how you assess, how you reassure, and how you decide when a number actually matters. What You'll Learn The real difference between primary, secondary, and perceived low milk supply—and why the distinction changes your entire plan of care Why milk supply is so hard to measure accurately, and what that means for how we interpret research What biomarkers like sodium and conductance can (and can't) tell you about secretory activation Where bioimpedance and at-home milk sodium testing are headed, and how to think about them before they land in your practice The infant behaviors that get misread as low supply—so you can spot them and reframe them for families How feeding technology and social media are driving parental anxiety, and your role in cutting through the noise Why milk intake "standards" deserve a second look, and how normal supply variability fits in When to bring in a breastfeeding medicine provider, and how that collaboration strengthens care How to hold objective tools and clinical judgment together instead of letting one override the other Chapters 00:00 — Introduction and Dr. Kivlighan's research background 05:53 — Low milk supply: types and challenges 08:12 — The role of perception in supply concerns 10:31 — Evaluating milk supply: tools and techniques 13:11 — Common misinterpretations of infant behavior 15:46 — How technology feeds parental anxiety 18:16 — Collaborating with lactation professionals 20:40 — Reassessing milk intake standards 26:39 — Understanding milk supply variability 27:20 — Emerging technologies in lactation 32:23 — Bioimpedance and milk measurement innovations 34:58 — Addressing delayed secretory activation 41:27 — The case for comprehensive lactation support 43:02 — Closing thoughts Resources Mentioned Kivlighan, K. T., & Demirci, J. R. (2026). Measuring low milk supply: Methods and implications for lactation research and clinical practice. Journal of Human Lactation, 42(1), 126–134. https://doi.org/10.1177/08903344261426744 Dr. Katie Kivlighan: Faculty page Research profile Your Next Steps Learn with Me: https://margaretsalty.com/courses Read the Blog: https://margaretsalty.com/blog Email Me: hello@margaretsalty.com LinkedIn: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/ Instagram: https://www.instagram.com/margaretsalty/ Facebook: https://www.facebook.com/profile.php?id=61550829710885 Music: The Magnifiers — "My Time Traveling Machine"

• Transcript

Inside the Milk Bank: Donor Milk, NEC Prevention, and the Myths That Hold Us Back with Dr. Lisa Stellwagen

In this episode, Dr. Lisa Stellwagen shares the journey of establishing a hospital-based milk bank, the science behind donor milk, and the future of infant nutrition and milk banking. Discover how policies, safety standards, and community efforts are transforming neonatal care and supporting vulnerable infants. Chapters: 00:00 Introduction to Milk Banking and Its Importance 04:07 The Journey to Establishing a Milk Bank 05:24 The Supporting Premature Infant Nutrition Program 08:43 The Need for More Milk Banks in California 11:45 Building a Milk Bank: Challenges and Triumphs 16:52 Understanding Hambana and Milk Bank Structures 20:14 Pasteurization Standards and Safety in Milk Banking 23:58 Fortification of Human Milk and Its Implications 30:18 The Importance of Accreditation and Safety Standards 34:39 The Donor Process: Ensuring Safety and Efficiency 35:33 Processing Milk: From Donation to Quality Control 37:27 Nutritional Targeting: Tailoring Milk for Tiny Patients 40:11 Analyzing Milk: Understanding Composition and Quality 43:23 Raising Awareness: The Importance of Milk Donation 44:30 Barriers to Access: Challenges in Milk Banking 46:16 The Role of Nonprofit Milk Banks: A Community Approach 51:58 The Cost of Donor Milk and NICU Decisions 57:21 Vision for the Future of Milk Banking 1:00:21 Honoring Bereaved Donors: The Cherry Blossom Program 1:04:49 Outro Resources Human Milk Banking Association of North America (HMBANA) Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical Report Find a Milk Bank Guest Links HMBANA-Dr. Stellwagen UC Health Milk Bank Connect with Margaret Email: hello@margaretsalty.com Instagram: @margaretsalty Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

What COVID and the Formula Shortage Taught Us About Breastfeeding Support with Dr. Elizabeth Kar

In this conversation, Dr. Elizabeth Kar discusses her research on breastfeeding promotion and the challenges faced by breastfeeding families during the COVID-19 pandemic, particularly the impact of reduced lactation support and the infant formula shortage. She emphasizes the importance of lactation consultants and community support in successful breastfeeding, critiques the marketing strategies of formula companies, and calls for better policies to protect and promote breastfeeding. In this conversation, Margaret Saltysiak and Elizabeth Kar discuss the complexities surrounding infant feeding choices, particularly the challenges of breastfeeding and formula feeding. They highlight the fragility of the infant feeding infrastructure in the U.S., the lessons learned from the pandemic regarding breastfeeding support, and the critical need for paid family leave to support new parents. The discussion also emphasizes the importance of addressing the needs of vulnerable populations and ensuring equitable access to breastfeeding support and resources. Chapters 00:00 Introduction to Elizabeth Kar and Her Work 03:03 Exploring the Triple Threat to Breastfeeding Families 06:00 The Impact of COVID-19 on Lactation Support 09:02 The Role of Lactation Consultants 11:59 The Formula Shortage and Its Effects 14:58 The Marketing Influence of Formula Companies 18:06 The Need for Better Infant Feeding Policies 21:43 The Challenges of Infant Feeding Choices 24:15 Fragility of Infant Feeding Infrastructure 27:20 Lessons from the Pandemic on Breastfeeding Support 30:25 The Need for Paid Family Leave 33:48 Addressing Vulnerable Populations in Breastfeeding Support Guest Elizabeth Kar, RDN, PhD, IBCLC Triple Threat or Mere Inconvenience? Exploring the Effect of COVID-19 Precautions, Lack of Access to Lactation Care, and the Infant Formula Shortage on Breastfeeding Behavior of Parents in the Midwest of the United States Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Informal Milk Sharing in the U.S. with Molly Waymouth

Margaret interviews, Molly Waymouth, a senior policy analyst at RAND, and they discuss her research on informal milk sharing, its prevalence, risks, and policy implications. They explores how systemic barriers and economic factors influence families' choices and what can be done to improve access to safe, affordable donor milk and lactation support. Chapters 00:00 Introduction to the Conversation 05:37 Molly's Background and Research Focus 07:10 Exploring Milk Sharing Practices 09:35 The Economics of Donor Milk 11:23 Understanding the Support Gaps 13:48 Equity and Access in Milk Sharing 16:27 Risks of Informal Milk Sharing 16:50 The Need for Comprehensive Support 18:34 Innovative Approaches to Milk Sharing 18:50 Designing an Ideal Support System 20:27 Conclusion and Future Directions 21:22 outro.mp3 Resources JAMA Open Network Publication - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048 RAND Corporation - https://www.rand.org/ LinkedIn Profile of Molly Waymouth - https://www.linkedin.com/in/mollywaymouth/ Connect with Margaret mail: hello@margaretsalty.com Instagram: @margaretsalty Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Rethinking Elimination Diets in Breastfeeding: What the Research Actually Shows with Dr. Trillitye Paullin

In this episode of Behind the Latch, Margaret Salty interviews Trillitye Paullin, CEO and co-founder of Free to Feed, who shares her groundbreaking work translating emerging research on food reactivity in breastfeeding into practical clinical guidance. Together, they unpack one of the most misunderstood topics in lactation: how dietary proteins transfer into breast milk and what that actually means for managing elimination diets. Trillitye explains why the long-standing belief that proteins remain in breast milk for weeks is not supported by current evidence—and how confusing “transfer timing” with “healing timing” has led to unnecessary dietary restriction and early weaning. They also explore the realities of non-IgE-mediated food allergies, why traditional allergy testing often fails these families, and how IBCLCs can more effectively assess, manage, and refer these cases. This conversation offers a practical, evidence-based framework that has the potential to change how clinicians support breastfeeding dyads navigating food reactivity. Key Takeaways for Clinicians Food proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeks The timeline we see clinically is often driven by infant healing, not ongoing exposure Elimination diets should be reassessed early (around 5 days) to determine effectiveness Not all symptoms warrant elimination—rule out more common causes first Most infants with food reactivity will have symptoms emerge between 2–4 months Cow’s milk and soy are the most common triggers, but other foods may be involved Reintroduction is critical to avoid unnecessary long-term restriction Severe symptoms or lack of improvement beyond dairy/soy elimination should prompt referral Non-IgE-mediated allergies cannot be diagnosed with standard allergy testing Supporting parental mental health is essential—elimination diets are a significant burden Guest Trillitye Paullin, PhD, CEO & Co-Founder, Free to Feed Free to Feed Supporting Families as They Navigate Infant Food Allergies Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Lactation During Bereavement with Victoria Fonville: A Research Review

In this episode of Behind the Latch, Margaret Salty interviews Victoria Fonville, MS, PhD candidate in Nutrition at UNC Greensboro, about her recent scoping review on lactation during perinatal bereavement. Together, they explore what the research actually tells us about lactation after infant loss—from the lived experiences of bereaved families to the gaps in care from healthcare providers. Victoria shares the key findings from her paper, including the four major areas studied—producing milk, support, stopping lactation, and donating milk—and the six themes that emerged: hurting, lacking, valuing, succeeding, connecting, and redeeming. They discuss how lactation can serve as a powerful source of connection and identity for grieving mothers, why suppression is often presented as the default (and why that’s problematic), and how milk donation can be experienced as a deeply meaningful and even healing process for families navigating loss. This episode challenges the way we approach bereavement care and emphasizes the importance of presenting all options—so families can make informed decisions that align with their goals and their grief. Key Takeaways for Clinicians Lactation after perinatal loss is common due to normal physiology, but remains poorly addressed in clinical care. Bereaved mothers often experience both physical pain and emotional distress related to lactation, requiring compassionate and informed support. “Lacking” was a dominant theme across studies, highlighting significant gaps in provider knowledge, training, and communication. Lactation suppression is frequently presented as the only option, but this does not reflect the full range of choices available. Producing milk can help maintain maternal identity and connection to the infant after loss. Milk donation is often experienced as “redeeming,” helping families create meaning and process grief. Healthcare providers should present all options—suppression, expression, donation, and keepsakes—without bias. There is an urgent need for quantitative research to better understand care practices, outcomes, and donation patterns. Compassion, presence, and individualized care are critical when supporting bereaved families. Guest Victoria Fonville, MS, PhD Candidate in Nutrition, University of North Carolina at Greensboro Lactation During Perinatal Bereavement From the Perspective of Families and Support Providers: A Scoping Review Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

More Than Milk: The Science, Systems, and Future of Human Lactation with Dr. Lars Bode

Dr. Bode shares his journey into human milk research and the founding of the Human Milk Institute—the only institute in the world dedicated entirely to studying human milk in all its complexity. Together, they explore how human milk research is evolving from isolated disciplines into a collaborative, systems-based science that integrates molecular biology, clinical care, and public health. The conversation dives deep into human milk oligosaccharides (HMOs), the limitations of reductionist thinking in lactation science, and the urgent need to translate research into real-world clinical impact. Dr. Bode also shares his vision for the future, including the development of “lactology” as a formal field of study and what it would take to truly normalize breastfeeding on a global scale. Key Takeaways for Clinicians Human milk is far more than nutrition—it is a dynamic system of signaling, protection, and communication. HMOs play multiple roles beyond the microbiome, including direct immune and systemic effects. Donor milk retains key bioactive components like HMOs even after pasteurization. Variation in milk composition across individuals and time is expected and biologically meaningful. Clinical care must align with real-world problems—research must start with the needs of families. Multidisciplinary collaboration is essential to advancing both science and clinical outcomes. Maternal health directly influences milk production and composition. Breastfeeding provides significant long-term health benefits for both infants and mothers. Formula can improve—but it cannot replicate the adaptive, responsive nature of human milk. Early identification of barriers and inequities is critical to improving breastfeeding outcomes. The future of lactation care depends on bridging research, clinical care, and public health systems. Guest Dr. Lars Bode, PhD Director, Human Milk Institute Human Milk Institute Triton Giving Day 04.29.2026 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

The High Lipase Myth: What’s Really Happening to Stored Breastmilk With Dr. Jimi Francis

What We Talk About The origin of the “high lipase” breastmilk myth and how it spread through the lactation community Why biologically it does not make sense that some mothers produce excess lipase in milk What lipase actually does in human milk and why it is critical for infant fat digestion What parents are actually noticing when milk smells “soapy,” “metallic,” or “rancid” How riboflavin oxidation and free radical reactions may contribute to off flavors in stored milk Why exposure to light, oxygen, and heat accelerates nutrient degradation Simple strategies for protecting expressed milk during storage The role of vitamin C and antioxidants in preventing oxidation Why scalding milk may damage valuable nutrients and enzymes How maternal diet influences the fatty acid profile of breastmilk The relationship between omega-3 and omega-6 fats in human milk Why formula cannot truly replicate human milk oligosaccharides or fatty acid complexity How breastfeeding exposes infants to diverse food flavors that shape lifelong eating patterns Why maternal nutrition matters—but breastfeeding remains resilient even with imperfect diets Future research questions about the human milk metabolome and maternal diet Key Takeaways for Clinicians The “high lipase milk” explanation for off-smelling stored milk may not be supported biologically or experimentally. Off flavors may instead result from nutrient oxidation, particularly involving riboflavin and free radical reactions. Protecting milk from light, oxygen, and heat exposure may help reduce degradation. Scalding milk may stop some reactions but can also damage enzymes, vitamins, and bioactive components. Maternal intake of vitamin C and antioxidants may influence milk stability during storage. Maternal diet does influence certain components of milk, especially fatty acid composition and water-soluble vitamins. The fatty acid profile of milk largely reflects the mother’s dietary fat intake. Human milk oligosaccharides vary between mothers and environments, making them difficult to replicate in formula. Even when milk has an unusual smell, it is often still safe for infants, and strategies like dilution with fresh milk can help babies accept it. Human milk remains one of the most biologically protected food systems in nature, even when maternal diets are imperfect. Guest Dr. Jimi Francis, PhD, RD, IBCLC https://drjimi.net/ References referred to in the discussion about Lipase in Human Milk: Allen, L. H. (2012). B vitamins in breast milk: Relative importance of maternal status and intake, and effects on infant status and function. Advances in Nutrition, 3(3), 362–369. https://doi.org/10.3945/an.111.001172 Bauman, D. E., & Bruce Currie, W. (1980). Partitioning of Nutrients During Pregnancy and Lactation: A Review of Mechanisms Involving Homeostasis and Homeorhesis. Journal of Dairy Science, 63(9), 1514–1529. https://doi.org/10.3168/jds.S0022-0302(80)83111-0 Chappell, J. E., Francis, T., & Clandinin, M. T. (1985). Vitamin A and E content of human milk at early stages of lactation. Early Human Development, 11(2), 157–167. https://doi.org/10.1016/0378-3782(85)90103-3 Daniel, A. I., Shama, S., Ismail, S., Bourdon, C., Kiss, A., Mwangome, M., Bandsma, R. H. J., & O’Connor, D. L. (2021). Maternal bmi is positively associated with human milk fat: A systematic review and meta-regression analysis. American Journal of Clinical Nutrition, 113(4), 1009–1022. https://doi.org/10.1093/ajcn/nqaa410 Demmelmair, H., & Koletzko, B. (2018). Lipids in human milk. Best Practice and Research: Clinical Endocrinology and Metabolism, 32(1), 57–68. https://doi.org/10.1016/j.beem.2017.11.002 Dickton, D., & Francis, J. (2018). Case review: food pattern effects on milk lipid profiles. J Nutr Health Food Eng, 8(6), 467–470. https://doi.org/10.15406/jnhfe.2018.08.00311 Donovan, S. M., Aghaeepour, N., Andres, A., Azad, M. B., Becker, M., Carlson, S. E., Järvinen, K. M., Lin, W., Lönnerdal, B., Slupsky, C. M., Steiber, A. L., & Raiten, D. J. (2023). Evidence for human milk as a biological system and recommendations for study design—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 4. American Journal of Clinical Nutrition, 117, S61–S86. https://doi.org/10.1016/j.ajcnut.2022.12.021 Dror, D. K., & Allen, L. H. (2018). Overview of nutrients in humanmilk. Advances in Nutrition, 9, 278S-294S. https://doi.org/10.1093/advances/nmy022 Evans, T. J., Ryley, H. C., Neale, L. M., Dodge, J. A., & Lewarne, V. M. (1978). Effect of storage and heat on antimicrobial proteins in human milk. Archives of Disease in Childhood, 53(3), 239–241. https://doi.org/10.1136/adc.53.3.239 Francis, J. (2015). Effects of Light on Riboflavin and Ascorbic Acid in Freshly Expressed Human Milk. Journal of Nutritional Health & Food Engineering, 2(6), 2–4. https://doi.org/10.15406/jnhfe.2015.02.00083 Francis, J., & Dickton, D. (2020). Feeding and refusal of expressed and stored human (FRESH) milk study - a short communication. J Nutr Health Food Eng, 8(6), 391–393. https://doi.org/10.15406/jnhfe.2018.08.00301 Francis, J., & Egdorf, R. (2020). Maternal Nutrient Metabolism and Requirements in Lactation. In B. Marriott, D. F. Birt, V. Stalling, & A. Yates (Eds.), Present Knowledge in Nutrition (11th ed., pp. 67–81). Elsevier. https://doi.org/10.1016/c2018-0-02422-6 Francis, J., Rogers, K., Brewer, P., Dickton, D., & Pardini, R. (2008). Comparative analysis of ascorbic acid in human milk and infant formula using varied milk delivery systems. International Breastfeeding Journal, 3(1), 19. https://doi.org/10.1186/1746-4358-3-19 Francis, J., Rogers, K., Dickton, D., Twedt, R., & Pardini, R. (2012). Decreasing retinol and αtocopherol concentrations in human milk and infant formula using varied bottle systems. Maternal and Child Nutrition, 8(2), 215–224. https://doi.org/10.1111/j.1740- 8709.2010.00279.x Hamosh, M., Clary, T. R., Chernick, S. S., & Scow, R. O. (1970). Lipoprotein lipase activity of adipose and mammary tissue and plasma triglyceride in pregnant and lactating rats. Biochimica et Biophysica Acta (BBA)/Lipids and Lipid Metabolism, 210(3), 473–482. https://doi.org/10.1016/0005-2760(70)90044-5 Hampel, D., Shahab-Ferdows, S., Islam, M. M., Peerson, J. M., & Allen, L. H. (2017). Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and singledose supplementation. Journal of Nutrition, 147(4), 603–611. https://doi.org/10.3945/jn.116.242941 Jensen, D. R., Gavigan, S., Sawicki, V., Witsell, D. L., Eckel, R. H., & Neville, M. C. (1994). Regulation of lipoprotein lipase activity and mRNA in the mammary gland of the lactating mouse. Biochemical Journal, 298(2), 321–327. https://doi.org/10.1042/bj2980321 Krebs, N. F., Belfort, M. B., Meier, P. P., Mennella, J. A., O’Connor, D. L., Taylor, S. N., & Raiten, D. J. (2023). Infant factors that impact the ecology of human milk secretion and composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 3. American Journal of Clinical Nutrition, 117, S43–S60. https://doi.org/10.1016/j.ajcnut.2023.01.021 Lackey, K. A., Williams, J. E., Meehan, C. L., Zachek, J. A., Benda, E. D., Price, W. J., Foster, J. A., Sellen, D. W., Kamau-Mbuthia, E. W., Kamundia, E. W., Mbugua, S., Moore, S. E., Prentice, A. M., K, D. G., Kvist, L. J., Otoo, G. E., García-Carral, C., Jiménez, E., Ruiz, L., … McGuire, M. K. (2019). What’s normal? Microbiomes in human milk and infant feces are related to each other but vary geographically: The inspire study. Frontiers in Nutrition, 6. https://doi.org/10.3389/fnut.2019.00045 Lee, H., Padhi, E., Hasegawa, Y., Larke, J., Parenti, M., Wang, A., Hernell, O., Lönnerdal, B., & Slupsky, C. (2018). Compositional dynamics of the milk fat globule and its role in infant development. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00313 Lemons, J. A., Moye, L., Hall, D., & Simmons, M. (1982). Differences in the composition of preterm and term human milk during early lactation. Pediatric Research, 16(2), 113–117. https://doi.org/10.1203/00006450-198202000-00007 Mitoulas L.R.*, Kent, J. C., Cox, D. B., Owens, R. A., Sherriff, J. L., & Hartmann, P. E. (2002). Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. British Journal of Nutrition, 88(1), 29–37. https://doi.org/10.1079/bjnbjn2002579 Nommsen, L. A., Lovelady, C. A., Heinig, M. J., Lönnerdal, B., & Dewey, K. G. (1991). Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: The DARLING Study. American Journal of Clinical Nutrition, 53(2), 457–465. https://doi.org/10.1093/ajcn/53.2.457 Nommsen-Rivers, L., Black, M. M., Christian, P., Groh-Wargo, S., Heinig, M. J., Israel-Ballard, K., Obbagy, J., Palmquist, A. E. L., Stuebe, A., Barr, S. M., Proaño, G. V., Moloney, L., Steiber, A., & Raiten, D. J. (2023). An equitable, community-engaged translational framework for science in human lactation and infant feeding—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 5. American Journal of Clinical Nutrition, 117, S87–S105. https://doi.org/10.1016/j.ajcnut.2023.01.020 Raiten, D. J., Steiber, A. L., Papoutsakis, C., Rozga, M., Handu, D., Proaño, G. V., Moloney, L., & Bremer, A. A. (2023). The “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Project – executive summary. American Journal of Clinical Nutrition, 117, S1–S10. https://doi.org/10.1016/j.ajcnut.2022.12.020 Rudolph, M. C., McManaman, J. L., Phang, T. L., Russell, T., Kominsky, D. J., Serkova, N. J., Stein, T., Anderson, S. M., & Neville, M. C. (2007). Metabolic regulation in the lactating mammary gland: A lipid synthesizing machine. Physiological Genomics, 28(3), 323–336. https://doi.org/10.1152/physiolgenomics.00020.2006 Schaefer W., Swindall R, Boyle J, &, & Francis J. (n.d.). Analysis of Macronutrient Content of Human Expressed Milk in East Texas Women. Smilowitz, J. T., Allen, L. H., Dallas, D. C., McManaman, J., Raiten, D. J., Rozga, M., Sela, D. A., Seppo, A., Williams, J. E., Young, B. E., & McGuire, M. K. (2023). Ecologies, synergies, and biological systems shaping human milk composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 2. The American Journal of Clinical Nutrition, 117(Suppl 1), S28. https://doi.org/10.1016/j.ajcnut.2022.11.027 Spencer, B., & Francis, J. (2021). The Composition and Specificity of Breastmilk. In K. A. Wambach & B. Spencer (Eds.), Breastfeeding and Human Lactation (Sixth, Four). Jones & Bartlett. https://www.jblearning.com/catalog/productdetails/9781284151565#productInfo Wang, C. S., Hartsuck, J., & McConathy, W. J. (1992). Structure and functional properties of lipoprotein lipase. Biochimica et Biophysica Acta (BBA)/Lipids and Lipid Metabolism, 1123(1), 1–17. https://doi.org/10.1016/0005-2760(92)90165-R Wang, Y., Tong, J., Li, S., Zhang, R., Chen, L., Wang, Y., Zheng, M., Wang, M., Liu, G., Dai, Y., Zhao, Y., & Li, N. (2011). Over-Expression of Human Lipoprotein Lipase in Mouse Mammary Glands Leads to Reduction of Milk Triglyceride and Delayed Growth of Suckling Pups. PLoS ONE, 6(6), e20895. https://doi.org/10.1371/journal.pone.0020895 Williams, J. E., McGuire, M. K., Meehan, C. L., McGuire, M. A., Brooker, S. L., Kamau-Mbuthia, E. W., Kamundia, E. W., Mbugua, S., Moore, S. E., Prentice, A. M., Otoo, G. E., Rodríguez, J. M., Pareja, R. G., Foster, J. A., Sellen, D. W., Kita, D. G., Neibergs, H. L., & Murdoch, B. M. (2021). Key genetic variants associated with variation of milk oligosaccharides from diverse human populations. Genomics, 113(4), 1867–1875. https://doi.org/10.1016/j.ygeno.2021.04.004 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Advocacy in Action: Securing Pumps for NICU Families with Mina Ognjanovic, IBCLC

What We Talk About How Mina’s grandmother’s experience as a wet nurse shaped her path into lactation Why “hospital-grade” doesn’t actually mean anything in marketing—and what truly defines a multi-user pump The critical first 7 days postpartum and why delayed access to an effective pump can permanently impact supply Why wearable pumps and personal-use pumps often fail NICU mothers trying to establish supply The surprising insurance paradox: why WIC families often receive pumps faster than privately insured hospital employees How some insurance plans (including certain HMOs and United Healthcare) do not recognize hospital-grade pumps as a covered benefit The behind-the-scenes work required to secure an E0604 pump rental through a DME supplier Why case management buy-in was one of the biggest roadblocks—and how Mina overcame resistance How embedding a lactation-specific workflow into Epic improved communication and reduced delays Why some hospitals profit from pump rentals—and why that raises ethical concerns How her hospital partnered with WIC to house 10 loaner hospital-grade pumps onsite The importance of prenatal pump planning when a NICU admission is anticipated What still isn’t fixed—and why the work continues Key Takeaways for Clinicians The first 7 days postpartum are physiologically critical for establishing milk supply. Delays in effective milk removal can make supply difficult to recover later. Not all pumps are equal. Wearable pumps and personal-use pumps may not provide adequate stimulation for separated NICU mothers. Insurance status can directly affect pump access timing, functioning as a social determinant of lactation success. Securing a hospital-grade pump typically requires: A prescription Diagnosis coding (NICU admission) Coordination with a DME supplier Case management involvement Standardizing communication within the EHR can dramatically improve workflow and reduce lost time. Patients should not bear the burden of navigating DME suppliers while managing a critically ill infant. Advocacy is within the scope of the hospital lactation consultant role—even when it requires challenging institutional norms. One practical first step: map your current NICU pump access process and identify where delays occur. 👩‍🏫 Guest Mina Ognianovich, IBCLC https://minalactation.com/ 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine #BehindTheLatch #NICULactation #HospitalGradePump #BreastfeedingEquity #IBCLC #LactationAdvocacy #MaternalHealth #PublicHealthLactation #NICUParents #BreastmilkIsMedicine

Barriers, Mentorship & Equity in Lactation Certification with Mandy Golman, PhD, MS, RN, IBCLC

In this episode of Behind the Latch, Margaret sits down with Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES, professor at the University of Texas at Tyler, to discuss her powerful qualitative study exploring the perceptions, barriers, and facilitators to obtaining the IBCLC certification among U.S. healthcare practitioners. Margaret first encountered this research as a poster presentation at the ILCA Conference in Tampa — and immediately knew it was a conversation the field needed to hear. Dr. Golman’s study, expected to be published later this year, examines who is able to enter the IBCLC pathway — and who is not — through a public health and equity lens. With 19,000 IBCLCs serving the United States and 93% identifying as white, the findings raise important questions about access, mentorship, compensation, and structural barriers within our profession. Together, Margaret and Dr. Golman unpack what the data reveal — and what must change. 🔍 What We Talk About How Dr. Golman’s background in maternal-child health and public health shaped this research Why workforce diversity in lactation care is a public health issue The perception that the IBCLC credential “adds weight” professionally — but often without financial return Why many hospital-based IBCLCs are required to certify without institutional financial support The persistent bias that IBCLCs must also be RNs to be considered “legitimate” Financial barriers beyond tuition — unpaid clinical hours, childcare, lost wages, transportation Why indirect costs often delay certification for years Mentorship as the central bottleneck in the IBCLC pipeline The lack of standardized mentorship processes and consistent training experiences Why “mass emailing IBCLCs” to find a mentor reflects a broken system What a centralized, structured mentorship model could look like The role of state coalitions, professional organizations, and grant funding Medicaid reimbursement challenges and why payment structures matter for access How passion alone cannot sustain a workforce without structural support What meaningful reform could look like — starting with mentorship 🧠 Key Takeaways for IBCLCs & Students The IBCLC credential is highly valued — but the pathway remains structurally inequitable. Indirect costs (lost wages, unpaid hours, childcare) are often more prohibitive than exam fees. Mentorship access is inconsistent and frequently the biggest barrier to certification. Without structural support and compensation reform, the field risks burnout and limited diversity. Improving mentorship infrastructure could significantly expand access and representation. Workforce diversity is foundational to culturally responsive lactation care and trust-building. Public health advocacy must include strengthening the IBCLC pipeline — not just improving breastfeeding rates. 👩‍🏫 Guest Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES Professor, University of Texas at Tyler 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

From Wonder to Publication: Writing a Case Study Without a PhD with Indira Lopez-Bassols, IBCLC

In this episode of Behind the Latch, Margaret interviews Indira Lopez-Bassols, IBCLC, educator, and PhD candidate based in London, about her journey from clinical lactation consultant to published author in the Journal of Human Lactation. Indira shares the story behind her case study, “Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate” and her recent reflection piece, “Three Seeds of Inspiration: How I Published My First Case Study Without a PhD” . Together, they unpack what holds IBCLCs back from publishing, how to move from clinical wonder to academic writing, and why research must become more accessible to practicing clinicians. What We Talk About Indira’s work in a specialist NHS breastfeeding clinic in the UK Teaching future lactation consultants and pursuing a PhD in breastfeeding education The three “seeds of inspiration” that moved her from reader to author Why attending a JHL writing session at ILCA changed everything What an editor told her when she doubted whether her case was “spicy” enough Why you do not need a PhD to write and publish a case study How she structured her first case study by studying medical literature methodology The powerful cleft lip and palate case that became her first JHL publication Assisted nursing using a nipple shield and NG tube to support direct breastfeeding Why cleft lip and palate infants are often assumed unable to breastfeed — and how this case challenged that assumption The emotional dimension of clinical practice: witnessing the “impossible” Why wonder is the essential ingredient for writing Burnout, mechanistic care, and losing the capacity to recognize awe Making research accessible for non-academic IBCLCs Her creation of the international Research Hub through the Centre for Breastfeeding Education and Research The Three Seeds of Inspiration Indira describes three pivotal moments: 1. Reading a Case Study A published case study on biological nurturing sparked the realization: “Maybe I could do this too.” 2. Attending a JHL Writing Session At ILCA, editors clearly explained manuscript types and encouraged non-academic clinicians to submit. When Indira expressed doubt, she was told simply: “Just write them.” 3. Witnessing the Impossible Supporting a mother determined to breastfeed her infant with a complete unilateral cleft lip and palate became the turning point. The dyad exclusively fed mother’s own milk, used no bottles, and later transitioned to direct breastfeeding without assistance after surgeries. That clinical experience — rooted in creativity, persistence, and humility — demanded to be shared. Key Takeaways for IBCLCs You do not need a PhD to publish. Case studies are about documenting what you witnessed, not proving expertise. If you are already reading journals, you are closer than you think. Study the structure of published case studies — they provide your map and compass. Wonder is a clinical skill — but burnout can dull it. Research must be accessible to frontline clinicians. Our field is still young — there is enormous opportunity for contribution. The Research Hub Indira created the International Research Hub through the Centre for Breastfeeding Education and Research (CBER): Free monthly online research discussion Open to IBCLCs worldwide Safe space to say “I don’t understand this statistic” Designed to make research approachable and collaborative Her mission: make research less intimidating and more joyful. Guest Indira Lopez-Bassols, BA (Hons), MSc, IBCLC Founder, Centre for Breastfeeding Education and Research (CBER) Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate Three Seeds of Inspiration: How I Published My First Case Study Without a PhD Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Mentorship That Matters: Training the Next Generation of IBCLCs with Kristina Chamberlain, CNM, ARNP, IBCLC

As more people pursue the IBCLC credential, mentorship has become one of the most critical—and misunderstood—components of lactation education. In this episode, Kristina and I take a close look at Pathway 2 and Pathway 3 mentorship, clarifying what mentors are actually responsible for and why mentorship must go beyond observation and paperwork. Kristina explains that effective mentorship is engaged, relational, and intentional. We discuss how mentors model professionalism, communication, boundaries, and ethical care—not just clinical skills. We also talk openly about the fears many IBCLCs have about becoming mentors, including concerns about readiness, time, liability, and “doing it right,” and why those fears shouldn’t stop experienced clinicians from stepping into mentorship roles. This conversation also highlights the structural supports built into Pathway 2 programs, the additional lift often required in Pathway 3 mentorship, and why access to high-quality mentorship remains a major barrier to growing and diversifying the IBCLC workforce. Throughout the episode, Kristina shares practical, experience-based strategies for both mentors and mentees—and a hopeful vision for how mentorship could be better supported and valued across the profession. 🔍 What We Talk About The difference between mentoring vs. supervising clinical hours What IBCLC mentors are truly responsible for in Pathway 2 and Pathway 3 How students should be gradually and ethically integrated into hands-on care Common gaps students face when transitioning from coursework to clinical practice Tools that support mentorship, including IBLCE outlines and LEAARC skill checklists Why learning from multiple mentors can strengthen clinical competence Liability, affiliation agreements, and student protections in Pathway 2 programs The professional and personal benefits of becoming a mentor Charging for mentorship: ethics, equity, and value exchange Why mentorship is part of our professional obligation as IBCLCs What Kristina hopes the future of lactation mentorship will look like 🧠 Key Takeaways Mentorship is an active teaching relationship, not passive oversight. Students need meaningful, hands-on experience—not observation alone. You do not need to be a “perfect” IBCLC to be an effective mentor. Mentorship strengthens clinical skills, confidence, and professional growth. Supporting mentors is essential to the future of the lactation profession. 👩‍🏫 Guest Kristina Chamberlain, CNM, ARNP, IBCLC Clinical Instruction in Lactation: https://www.amazon.com/Clinical-Instruction-Lactation-Teaching-Generation/dp/1939807948 LEAARC Criteria for Endorsed Courses: https://leaarc.org/docs/2022%20Endorsed%20Courses%20Core%20Curricula%20FINAL%201.pdf 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

Body-Led Breastfeeding: Understanding Infant Suck Strength with Dr. Ellen Chetwynd

In this episode of Behind the Latch, Margaret sits down with Ellen Chetwynd, IBCLC, PhD, and longtime Editor-in-Chief of the Journal of Human Lactation, to explore a fundamentally different way of understanding breastfeeding challenges: body-led breastfeeding and the Infant Suck Strength Exam (ISSE). Dr. Chetwynd shares how years of clinical practice—and noticing what wasn’t explained by common diagnoses like thrush, Raynaud’s, or tongue-tie—led her to focus more closely on the infant’s body, neurology, and suck function. Together, Margaret and Ellen unpack how the ISSE helps clinicians move beyond appearance-based latch assessment to identify where suck strength is weak, how the tongue is functioning at the breast, and how infant compensation patterns often drive pain, inefficiency, and feeding struggles. This conversation bridges lactation science, cranial nerve physiology, and gentle body-based intervention, offering clinicians practical tools while challenging reductionist approaches to infant oral dysfunction. 🔍 What We Talk About How Ellen entered the field of lactation through nursing and public health Why “bucket diagnoses” (yeast, Raynaud’s, tongue-tie) persist in lactation care What body-led breastfeeding means—and why the baby is often the primary driver The clinical gap that inspired development of the Infant Suck Strength Exam (ISSE) Why digital oral exams miss what’s happening at the breast How the ISSE is performed and what each pull-back reveals about suck strength Why the ISSE often functions as both assessment and treatment Infant compensation patterns: jaw movement, lip use, body tension, and asymmetry The role of cranial nerves and the cranial base in feeding function Why asymmetric latch and “guppy pose” can sometimes worsen dysfunction Gentle, parent-taught techniques to support infant regulation and suck strength How bottle-feeding strategies must align with breastfeeding goals When to consider referral for craniosacral or body-based therapy Why frenotomy alone may destabilize function if body tension isn’t addressed What future research is needed to validate and study the ISSE 🧠 Key Takeaways for Clinicians A visually “good” latch can hide significant internal dysfunction. Infant suck strength and tongue function must be assessed during active feeding. Many breastfeeding problems originate in infant neuromuscular coordination—not maternal anatomy. Babies often compensate with their bodies when oral function is inefficient. Gentle pull-back techniques can cue strength and improve function without causing pain. Positioning that supports a neutral cranial base is critical for effective feeding. Body-based approaches may reduce unnecessary procedures and improve long-term outcomes. The ISSE offers clinicians a structured, repeatable way to assess progress over time. 👩‍🏫 Guest Ellen Chetwynd, PhD, IBCLC www.bodyledbreastfeeding.com Upcoming Workshop: https://www.bodyledbreastfeeding.com/lactation-support-workshops Self-Paced Courses: https://teachingbabiestonurse.thinkific.com/collections Body-Led Breastfeeding Podcast: Spotify: https://open.spotify.com/show/7sxiNwaRMppZ8AfjF98C6K Apple: https://podcasts.apple.com/gb/podcast/body-led-breastfeeding/id1789167683 Former Editor-in-Chief, Journal of Human Lactation Co-founder, Body-Led Breastfeeding Chapel Hill & Durham, North Carolina 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙 Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe and leave a review! #BehindTheLatch #IBCLC #BodyLedBreastfeeding #InfantSuck #CranialNerves #LactationAssessment #BreastfeedingScience #OutpatientLactation #LactationEducation

Culturally Responsive Lactation Care with Jewish Families with Maya Lott, IBCLC

In this episode of Behind the Latch, Margaret sits down with former student and practicing IBCLC Maya Lott to explore culturally responsive lactation care through the lens of working with Jewish families. Drawing from Maya’s clinical experience, academic background in Jewish philosophy and law, and her widely shared paper on counseling Jewish families, this conversation offers practical guidance for IBCLCs seeking to build trust, reduce friction, and deliver truly family-centered care. Maya shares how cultural norms, religious practices, and community structures can shape breastfeeding decisions—and how IBCLCs can approach these dynamics with curiosity rather than assumptions. From baby naming practices and modesty considerations to Shabbat, donor milk logistics, and the role of rabbis in healthcare decision-making, this episode provides concrete, respectful strategies clinicians can use immediately in practice. 🔍 What We Talk About Maya’s path to becoming an IBCLC through Pathway 2—and why it worked well for her as a parent Why cultural humility matters in lactation care (and what it looks like in real visits) Breastfeeding as a cultural norm in many Jewish communities—and the pressures that can create Baby naming practices in observant Jewish families and why asking “Does your baby have a name yet?” matters Modesty, family roles, and how they can influence in-home lactation visits Preparing infants for circumcision (bris) and how this can intersect with feeding support Shabbat, milk removal, and how IBCLCs can collaborate respectfully without practicing religious law The role of rabbis in health-related decisions—and why this can be empowering for families Donor milk, milk sharing, and kosher kitchen logistics How informal milk sharing functions in tight-knit communities Parallels with other cultural and religious practices (including Muslim milk-kinship laws) Practical language IBCLCs can use to avoid alienation and build rapport Why curiosity—not expertise in religious law—is the key clinical skill 🧠 Key Takeaways for Clinicians Cultural competence starts at the doorstep—small language choices can shape the entire visit. You don’t need to be an expert in religious law to provide excellent care; awareness of considerations is enough. Asking open, respectful questions helps families integrate lactation care with lifelong values. Rabbis (and other faith leaders) often serve as supportive collaborators, not barriers, in healthcare decisions. Donor milk use may be less about theology and more about household logistics—problem-solving builds trust. Many cultural “rules” can feel rigid from the outside but are experienced as empowering within the community. These principles apply far beyond Jewish families—this is a framework for all culturally responsive lactation care. 👩‍🏫 Guest Maya Lott, IBCLC What IBCLCs Need to Know About Counseling Jewish Families: A Lactation Consultant's Guide to Cultural Competence When Working with Dyads who Practice Judaism mayalottibclc.com Tamari Jacob: https://www.instagram.com/onewiththepump/ Miriam Ezagui: https://www.instagram.com/miriam.ezagui/ 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙️ Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe, share, and leave a review to help other lactation professionals find the show. #BehindTheLatch #IBCLC #CulturalCompetence #CulturallyResponsiveCare #JewishFamilies #LactationEducation #BreastfeedingSupport #DEIInHealthcare #PublicHealthLactation

Craniosacral Therapy and Infant Feeding with Meaghan Beames, RMT

Lactation Exam Mastery Course! Master the IBCLC Exam Today! In this episode of Behind the Latch, Margaret interviews Meaghan Beames, Registered Massage Therapist, educator, and infant craniosacral therapy specialist based in Toronto. Meaghan shares her journey into craniosacral therapy following her own early breastfeeding struggles and explains how this gentle, hands-on modality can support infants experiencing feeding difficulties, poor latch, weak suck, reflux, tension patterns, and post-birth dysregulation. Together, Margaret and Meaghan unpack what craniosacral therapy actually is—and what it is not—moving beyond common misconceptions of it as “woo” or energy work. Meaghan offers a clear, physiology-based explanation grounded in fascia, cranial nerve function, nervous system regulation, and developmental biomechanics, helping clinicians understand how subtle tension patterns from gestation and birth can profoundly affect infant feeding and behavior. Throughout the conversation, they explore the clinical intersections between lactation care and bodywork, including the role of cranial nerves in suck function, the relationship between birth mechanics and oral dysfunction, and how craniosacral therapy may improve outcomes before and after frenotomy. Meaghan also provides practical language clinicians can use with families, guidance on practitioner training and safety, and insight into when referrals to other disciplines are appropriate. 🔍 What We Talk About How Meaghan entered infant craniosacral therapy after her own postpartum and breastfeeding experience What craniosacral therapy is, how it works, and how it differs from chiropractic, osteopathy, and physical therapy Fascia, tension patterns, and why the body must be viewed as a single integrated system The role of cranial nerves in infant feeding, suck strength, and oral coordination How gestational positioning, birth interventions, and delivery mechanics influence feeding outcomes Why babies may feed well on one side but struggle on the other Weak suck, poor oral sensation, and why some infants “can’t feel” the nipple The limitations of appearance-based tongue-tie assessment and why function must come first How craniosacral therapy may improve frenotomy outcomes and reduce reattachment risk Why cutting a dysfunctional tongue without addressing body tension can worsen feeding What a typical infant craniosacral session looks like, including assessment and treatment flow How many sessions are typically needed and why “snapback” can occur How craniosacral therapy supports nervous system regulation and reflex integration What families may notice after treatment, including emotional release and behavior changes How to talk with parents about craniosacral therapy in clear, non-alarming language Safety considerations, training standards, and how to identify qualified practitioners What the current research does—and does not—tell us about craniosacral therapy Options for families who cannot access or afford bodywork services 🧠 Key Takeaways for Clinicians Infant feeding difficulties are often rooted in whole-body tension patterns, not isolated oral anatomy. Cranial nerve dysfunction can impair suck, coordination, and sensation even when oral anatomy appears “normal.” Craniosacral therapy uses extremely light touch to identify and release fascial restrictions affecting function. Birth mechanics, including fetal position and obstetric interventions, can significantly impact feeding. Frenotomy without addressing underlying body tension may destabilize tongue function and worsen outcomes. Craniosacral therapy may support feeding both before and after tongue-tie release. Language matters: explaining the work in functional, observable terms builds parent trust. Practitioner training and infant-specific education are critical for safety and effectiveness. Craniosacral therapy is low risk when performed appropriately, but not interchangeable with adult-based bodywork. Supporting parental intuition and confidence is an essential part of infant care. 👩‍🏫 Guest Meaghan Beames, RMT Infant Craniosacral Therapist & Educator, Toronto, Canada Beames CST MyBaby Craniosacral Podcast MyBaby Instagram 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙 Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine #BehindTheLatch #CraniosacralTherapy #InfantFeeding #IBCLC #BodyworkAndLactation #CranialNerves #TongueTie #InfantRegulation #BreastfeedingSupport #LactationEducation #WholeBodyCare 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe and leave a review!

Why Early Colostrum Feeding Matters: Insights from Dr. Valérie Verhasselt

Lactation Exam Mastery Course! Master the IBCLC Exam Today! In this episode of Behind the Latch, Margaret interviews Dr. Valérie Verhasselt, Professor of Immunology at the University of Western Australia and Head of the LRF Centre for Immunology and Breastfeeding. Dr. Verhasselt discusses her groundbreaking research on colostrum and food allergy prevention, focusing on her recent study demonstrating that partial colostrum feeding in the first 72 hours of life increases the risk of peanut allergy, while exclusive colostrum feeding appears profoundly protective. Her findings offer a powerful reframing of early postpartum lactation care: the risk may not stem solely from early cow’s milk exposure, but from reduced colostrum intake during the critical adaptation period when the newborn’s gut, immune system, and microbiota are being programmed. She explains how colostrum’s unique concentration of growth factors, IgA, vitamin A, and immune-modulating bioactive components help seal the gut, seed the microbiome, strengthen the skin barrier, and establish immune tolerance—laying the foundation for lifelong resilience. Dr. Verhasselt also shares insights from mouse models, discusses why donor mature milk is not a substitute for colostrum, and explores future directions including donor colostrum banks, colostrum-derived therapeutics, and new research on colostrum’s role in brain development. https://pubmed.ncbi.nlm.nih.gov/40968490/ 🔍 What We Talk About How Dr. Verhasselt entered lactation immunology after a “flash” inspiration during her early research career Why the transition from intrauterine to extrauterine life makes newborns uniquely vulnerable to allergy development How colostrum supports gut closure, immune regulation, microbiota seeding, and skin barrier maturation Why giving formula in the first days displaces colostrum intake rather than simply “topping up” Evidence showing a five-fold increase in peanut allergy among infants who received partial colostrum feeding The striking finding that no infants who received ≥9 colostrum feeds developed peanut allergy by 12–18 months What early formula exposure does to the infant microbiome weeks and months later How parental allergy risk influences—but does not override—the protective effect of colostrum Why exclusive breastfeeding data often overlook the critical first 72 hours The interplay between infant skin permeability, environmental exposure, detergent use, and allergy sensitization What mouse models teach us about colostrum, mature milk, and developmental programming Why donor milk does not replicate colostrum’s early immunological function The concept of exclusive colostrum feeding as a distinct clinical and public health priority Future research avenues: colostrum-derived metabolites, donor colostrum banks, and early-life allergy prevention strategies 🧠 Key Takeaways for Clinicians Colostrum’s immunological role is unique and time-sensitive—its composition cannot be replicated by mature milk, donor milk, or formula. Supplementation in the first days displaces colostrum volume, which may be the primary mechanism increasing allergy risk. As few as nine colostrum feeds in the first 72 hours appear profoundly protective against peanut allergy. Early formula exposure—even brief—can alter the infant gut microbiota for months. The newborn’s gut and skin barriers are uniquely permeable, making early antigen exposure highly consequential. Parents who partially colostrum feed may benefit from earlier peanut introduction, while exclusively colostrum-fed infants may have more flexibility. The language we use (“milk coming in”) can unintentionally undermine parents’ confidence; reframing colostrum as “the milk for those days” is more accurate and supportive. Research supports reframing early postpartum care around exclusive colostrum feeding, not just exclusive breastfeeding. 👩‍🏫 Guest Dr. Valérie Verhasselt, MD, PhD Professor, University of Western Australia Head, LRF Centre for Immunology and Breastfeeding Perth Children’s Hospital, Telethon Kids Institute 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙 Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine #BehindTheLatch #Colostrum #BreastfeedingResearch #FoodAllergyPrevention #PeanutAllergy #Immunology #BreastmilkScience #LactationResearch #HumanMilk #ColostrumIsLiquidGold #InfantFeeding #PublicHealthLactation 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe and leave a review!

Inside the Lactating Breast: Ultrasound, Adiposity & Milk Production with Dr. Zoya Gridneva

LACTATION EXAM MASTERY COURSE- Stop Guessing How to Study for the IBCLC Exam. In this episode of Behind the Latch, Margaret interviews Dr. Zoya Gridneva, Research Fellow with the Geddes–Hartmann Human Lactation Research Group. Zoya discusses her research exploring maternal adiposity, glandular tissue distribution, breast anatomy, milk production, puberty timing, parity, and breast development across lactations, using ultrasound imaging to examine the lactating breast in a way few studies have before Her findings help illuminate why some parents experience low supply despite doing “everything right,” and demonstrate how maternal factors—especially adiposity—may influence glandular tissue development, breast storage capacity, and milk removal efficiency. She also shares emerging tools that may help clinicians screen for lactation risk prenatally and why early identification may matter profoundly for parental experience and outcomes. 🔍 What We Talk About How Zoya entered lactation research after her own breastfeeding experience Why adiposity is emerging as a central factor in milk production outcomes What ultrasound can tell us about ductal branching, glandular volume, and breast storage capacity Why more ductal development doesn’t always equal meaningful clinical increase in supply The relationship between puberty timing, parity, contraception, adiposity & milk output — what we know and what we don’t Why breast size ≠ glandular volume, and why small breasts may produce normal volumes The need for better screening for primary low supply and insufficient glandular tissue (IGT) A new 5-minute lactation risk screening tool used in Western Australia & its clinical promise Why single-feed weights are not enough — and why 24-hour production is more meaningful Where research must go next: larger samples, longitudinal data, and early-life glandular development 🧠 Key Takeaways for Clinicians Adiposity may influence breast growth, glandular proportion, and storage capacity, mediating supply outcomes. Ultrasound can visualize breast structure but requires skill, training, and access — not yet feasible for routine care. We may be able to identify high-risk parents prenatally using simple clinical screening tools, improving early intervention timing. Puberty, hormonal exposure, and menarche timing could play a significant role in final glandular development — a research area wide open for exploration. 24-hour test-weighing is one of the most reliable ways to identify low production early, long before a “weight problem” appears. Clinically, risk awareness + early frequent milk removal support may be key for at-risk families. 👩‍🏫 Guest Dr. Zoya Gridneva, PhD Maternal Factors, Breast Anatomy & Milk Production — An Ultrasound-Based Look Inside Lactation Research Fellow, Geddes–Hartmann Human Lactation Research Group University of Western Australia 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙️ Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine #BehindTheLatch #BreastfeedingSupport #LactationResearch #OutpatientLactation #IBCLC #PostpartumCare #BreastfeedingEquity #MaternalHealth #LactationPolicy #PublicHealthLactation 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe and leave a review!

Why Outpatient IBCLC Care Matters: A Conversation with Dr. Anita Lugo

In this episode of Behind the Latch, Margaret Salty interviews Dr. Anita Lugo, Pediatric Nurse Practitioner, IBCLC, researcher, and Assistant Professor at Moravian University in Pennsylvania. Dr. Lugo’s work focuses on one of the most critical—and often overlooked—components of breastfeeding success: outpatient lactation care after hospital discharge. Her recent review highlights the powerful impact of early, skilled IBCLC support on breastfeeding exclusivity and duration, and shines a light on the persistent gaps families face when navigating the postpartum period. Together, they explore the evidence behind outpatient IBCLC interventions, the systemic barriers that prevent equitable access to care, and the urgent need for stronger policies, better reimbursement models, and more consistent pathways for families to receive the level of support they truly need. Dr. Lugo also discusses how timing, frequency, and modality of lactation care—whether in-person, outpatient clinic, in-home, or telehealth—shape outcomes, and what future research should focus on to strengthen breastfeeding support across diverse communities. They discuss: Why many breastfeeding challenges intensify after families leave the hospital Evidence showing that IBCLC support at 3 days and 2 weeks postpartum yields the best outcomes Gaps in outpatient access, especially for families with Medicaid or grandfathered plans Geographic disparities in IBCLC availability and why they matter The limitations of relying solely on prenatal classes or hospitalization support The role of telelactation and what parents find helpful—or challenging—about virtual consults The need for clearer distinctions between lactation credentials and their scopes of practice How policy, insurance reform, and better public awareness could improve breastfeeding equity Future research needed on optimal visit numbers, timing, and support models 👩‍🏫 Guest Info Dr. Anita Lugo, DNP, PNP, IBCLC An integrative review of the impact of International Board Certifed Lactation Consultants in outpatient postnatal settings in the United States Assistant Professor, Moravian University Pediatric Nurse Practitioner & IBCLC Prenatal Educator, St. Luke’s University Hospital LinkedIn: Anita Lugo 📝 Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty 🎙️ Podcast: Behind the Latch Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine #BehindTheLatch #BreastfeedingSupport #LactationResearch #OutpatientLactation #IBCLC #PostpartumCare #BreastfeedingEquity #MaternalHealth #LactationPolicy #PublicHealthLactation #Telolactation #BreastfeedingOutcomes #InfantFeeding #NewParentSupport 🎧 Listen now on your favorite podcast app — and don’t forget to subscribe and leave a review!