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What if some of what we still teach about breast anatomy, milk supply, pumping, and milk ejection is based on an outdated understanding of how the lactating breast actually works?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 researchThe history behind the traditional anatomical models of the lactating breastWhat ultrasound revealed that older breast anatomy diagrams got wrongWhy the concept of large “lactiferous sinuses” does not match what we see in the living breastHow widely milk duct anatomy can vary between individualsWhy some people can hand express milk easily while others struggleWhether having fewer lobes necessarily means a person will have low milk productionWhat we currently understand—and still don't understand—about mammary hypoplasiaWhy breast size alone tells us very little about milk-making capacityBreast changes during pregnancy and what clinicians should be asking about prenatallyThe relationship between blood flow to the breast and milk productionPregnancy complications such as gestational diabetes, preeclampsia, and fetal growth restriction as potential clues to later lactation challengesMetabolic health, inflammation, and their possible relationship to milk productionWhy identifying risk does not mean predicting failureThe importance of anticipatory guidance for families at increased risk for low milk productionWhy intensive feeding plans such as triple feeding should have clear goals and endpointsWhat ultrasound has taught us about the milk ejection reflexWhy many people do not actually feel their milk ejectionsWhy 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 flowThe difference between anatomy-driven fast flow and true oversupplyWhy automatically trying to decrease milk production can sometimes create a new problemHow milk storage capacity differs dramatically from one person to anotherWhy frequent feeding does not automatically indicate low milk supplyWhy infant growth, behavior, milk transfer, maternal experience, and the whole clinical picture matter more than feeding frequency aloneWhy the right and left breast should not necessarily be expected to function identicallyHow researchers estimate the percentage of available milk removed from the breastWhy simply comparing pumping volumes between people can be misleading A Bigger Lesson for Lactation ProfessionalsThroughout 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 sizingInfant body compositionBiomarkers associated with low milk productionProteomics and metabolomicsClinical measures that could help identify low milk production earlierAntenatal and early postpartum screening toolsGestational diabetes and lactation outcomesBundled-care interventionsUltrasound phenotypingAI-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 GeddesDr. 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 MoreDonna 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/coursesRead the Blog: https://margaretsalty.com/blogEmail Me: [email protected]: 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"

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 handsThe 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 todayHow to know when you're "done" — the outcome to feel for instead of a number to hitWhy 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 stuckWhy she calls herself a lactation therapist, not a consultant — and what that reframe unlocksHow mindful latching flips the script: the parent doesn't latch the baby, she positions so the baby can latchWhere 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.comBolman, 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/10.1177/0890334413475527Witt, 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/10.1177/0890334415619439Witt, 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/coursesRead the Blog: https://margaretsalty.com/blogEmail Me: [email protected]: 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"

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 LearnThe real difference between primary, secondary, and perceived low milk supply—and why the distinction changes your entire plan of careWhy milk supply is so hard to measure accurately, and what that means for how we interpret researchWhat biomarkers like sodium and conductance can (and can't) tell you about secretory activationWhere bioimpedance and at-home milk sodium testing are headed, and how to think about them before they land in your practiceThe infant behaviors that get misread as low supply—so you can spot them and reframe them for familiesHow feeding technology and social media are driving parental anxiety, and your role in cutting through the noiseWhy milk intake "standards" deserve a second look, and how normal supply variability fits inWhen to bring in a breastfeeding medicine provider, and how that collaboration strengthens careHow to hold objective tools and clinical judgment together instead of letting one override the other Chapters00:00 — Introduction and Dr. Kivlighan's research background05:53 — Low milk supply: types and challenges08:12 — The role of perception in supply concerns10:31 — Evaluating milk supply: tools and techniques13:11 — Common misinterpretations of infant behavior15:46 — How technology feeds parental anxiety18:16 — Collaborating with lactation professionals20:40 — Reassessing milk intake standards26:39 — Understanding milk supply variability27:20 — Emerging technologies in lactation32:23 — Bioimpedance and milk measurement innovations34:58 — Addressing delayed secretory activation41:27 — The case for comprehensive lactation support43:02 — Closing thoughts Resources MentionedKivlighan, 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/10.1177/08903344261426744Dr. Katie Kivlighan:Faculty pageResearch profile Your Next StepsLearn with Me: https://margaretsalty.com/coursesRead the Blog: https://margaretsalty.com/blogEmail Me: [email protected]: 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"

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 Importance04:07 The Journey to Establishing a Milk Bank05:24 The Supporting Premature Infant Nutrition Program08:43 The Need for More Milk Banks in California11:45 Building a Milk Bank: Challenges and Triumphs16:52 Understanding Hambana and Milk Bank Structures20:14 Pasteurization Standards and Safety in Milk Banking23:58 Fortification of Human Milk and Its Implications30:18 The Importance of Accreditation and Safety Standards34:39 The Donor Process: Ensuring Safety and Efficiency35:33 Processing Milk: From Donation to Quality Control37:27 Nutritional Targeting: Tailoring Milk for Tiny Patients40:11 Analyzing Milk: Understanding Composition and Quality43:23 Raising Awareness: The Importance of Milk Donation44:30 Barriers to Access: Challenges in Milk Banking46:16 The Role of Nonprofit Milk Banks: A Community Approach51:58 The Cost of Donor Milk and NICU Decisions57:21 Vision for the Future of Milk Banking1:00:21 Honoring Bereaved Donors: The Cherry Blossom Program1:04:49 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: [email protected] Instagram: @margaretsalty Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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: [email protected] Instagram: @margaretsalty Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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 CliniciansFood proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeksThe timeline we see clinically is often driven by infant healing, not ongoing exposureElimination diets should be reassessed early (around 5 days) to determine effectivenessNot all symptoms warrant elimination—rule out more common causes firstMost infants with food reactivity will have symptoms emerge between 2–4 monthsCow’s milk and soy are the most common triggers, but other foods may be involvedReintroduction is critical to avoid unnecessary long-term restrictionSevere symptoms or lack of improvement beyond dairy/soy elimination should prompt referralNon-IgE-mediated allergies cannot be diagnosed with standard allergy testingSupporting parental mental health is essential—elimination diets are a significant burden GuestTrillitye Paullin, PhD, CEO & Co-Founder, Free to Feed Free to Feed Supporting Families as They Navigate Infant Food Allergies Connect with Margaret📬 Email: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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 CliniciansLactation 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. GuestVictoria 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: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

What We Talk AboutThe 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 CliniciansThe “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. GuestDr. 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,...

What We Talk AboutHow 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 CliniciansThe 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 prescriptionDiagnosis coding (NICU admission)Coordination with a DME supplierCase 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. 👩‍🏫 GuestMina Ognianovich, IBCLC https://minalactation.com/ 📝 Connect with Margaret📬 Email: [email protected] 📸 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

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 AboutHow 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 & StudentsThe 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. 👩‍🏫 GuestDr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES Professor, University of Texas at Tyler 📝 Connect with Margaret📬 Email: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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 AboutIndira’s work in a specialist NHS breastfeeding clinic in the UKTeaching future lactation consultants and pursuing a PhD in breastfeeding educationThe three “seeds of inspiration” that moved her from reader to authorWhy attending a JHL writing session at ILCA changed everythingWhat an editor told her when she doubted whether her case was “spicy” enoughWhy you do not need a PhD to write and publish a case studyHow she structured her first case study by studying medical literature methodologyThe powerful cleft lip and palate case that became her first JHL publicationAssisted 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 assumptionThe emotional dimension of clinical practice: witnessing the “impossible”Why wonder is the essential ingredient for writingBurnout, mechanistic care, and losing the capacity to recognize aweMaking research accessible for non-academic IBCLCsHer creation of the international Research Hub through the Centre for Breastfeeding Education and Research The Three Seeds of InspirationIndira 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 IBCLCsYou 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 HubIndira created the International Research Hub through the Centre for Breastfeeding Education and Research (CBER): Free monthly online research discussionOpen to IBCLCs worldwideSafe 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. GuestIndira 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: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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 AboutThe difference between mentoring vs. supervising clinical hoursWhat IBCLC mentors are truly responsible for in Pathway 2 and Pathway 3How students should be gradually and ethically integrated into hands-on careCommon gaps students face when transitioning from coursework to clinical practiceTools that support mentorship, including IBLCE outlines and LEAARC skill checklistsWhy learning from multiple mentors can strengthen clinical competenceLiability, affiliation agreements, and student protections in Pathway 2 programsThe professional and personal benefits of becoming a mentorCharging for mentorship: ethics, equity, and value exchangeWhy mentorship is part of our professional obligation as IBCLCsWhat Kristina hopes the future of lactation mentorship will look like 🧠 Key TakeawaysMentorship 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. 👩‍🏫 GuestKristina 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: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Hosted by: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

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 AboutHow Ellen entered the field of lactation through nursing and public healthWhy “bucket diagnoses” (yeast, Raynaud’s, tongue-tie) persist in lactation careWhat body-led breastfeeding means—and why the baby is often the primary driverThe clinical gap that inspired development of the Infant Suck Strength Exam (ISSE)Why digital oral exams miss what’s happening at the breastHow the ISSE is performed and what each pull-back reveals about suck strengthWhy the ISSE often functions as both assessment and treatmentInfant compensation patterns: jaw movement, lip use, body tension, and asymmetryThe role of cranial nerves and the cranial base in feeding functionWhy asymmetric latch and “guppy pose” can sometimes worsen dysfunctionGentle, parent-taught techniques to support infant regulation and suck strengthHow bottle-feeding strategies must align with breastfeeding goalsWhen to consider referral for craniosacral or body-based therapyWhy frenotomy alone may destabilize function if body tension isn’t addressedWhat future research is needed to validate and study the ISSE 🧠 Key Takeaways for CliniciansA 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. 👩‍🏫 GuestEllen 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: [email protected] 📸 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