In this episode of Behind the Latch, Margaret Salty interviews Joanie Randle, RN and clinical research nurse at Nationwide Children's Hospital. Joanie introduces her innovative Comprehensive Lactation Care Model—a paradigm shift in how lactation support is delivered to NICU families. Drawing from decades of experience and deep roots in La Leche League, Joanie outlines how a consistent, anticipatory, and relationship-based model can improve outcomes for preterm and medically complex infants.

Randle, J. (2024). The case for a paradigm shift in lactation care for NICU families: A comprehensive lactation care model. Journal of Human Lactation, 41(1), 34–38. https://doi.org/10.1177/08903344241299722

Joanie’s Journey into Lactation Support

Joanie shares how:

• Her early days as a La Leche League leader sparked a lifelong passion for lactation support.
• Her nursing career took her from bedside NICU work to clinical research and maternal-child health.
• She recognized the disconnection between early feeding guidance and actual practice in NICUs—fueling her vision for a new care model.

What Is the Comprehensive Lactation Care Model?

Joanie explains:

• The model starts with prenatal or antepartum lactation education, especially for parents anticipating NICU stays.
• One consistent lactation provider follows the family from prenatal contact through postpartum and NICU discharge.
• Lactation professionals are embedded into the clinical team—attending rounds, monitoring milk supply, and ensuring communication flows between staff and family.

Aims and Structure of the Model

They explore:

• The primary study goal: whether early, structured lactation education increases mother’s milk provision during the NICU stay.
• The use of customized, repeated visits to build lactation skills and confidence.
• How lactation providers serve as care coordinators, bridging the gaps between parent, clinical team, and hospital systems.

Clinical Culture Shift: IBCLCs at the Table

Joanie highlights:

• IBCLCs are often excluded from clinical decision-making and viewed as either miracle workers or rigid idealists.
• Full integration means treating mother’s milk as medicine—not a lifestyle choice—and supporting the dyad holistically.
• The NICU requires a specialized skill set that goes beyond latch and includes an understanding of maternal and infant health conditions.

Structural Barriers and Real-Life Solutions

They discuss:

• The need to preemptively address insurance and pump access before delivery.
• How pump routines should be personalized—not standardized—for maternal well-being and long-term success.
• The importance of repeated education post-delivery, especially for mothers who didn’t receive antepartum support.

Moving from Theory to Practice

Joanie and Margaret talk about:

• The need for administrative buy-in and physician champions to implement the model.
• Collaboration with maternal-fetal medicine and NICU leadership to flag high-risk dyads early.
• Plans for training and developing specialized NICU IBCLC education alongside Claire Eden.

Guest Info:

Joanie Randle is a nurse, clinical researcher, and lifelong lactation advocate. She currently works at Nationwide Children’s Hospital and is developing research around her Comprehensive Lactation Care Model. She and colleague Claire Eden are leading efforts to revolutionize NICU lactation support.

📧 Email: [Available upon request]

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

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🎙 Hosted by: Margaret Salty

🎧 Guest: Joanie Randle, RN

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

Hashtags & Keywords:

#BehindTheLatch #NICULactationCare #IBCLC #BreastfeedingSupport #ComprehensiveLactationModel #PretermInfantFeeding #ClinicalTeamIntegration #LactationLeadership #LactationCareModel

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In this episode of Behind the Latch, Margaret Salty reviews four recent studies covering the power of the breast milk microbiome, maternal confidence in NICU milk expression, cultural insights into human milk donation, and the reality of prescription drug use during lactation. Each study offers timely, practical takeaways to inform how IBCLCs support families in clinical and community settings.

Citation: Rebello, S. J., et al. (2025). Journal of Pure and Applied Microbiology, 19(2), 902–913. https://doi.org/10.22207/JPAM.19.2.51

🔍 What They Studied:

A literature review of the breast milk microbiome’s impact on gut colonization, immune development, and disease prevention in infants—especially in preterm populations.

🧠 Key Findings:

• Breast milk contains active strains like Lactobacillus and Bifidobacterium
• Breastfed infants have healthier microbiota than formula-fed infants
• Milk microbes help prevent NEC, infections, colic, and eczema
• Supplemental probiotics (when used appropriately) are generally safe and effective

✅ Implications for IBCLCs:

• Reinforces that breast milk is immunologically active—not just nutrition
• IBCLCs can educate families and advocate for milk as medicine
• Understanding probiotic research supports informed collaboration in NICU care

Citation: Kheawlamyong, R., et al. (2025). Journal of Health Research, 39(3), 244–252. https://doi.org/10.56808/2586-940X.1138

🔍 What They Studied:

Which maternal perceptions (based on the Health Belief Model) best predict breastfeeding preparation behaviors in mothers of preterm infants receiving donor milk.

🧠 Key Findings:

• Only self-efficacy significantly predicted positive lactation behaviors
• Risk awareness, benefits, and barriers weren’t correlated with milk expression efforts
• Mothers who believed in their ability to succeed were more likely to store and prepare milk

✅ Implications for IBCLCs:

• Building confidence, not just providing education, is key in NICU support
• Donor milk can reduce urgency—so reinforce the value of MOM (mother’s own milk)
• Effective support includes hands-on help, emotional validation, and tailored plans

Citation: Mahdikhani, Z., et al. (2025). International Breastfeeding Journal, 20(50). https://doi.org/10.1186/s13006-025-00740-6

🔍 What They Studied:

A meta-synthesis of 36 qualitative studies exploring the lived experiences of milk donors, recipients, and healthcare providers worldwide.

🧠 Key Findings:

• Donating milk can be healing, especially after infant loss
• Cultural beliefs, stigma, and religion heavily influence donor milk decisions
• Healthcare provider encouragement increases milk bank participation
• Systemic barriers—like transport, lack of access, and misinformation—limit engagement

✅ Implications for IBCLCs:

• We play a central role in normalizing donor milk and offering trauma-informed support
• Cultural sensitivity and evidence-based reassurance are critical
• Bereaved donors deserve compassionate care and informed options
• Push for system improvements: access, education, and provider training

Citation: Gotfredsen, D. R., et al. (2025). British Journal of Clinical Pharmacology. https://doi.org/10.1002/bcp.70139

🔍 What They Studied:

A register-based cohort study in Denmark analyzing over 534,000 breastfeeding dyads to understand medication use and the availability of lactation safety data (RID).

🧠 Key Findings:

• 54.5% of breastfeeding mothers used at least one prescription drug
• Most common: antibiotics, IUDs, and pain medications
• 51.5% of systemic drugs lacked Relative Infant Dose (RID) data
• Major gaps in evidence limit clinical guidance for safe use

✅ Implications for IBCLCs:

• Prescription drug use is common—knowledge and referral are essential
• Lack of data can lead to over-caution or unnecessary weaning
• Collaborate with prescribers and refer to LactMed, Hale’s, or InfantRisk
• Advocate for policy change to improve data collection and transparency

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #ResearchRecap #IBCLC #BreastMilkMicrobiome #MilkDonation #DonorMilk #NICULactation #PrescriptionDrugsAndBreastfeeding #LactationSupport #EvidenceBasedCare

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In this episode of Behind the Latch, Margaret Salty interviews Marsha Walker—nurse, IBCLC, author, and president of the National Lactation Consultant Alliance (NLCA). They dive into everything you need to know about IBCLC licensure: what it is, why it matters, and how it can improve safety, access, and professional recognition for lactation care providers and the families they serve.

Marsha shares:

• Her own positive breastfeeding experience—but lack of support—sparked her journey
• She began as a volunteer breastfeeding counselor, then became a Lamaze instructor, nurse, and eventually an IBCLC
• She helped write the very first IBCLC exam and has spent decades shaping the field through education, writing, and advocacy

Marsha explains:

• Certification (what IBCLCs currently hold) confirms education and clinical competencies but doesn’t carry legal standing
• Licensure is a legal designation granted by a state to protect public safety and ensure practitioners are vetted to provide care
• Licensure defines legal scope of practice, while certification outlines competencies

Key points:

• Families can’t access care they can’t afford—licensure allows for insurance reimbursement
• Vulnerable populations are most likely to experience poor health outcomes when care isn’t accessible
• Licensure gives insurers, Medicaid, and policy makers a clear, trusted pathway to include IBCLCs in networks

Marsha emphasizes:

• Scope of practice is legally defined through licensure—not certification alone
• Without licensure, there is no formal oversight or legal accountability if an IBCLC causes harm
• Ethics matter: working for formula companies or interpreting labs without proper credentials can erode public trust
• Licensure offers a system of recourse for patients and safeguards our profession’s integrity

Marsha addresses:

• Licensure is not surveillance—it’s not about micromanaging your practice
• It doesn’t mean you have to be a nurse or advanced practice provider
• Costs are typically nominal and vary by state
• Most licensure laws adopt existing IBCLC competencies, so the work doesn’t change dramatically—just the legal recognition

They discuss:

• Massachusetts’ WIC model, where peer counselors refer to regional IBCLCs
• The importance of teamwork and risk-appropriate care—educators/supporters provide foundational support, IBCLCs manage complex cases
• How licensure helps close the care gap with structured referral systems

In states where licensure exists:

• IBCLCs can join insurer panels (including Medicaid), even without being RNs
• Access expands for families and job opportunities increase for consultants
• Licensure becomes a tool for both professional recognition and public health improvement

Marsha Walker, RN, IBCLC is the president of the National Lactation Consultant Alliance (NILCA), a longtime advocate for ethical, evidence-based lactation care, and the author of Breastfeeding Management for the Clinician.

🌐 Website: www.nlca.us

📘 Book: Breastfeeding Management for the Clinician: Using the Evidence

📥 Download NILCA's licensure briefs and model bill on their website

📌 NLCA – National Lactation Consultant Alliance

📌 US Women’s Preventive Services Initiative (WPSI)

📌 IBCLC Scope vs. Competency Guidance

📌 Academy of Breastfeeding Medicine

📌 State licensure legislation efforts

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Marsha Walker, RN, IBCLC

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #IBCLCLicensure #LactationProfessionals #ScopeOfPractice #LactationEthics #PublicHealth #AccessToCare #BreastfeedingSupport #NLCA #IBCLCPolicy

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In this episode of Behind the Latch, Margaret Salty reviews four new studies with big implications for hospital, NICU, and community-based lactation care. From evidence-based pain relief strategies to debunked interventions and mobile clinic models that build breastfeeding confidence, this Research Recap delivers practical takeaways for IBCLCs working across settings.

This randomized controlled trial examined whether exposing very preterm infants to the smell and/or taste of breast milk before tube feeds improves growth or reduces length of hospital stay.

Key findings:

• No significant difference in weight gain or time to discharge
• Intervention group: 715g weight gain vs. 657g in control (p = 0.60)
• No impact on secondary outcomes like NEC or breastfeeding at discharge

🔍 Implications for IBCLCs:

• Be cautious about implementing new NICU interventions without strong evidence
• Prioritize time and resources toward proven strategies (skin-to-skin, milk supply protection, cue-based readiness)
• Set realistic expectations with NICU families about evidence-based support

Citation: Fonseca, L. G. R., et al. (2025). The lack of benefit of exposing the premature infant to breast milk smell and/or taste before tube feeding: A double-blind randomized clinical trial. Breastfeeding Medicine. https://doi.org/10.1089/bfm.2025.0042

A quasi-experimental study evaluated the effect of breastfeeding during blood sampling in infants under one year old.

Key findings:

• FLACC pain scores were 2.6 in breastfed infants vs. 6.7 in controls
• Breastfed infants had more stable vitals, less crying, and quicker recovery
• 63% of non-breastfed infants experienced severe pain—compared to 0% in the breastfeeding group

🔍 Implications for IBCLCs:

• Advocate for breastfeeding during minor procedures like heel sticks and venipuncture
• Use this study to educate hospital staff about non-pharmacologic pain relief
• Reinforce for families: breastfeeding isn’t just for nutrition—it reduces pain

Citation: Sharbat, R., et al. (2025). Effect of breastfeeding on pain intensity among infants during blood sampling. Minia Scientific Nursing Journal, 17(2), 46–62.

This study explored the effects of music therapy on milk volume and stress in NICU mothers using Indian classical ragas.

Key findings:

• Milk volume was slightly higher in the non-music group
• But the music therapy group showed significant reductions in stress and cortisol levels
• Suggests music may improve milk supply indirectly via stress reduction

🔍 Implications for IBCLCs:

• Music therapy may not boost output directly—but it supports maternal well-being
• Lower stress = better lactation outcomes long-term
• Recommend calming music as a low-cost, adaptable intervention in NICU or home settings

Citation:  Dixit, S., & Singh, B. (2017). Impact of music therapy on amount of breast milk secretion among mothers of premature newborns. International Journal of Life Sciences, Biotechnology and Pharma Research, 6(12), 5–8.

This community-based study evaluated a nurse-led mobile lactation clinic serving postpartum families in Gurugram, India.

Key findings:

• Breastfeeding self-efficacy scores were significantly higher in the mobile clinic group
• Maternal satisfaction also increased dramatically
• Demonstrates the value of mobile, proactive, structured lactation support

🔍 Implications for IBCLCs:

• Community-based, nurse-led models are effective and scalable
• Higher confidence = longer breastfeeding duration
• IBCLCs can help train or collaborate with nurse teams in under-resourced settings

Citation: Sonam, K. M., Deepak, S., Shalu, B., Banapriya, M., & Yadav, P. (2025). A study to assess the effectiveness of nurses-led breastfeeding mobile clinic (NLBMC) on breastfeeding outcomes in lactating mothers at selected areas of Gurugram. Journal of Neonatal Surgery, 14(12s), 1117–1123.

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #LactationResearch #NICU #BreastfeedingSupport #IBCLC #MilkSupply #BreastfeedingPainRelief #LactationAdvocacy #MobileClinics #MusicTherapy

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In this episode of Behind the Latch, Margaret Salty interviews Nicole Longmire, IBCLC—an educator, lactation consultant, and vocal advocate for ethical, parent-centered lactation care. Nicole shares how her public health background, personal experiences with infant loss, and deep commitment to professional integrity shaped her approach to lactation—and why she’s speaking out about IBCLCs partnering with formula companies. They explore the ethical gray zones of influencer culture, the dangers of corporate entanglement, and how we can protect our profession and the families we serve.

Nicole shares how:

• Working in WIC and public health fueled her passion for feeding equity
• Her own experience with pregnancy loss shaped her sensitivity in client care
• A career pivot into lactation allowed her to bring trauma-informed, parent-led care to the forefront
• She began using social media to advocate for better ethics, clearer scope boundaries, and professional integrity in the lactation space

Nicole explains:

• Why IBCLCs partnering with formula companies—like Bobby—sets a dangerous precedent
• How these partnerships blur the lines of trust between families and professionals
• Why it’s not just about WHO Code violations, but also about influence, power, and profit
• The harm caused when parent choices are manipulated by marketing dressed as support

Margaret and Nicole discuss:

• What staying within scope really means—and why it protects both the provider and the client
• Why IBCLCs recommending, selling, or affiliating with commercial products raises red flags
• How the profession is at risk of losing credibility without clearer standards and boundaries
• Why "soft violations" of the WHO Code are still violations

They explore:

• How algorithm-driven platforms reward popularity over accuracy
• The difference between sharing lived experience and monetizing professional influence
• Why working “with the formula company that respects breastfeeding” is still problematic
• How profit-driven care de-centers the needs of families

Nicole offers insight on:

• How to uphold ethics in your practice—even when others don’t
• The importance of community accountability and speaking up
• Building back professional trust through transparency and education
• Where IBCLCs go from here—and why we can’t afford to stay silent

Nicole Longmire, IBCLC is an educator, lactation consultant, and public health advocate specializing in ethical lactation care and trauma-informed support. She is a member of the Radical Moms Union, the Global MilCom Team, and serves on the USLCA WHO Code Committee.

📱 Instagram: @motheringismedicine @radical_moms_union

🌐 Learn more: www.mothernurtureconsulting.com

#backoffbobbie

📌 The WHO International Code of Marketing of Breast-milk Substitutes

📌 USLCA WHO Code Committee

📌 Radical Moms Union & Global MilCom

📌 ABM Clinical Protocols

📌 Research on influencer culture in maternal health

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Nicole Longmire, IBCLC

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #IBCLC #LactationEthics #WHOCode #FormulaMarketing #BreastfeedingSupport #LactationScope #ParentCenteredCare #TraumaInformedLactation #InfantFeedingEthics

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In this episode of Behind the Latch, Margaret Salty explores four essential studies shaping lactation practice: the impact of breastfeeding on long-term kidney health, how photobiomodulation may help heal nipple injuries, how breastfeeding network prevalence is shaped by race and community in Mississippi, and what effective breastfeeding technique really looks like in an Ethiopian hospital. Each paper reveals actionable insights for IBCLCs striving to support diverse families with evidence-based care.

1️⃣ Breastfeeding and Long-Term Renal Health

Citation:

Sivasankar, M., Raja, I. N., Parthasarathy, S., & Suchitra, M. R. (2025). The protective role of neonatal breastfeeding in renal health: A systematic review. Journal of Neonatal Surgery, 14(6s), 138–144.

• Breastfeeding lowers the risk of UTIs in infancy and chronic kidney disease later in life.
• Protective mechanisms include immune system maturation, healthier metabolic programming, and a balanced gut microbiome.

IBCLC Takeaway: Breastfeeding does more than nourish—it protects renal health long-term. Advocate early and often, especially for at-risk infants.

2️⃣ Photobiomodulation for Nipple Injury

Citation:

Alves, R. O., Ragghianti, M. H. F., Nunes, L. P., Ferreira, M. F., et al. (2025). Photobiomodulation as a promising approach in the management of nipple lesions during breastfeeding: A systematic review and meta-analysis of randomized clinical trials. Lasers in Medical Science, 40, 276. https://doi.org/10.1007/s10103-025-04531-7

• PBM (low-level laser therapy) significantly reduces nipple pain and promotes healing.
• Meta-analysis showed improved outcomes with minimal side effects.

IBCLC Takeaway: While outside our scope to deliver PBM, we can support referral and advocate for evidence-based adjunct therapies for painful nipple trauma.

3️⃣ Breastfeeding Network Disparities in the Deep South

Citation:

Bartkowski, J. P., Klee, K., Xu, X., Roach, J. B., & Jones, S. (2025). Breastfeeding and intersectionality in the Deep South: Race, class, gender and community context in Coastal Mississippi. Women, 5(2), 21. https://doi.org/10.3390/women5020021

• African American women had lower breastfeeding network prevalence.
• Higher income and community support significantly reduced disparities.

IBCLC Takeaway: To close gaps in breastfeeding equity, we must build strong, culturally relevant support networks—and work alongside communities, not just within clinics.

4️⃣ What Effective Breastfeeding Really Looks Like

Citation:

Abebe, Y., & Dadi, B. (2025). Effective breastfeeding practices among mothers exclusively breastfeeding infants in Ethiopia. Clinical Epidemiology and Global Health, 34, 102089. https://doi.org/10.1016/j.cegh.2025.102089

• Only 23% of mothers met criteria for effective breastfeeding based on WHO technique standards.
• Postpartum counseling, demonstration, and previous experience were key factors.

IBCLC Takeaway: Technique matters. Observation, demonstration, and follow-up are crucial. Even exclusive breastfeeding may not be effective without proper latch, positioning, and suckling.

📸 Instagram: @margaretsalty

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📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #BreastfeedingResearch #IBCLC #KidneyHealth #NipplePain #PBMTherapy #BreastfeedingInequities #EffectiveLatch #GlobalLactation #LactationEducation

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In this episode of Behind the Latch, Margaret Salty interviews Rebekah Scroggy, IBCLC—a nurse, lactation consultant, and passionate advocate for neurodivergent-informed care. Rebekah shares how her personal experiences with autism and ADHD in her family, and eventually in herself, completely reshaped her approach to lactation support. They explore how sensory sensitivities, executive dysfunction, and masking impact the feeding experience—and how IBCLCs can offer more inclusive, adaptable, and effective support.

Rebekah shares how:

• Her son’s feeding struggles and her own traumatic experience with weight checks sparked her lactation curiosity
• Volunteering in a Facebook group led her to discover her passion for lactation support
• She left pediatric ER work and pursued public health before becoming an IBCLC
• Her transition to full-time private practice included advocacy, content creation, and contract work with Ceres Chill and The Better Boob

Rebekah explains:

• Her son and husband were both diagnosed with autism within the same summer
• Learning to support their needs helped her understand sensory overwhelm and rigidity
• She began noticing her own sensory patterns and was later diagnosed with ADHD
• These experiences fueled her desire to provide trauma-informed, neurodivergent-aware lactation care

They discuss:

• How breastfeeding can create intense sensory input for both parent and baby
• Why a baby might refuse to nurse during the day but accept the breast in a dark, quiet room
• Examples of babies who need movement while nursing vs. babies who shut down with too much stimulation
• Why flexibility, observation, and trial-and-error are key to care

Rebekah highlights common struggles:

• Sensory overload (wet bras, milk on skin, baby grabbing, loud sounds)
• Executive dysfunction—difficulty following through on steps like getting dressed, eating, or pumping
• Masking during consults—parents may appear to understand but feel lost after you leave
• Rigidity around feeding schedules, wake windows, and needing structure

Rebekah recommends:

• Thorough, clear after-visit summaries with specific cues for when to reach out
• Multi-modal care plans—use words, visuals, and even video examples
• Journaling or voice notes to help parents track and describe their experience
• Offering realistic solutions, like moving a baby swing into the bathroom to facilitate self-care

They explore:

• Why all lactation professionals—not just those with lived experience—can and should support neurodivergent families
• The importance of acknowledging when a case may be outside your scope and referring to others
• How including neurodivergent-friendly tools and communication strategies benefits all families

Rebekah Scroggy, IBCLC is a nurse, lactation consultant, and mother who specializes in neurodivergent-informed lactation support. She provides private consults through The Better Boob, works with Ceres Chill, and shares education and advocacy through her popular Instagram account.

📱 Instagram: @caffeinatedlactation

🌐 Learn more: The Better Boob

🍼 Products: Ceres Chill

📌 Jenny Stiller’s Neurodivergent Lactation Specialist Course

📌 Research on neurodivergence in lactation care

📌 Instagram accounts focused on early signs of autism and parenting neurodivergent kids

📌 Tools for sensory regulation and executive functioning

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Rebekah Scroggy, IBCLC

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #NeurodivergentParenting #IBCLC #LactationConsulting #InclusiveCare #BreastfeedingSupport #AutismParenting #ADHDandBreastfeeding #SensoryNeeds #LactationEducation

In this episode of Behind the Latch, Margaret Salty explores four critical pieces of research affecting lactation professionals: a rare case of breast milk-transmitted GBS infection, an under-recognized complication known as lactational phlegmon, the effectiveness of peer support in UK breastfeeding programs, and gaps in midwifery breastfeeding education in South Africa. Each study offers key clinical insights and action points for IBCLCs supporting breastfeeding families in real-world settings.

Key Studies and Takeaways:

1️⃣ Late-Onset Group B Streptococcal Disease via Contaminated Breast Milk

Citation: Mazeda, I., Vieira, B., Pinho, J., Branco, S., & Oliveira, G. (2025). International Journal of Pediatrics and Neonatology, 7(1), 83–85. https://doi.org/10.33545/26648350.2025.v7.i1b.125

• A one-month-old developed late-onset GBS traced to the mother's breast milk, despite her being asymptomatic and GBS-negative during pregnancy.
• Both infant and mother were successfully treated with antibiotics, and breastfeeding was resumed post-clearance.
• IBCLC Takeaway: Always consider breast milk as a potential GBS source—even in asymptomatic cases—and support safe milk handling and temporary cessation strategies when needed.

2️⃣ Lactational Phlegmon: A Rare Clinical Entity

Citation: AlArafah, S. K., Aldhafeeri, D. A., Aldhafeeri, A. S., Aldhafeeri, F. S., & Aldhafeeri, S. M. (2025). Mega Journal of Case Reports, 8(5), 2001–2005.

• A 28-year-old presented with severe breast pain misdiagnosed as mastitis, later identified via imaging as a lactational phlegmon.
• Conservative treatment with antibiotics and compresses avoided surgery.
• IBCLC Takeaway: Advocate for ultrasound in unresolved mastitis cases. Phlegmon can mimic abscess but may be treated non-invasively.

3️⃣ Peer Support & Community Interventions for Breastfeeding in the UK

Citation: Evans, C., Hargreaves, K., & Hoddinott, P. (2025). Maternal & Child Nutrition, 21(1), e13538. https://doi.org/10.1111/mcn.13538

• Scoping review of 21 systematic reviews found peer support improves breastfeeding when it's sustained and culturally tailored.
• Quality of evidence varies; systemic implementation and inclusivity are needed.
• IBCLC Takeaway: Champion peer support and community engagement. Push for better research and equity-focused program design.

4️⃣ Breastfeeding Education Gaps in South African Midwifery Training

Citation: Amegashie, L. Y., Tlou, B., & Mukumbang, F. C. (2025). BMC Medical Education, 25, Article 341. https://doi.org/10.1186/s12909-025-07341-1

• Midwifery students reported fragmented, insufficient breastfeeding training, relying heavily on personal experiences.
• Strong desire for more practical, skills-based learning.
• IBCLC Takeaway: Collaborate with midwifery educators. Mentor students and strengthen clinical breastfeeding education to improve early care.

Connect with Me:

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📧 Email: [email protected]

📘 Facebook: Margaret Salty

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

Hashtags and Keywords:

#BehindTheLatch #BreastfeedingResearch #IBCLC #GroupBStrep #Phlegmon #MidwiferyEducation #PeerSupport #LactationCare #BreastfeedingSupport #MilkSafety

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In this episode of Behind the Latch, Margaret Salty interviews Nikki Lee—nurse, lactation consultant, educator, and passionate advocate for whole-person care. They explore what it truly means to practice holistic lactation support, the power of touch, how to integrate craniosacral therapy into lactation visits, and why honoring the parent-baby dyad requires more than just clinical skill.

Nikki shares how:

• Her personal experience with trauma and her mother's breastfeeding shaped her worldview
• Becoming a nurse and then a mother guided her into lactation work
• Public health taught her to “be a guest in people’s lives” and see the full picture
• Grandparenting has opened new insights into intergenerational support and growth

Nikki defines holistic care as:

• Treating people as whole beings—not just a set of symptoms or body parts
• Considering physical, emotional, energetic, and spiritual dimensions of health
• Paying attention to the space, energy, relationships, and dynamics in the home
• Letting intuition, observation, and deep listening guide care—not just checklists

In this episode, you’ll hear:

• How Nikki uses gentle, intention-based touch to support healing
• Why craniosacral therapy isn’t manipulation, but rather listening through the hands
• How this work calms the nervous system and boosts oxytocin for both parent and baby
• The importance of in-person, hands-on training to learn this modality safely and ethically

Nikki walks through a powerful case example:

• A mother presented with nipple pain, oversupply, and a baby refusing the breast
• Craniosacral therapy helped both parent and baby regulate and reconnect
• The home environment—including subtle undermining from family—was a key factor
• Small changes like music, safe bedsharing, and community support transformed the experience

Margaret and Nikki discuss:

• Why hospitals are often inhospitable places for breastfeeding
• The risks of sleep deprivation and the need for honest conversations about safe sleep
• How to gently guide families while honoring their choices
• The importance of truth-telling and emotional regulation in protecting against burnout

Nikki encourages new professionals to:

• Observe as much normal breastfeeding as possible
• Follow their interests—whether it’s mental health, massage, childbirth ed, or herbs
• Bring their whole selves to their work, and pursue therapy to unpack personal triggers
• Remember: “Be the provider you’d want for your own grandbaby.”

Nikki Lee, RN, IBCLC is a lactation consultant, educator, and holistic practitioner with decades of experience in breastfeeding support, craniosacral therapy, and public health. She offers courses, private sessions, and mentorship in holistic lactation.

🌐 Website: www.nikkileehealth.com

📘 Facebook: Nikki Lee Health

📚 Books: Breastfeeding: A Parent’s Guide and Complementary and Alternative Medicine in Breastfeeding (Proclaris Press)

📌 Upledger Institute – Craniosacral Therapy Training

📌 James McKenna’s Safe Infant Sleep

📌 Pathways to holistic certification: PSI, childbirth ed, and more

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Nikki Lee, RN, IBCLC

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

#BehindTheLatch #HolisticLactation #CraniosacralTherapy #BreastfeedingSupport #IBCLC #LactationConsulting #SafeSleep #BreastfeedingJourney #WholePersonCare #ComplementaryMedicine

Addressing Bias and Inequity in Breastfeeding Support: A Global Perspective

In this episode of Research Recap, we explore four new studies that shed light on how systemic racism, insurance disparities, maternal confidence, and substance use policies intersect to shape breastfeeding support in diverse settings. From Boston to Japan to the NICU, these findings highlight where the system is failing—and what IBCLCs can do about it.

1️⃣ Racial and Ethnic Disparities in Obesity-Related Breastfeeding Support

Citation:

Stuebe, A. M., Bryant, A. S., & Oken, E. (2024). Racial and ethnic disparities in obesity-related breastfeeding support: A conceptual framework and call to action. Obesities, 5(3), 38. https://doi.org/10.3390/obesities5030038

Takeaways:

• Black and Brown mothers in larger bodies face "triple jeopardy": racism, weight bias, and systemic inequities that reduce breastfeeding support.
• These are system-level failures, not individual ones.
• IBCLCs must adopt trauma-informed, inclusive practices and push for structural reforms in healthcare spaces.

2️⃣ Disparities in Lactation Support for Medicaid-Covered Births in Boston

Citation:

Muniz, J. L., Wharam, J. F., Land, T., Zera, C. A., & Perrin, J. M. (2025). Disparities in lactation support for Medicaid-covered births at Boston-area birthing hospitals, 2018–2020. BMC Public Health, 25, 1032. https://doi.org/10.1186/s12889-025-23084-6

Takeaways:

• Medicaid-covered births had 44% lactation support documentation vs. 76% for commercially insured births.
• Disparities existed within hospitals, not just between them.
• Insurance status was a strong, independent predictor of lactation support access.
• IBCLCs should advocate for standardized, universal access to lactation care.

3️⃣ Maternal Predictors of Early Introduction of Formula and Solids in Japan

Citation:

Hatsukawa, Y., Iwaoka, Y., Yoshida, H., Ota, E., & Fukui, K. (2024). Maternal predictors of the early introduction of formula milk and solid foods: A cross-sectional study using data from the Japanese Pregnancy and Birth Survey. Environmental Health and Preventive Medicine, 29, 3. https://doi.org/10.1265/ehpm.1401012737

Takeaways:

• Nearly half of mothers introduced formula before 1 month, and 16% introduced solids before 5 months.
• Key risk factors: primiparity, cesarean delivery, younger age, lower income, and shorter maternity leave.
• Low breastfeeding self-efficacy was one of the most consistent predictors of early supplementation.
• IBCLCs must provide proactive, confidence-building support—especially for first-time mothers and those returning to work early.

4️⃣ Marijuana Toxicology Screening and Breast Milk Use in NICU Policies

Citation:

Bae, E., Patil, U., Larkin, D., Jones, C. L., & Chamberlain, L. J. (2025). Toxicology screening for marijuana and impact on breast milk feeding policies in neonatal intensive care. Journal of Perinatology. Advance online publication. https://doi.org/10.1038/s41372-024-01726-6

Takeaways:

• A positive marijuana screen drastically reduced maternal milk use (19% vs. 83%).
• No standardized testing policy—decisions were subjective and provider-driven.
• Black and Hispanic mothers were disproportionately tested.
• IBCLCs must advocate for harm-reduction, evidence-based, and equitable policies in NICU lactation care.

Conclusion:

These studies highlight the ongoing need for IBCLCs to not only offer skilled lactation care—but also to advocate for systemic change. Bias, disparities, and inequities are not just individual challenges; they are institutional failures we must confront to create truly inclusive and supportive spaces for all families.

Connect with Me:

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty

🌐 Website: margaretsalty.com

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, “My Time Traveling Machine”

Hashtags & Keywords:

#ResearchRecap #BreastfeedingSupport #IBCLC #EquityInLactation #MaternalHealth #TraumaInformedCare #BreastfeedingDisparities #MedicaidCoverage #NICUFeedingPolicies #LactationAdvocacy

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