In this episode of Behind the Latch, Margaret Salty reviews five fascinating new studies covering maternal autonomy in India, breastfeeding practices in Saudi Arabia, real-world concerns shared on social media, the circadian rhythm of breast milk, and more. Each study offers a unique lens on how culture, policy, biology, and digital spaces shape the feeding experience—and what lactation professionals can do to support families more effectively.

Key Studies and Takeaways:

1. “Infant and Young Child Feeding Practices and Their Association with Women's Autonomy: A Community-Based Study in Rural West Bengal”

Citation: Sarkar, N. H., et al. (2025). Healthline, 16(1), 35–44. https://doi.org/10.51957/Healthline_689_2025

• Cross-sectional study with 161 mothers in rural India
• While 96% breastfed, only 63% initiated within the first hour and 24% exclusively breastfed
• Maternal autonomy (decision-making, mobility, financial control) positively correlated with better IYCF practices
• Cesarean birth and female infants were associated with poorer outcomes
• IBCLCs must address family dynamics, autonomy, and equity—not just technique

2. “Knowledge, Attitude, and Practice of Breastfeeding Among Mothers Attending King Abdulaziz University Hospital, Jeddah, Saudi Arabia”

Citation: Alhamedi, N. M., et al. (2025). Journal of Family Medicine and Primary Care, 14(4), 1295–1306. https://doi.org/10.4103/jfmpc.jfmpc_1465_23

• Mixed-methods study with 334 mothers
• 88% initiated breastfeeding, but only 39% exclusively breastfed to 6 months
• Working mothers had better knowledge and earlier initiation, but faced structural barriers
• Formula use was common; 71% used ready-made formula in the hospital
• IBCLCs must go beyond education—advocacy for workplace and hospital support is essential

3. “Analysis of Social Media Posts: Breastfeeding Mothers Concerned About Breast Milk Supply, Logistics of Breastfeeding, and Child Development Outcomes”

Citation: Heng, W. X., & Azhari, A. (2025). Women’s Reproductive Health. https://doi.org/10.1080/23293691.2025.2489500

• Qualitative analysis of 504 Facebook posts from Singapore mothers
• Top concerns: milk supply, breastfeeding logistics (especially while working), and infant growth
• Many mothers used the group to seek practical advice—not emotional validation
• Reveals that self-efficacy is fragile, and community forums often serve as informal knowledge hubs
• IBCLCs should consider engaging in or partnering with online communities to share accurate guidance

4. “Chrononutrition and the Role of Melatonin in Neonates”

Citation: Markowska, M. (2025). Pediatrics and Family Medicine, 21(1), 46–50. https://doi.org/10.15557/PiMR.2025.0005

• Narrative review exploring melatonin in breast milk and its circadian rhythm
• Breast milk contains melatonin at night, which helps establish infant sleep cycles
• Preterm infants rely entirely on maternal melatonin for early circadian regulation
• Recommends time-matched milk labeling in NICUs and awareness of donor milk limitations
• Adds a new dimension to lactation counseling: breastfeeding isn’t just nourishment—it’s biological programming

Conclusion:

From biological rhythms to social dynamics, breastfeeding is shaped by so much more than supply and demand. These studies offer clinical, cultural, and digital insights that can help IBCLCs personalize care, address hidden barriers, and advocate for system-wide changes.

Connect with Me:

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #IBCLC #BreastfeedingResearch #MaternalAutonomy #SocialMediaSupport #MelatoninInMilk #BreastfeedingBarriers #LactationSupport

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In this episode of Behind the Latch, Margaret Salty interviews Dr. Cindy Rubin, a pediatrician, IBCLC, and board-certified breastfeeding and lactation medicine physician, about her clinical approach to managing complex lactation cases—including the hotly debated topic of triple feeding. They explore when triple feeding is appropriate, how to support families through it, when to wean, the role of galactagogues, and how IBCLCs and breastfeeding medicine physicians can work together for better outcomes.

Dr. Rubin’s Path to Breastfeeding Medicine

Dr. Rubin shares how her own struggles with breastfeeding as a pediatrician changed her perspective:

• Realized how little she truly knew about lactation
• Became an IBCLC and later certified in breastfeeding and lactation medicine
• Left the traditional system to open a home visit and telehealth practice in the Chicagoland area

Healing the Divide: Physicians and IBCLCs Working Together

Margaret and Dr. Rubin discuss:

• The historic divide between providers and IBCLCs
• How breastfeeding medicine fills a gap—not competes with IBCLCs
• The importance of staying within scope and collaborating for comprehensive care
• Why referring to each other strengthens—not weakens—practice

Triple Feeding: What It Is and When to Use It

Dr. Rubin explains:

• Triple feeding = nursing at the breast, pumping, and supplementing
• It’s a short-term tool—not a long-term solution
• Often used when it’s unclear whether the issue is supply or transfer
• May be used as a “test” to guide next steps

When Triple Feeding May Not Be Necessary

Key points:

• If baby is nursing well but supply is low, pumping may not be needed
• Sometimes nursing + supplementing (double feeding) is sufficient
• Always consider mental health and sustainability for the parent

Pumping Frequency, Sleep, and Mental Health

Dr. Rubin emphasizes:

• Seven pump sessions with one long stretch of sleep is often better than eight with no rest
• No amount of milk is worth compromising the parent’s mental or physical health
• Customize plans based on the parent’s needs, goals, and capacity

SNS Use and Feeding Plan Flexibility

They discuss:

• Why SNS can be helpful—but isn’t right for everyone
• Feeding at the breast once or twice daily while pumping/bottle feeding the rest can reduce burnout
• The importance of patient choice and informed consent

How to Know When to Wean from Triple Feeding

Dr. Rubin recommends:

• Weighted feeds to assess if baby can take full or near-full volume at the breast
• “Boot camp” weekends where the dyad nurses ad lib without pumping or supplementing
• Watching for signs of success: swallowing, relaxed hands, diaper output, and steady weight gain

The Role of Galactagogues

Dr. Rubin explains:

• She uses galactagogues selectively, often after trying triple feeding first
• Goats’ rue may be beneficial in parents with insulin resistance or PCOS
• Always considers side effects and tailors to the individual
• Emphasizes that IBCLCs should refer, not recommend or sell galactagogues

Referral Networks and Working Across Disciplines

Dr. Rubin offers guidance:

• Use the NABBLM website to find breastfeeding medicine physicians in your area
• Understand physician licensure restrictions across state lines
• Attend conferences like the Academy of Breastfeeding Medicine to network
• Offer education (like grand rounds) at local hospitals to build relationships

Advice for Aspiring IBCLCs and Physicians

Dr. Rubin shares:

• For aspiring IBCLCs: learn to be deeply curious and a great listener
• For physicians: consider certification through the North American Board of Breastfeeding and Lactation Medicine if you're interested in filling the medical gap

Guest Info:

Dr. Cindy Rubin, MD, IBCLC, is a pediatrician and board-certified breastfeeding and lactation medicine physician. She is the founder of In Touch Pediatrics and Lactation, providing home and telehealth services in Illinois.

🌐 intouchpediatrics.com

📱 Instagram: @drcindyrubin

📹 YouTube: @cindyrubinmd

🔗 LinkedIn: Cindy Rubin, MD

Resources Mentioned in This Episode:

📌 North American Board of Breastfeeding and Lactation Medicine (NABBLM)

📌 Academy of Breastfeeding Medicine (ABM)

📌 Dr. Anne Eglash – Breastfeeding medicine pioneer

📌 Research on galactagogues and insulin resistance

📌 Goats’ rue for low milk supply with insulin resistance/PCOS

Connect with Me:

Have questions or suggestions for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Cindy Rubin

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #TripleFeeding #BreastfeedingMedicine #LactationSupport #IBCLC #Galactagogues #BreastfeedingPhysician #LowMilkSupply #LactationCare #LactationConsultant

🎧 Listen now on your favorite podcast app!

Don’t forget to subscribe to Behind the Latch and leave a review!

In this episode of Behind the Latch, Margaret Salty shares five new research studies that illuminate how culture, trauma, nutrition, and social support shape breastfeeding experiences around the world. From COVID recovery in Jordan to tribal food taboos in India, seafood during pregnancy, and the complex role of family dynamics—this episode delivers evidence-based insights every IBCLC needs.

Key Studies and Takeaways:

1. “Breastfeeding Experiences of COVID-19 Survivor Multipara Mothers During Pre- and Post-COVID-19: A Comparative Phenomenological Study”

Citation: Abuhammad, S., et al. (2025). BMC Pregnancy and Childbirth, 25, 502. https://doi.org/10.1186/s12884-025-07610-3

• Jordanian mothers who had breastfed both before and after COVID described physical, emotional, and supply-related challenges
• Post-infection breastfeeding was harder—many noted early weaning and emotional exhaustion
• Concerns about the vaccine’s impact on milk supply created uncertainty and stress
• Lack of consistent lactation education and mental health support intensified these struggles
• IBCLCs should lead with empathy, normalize emotional challenges post-COVID, and provide clear, compassionate vaccine counseling

2. “Association Between Family Support and Breastfeeding Self-Efficacy in a Cross-Sectional Study”

Citation: Hu, L., He, W., & Zhou, L. (2025). Nursing Open, 12, e70210. https://doi.org/10.1002/nop2.70210

• Study of 217 mothers in China found that greater family support was strongly associated with higher breastfeeding self-efficacy
• However, support from parents or spouses—when controlling or emotionally intense—was linked to lower BSE
• Support from in-laws or hired caregivers (e.g., nannies) showed more positive effects
• IBCLCs should assess not only the presence of support, but its quality and emotional tone
• Family involvement in education is important—but only when it supports maternal autonomy

3. “A Study on Traditional Food Practices and Taboo During Pregnancy and Lactation in Tribal Population of Eastern Gujarat”

Citation: Zaveri, N. H., et al. (2025). Journal of Family Medicine and Primary Care, 14(4), 1333–1337. https://doi.org/10.4103/jfmpc.jfmpc_1505_24

• Focus group study of 80 women revealed extensive food taboos: avoiding “hot,” “cold,” or “heavy” foods, and rejecting colostrum
• Mothers commonly gave goat or cow milk in place of colostrum and consumed restrictive postpartum diets
• Cultural beliefs were shaped by safety concerns, aesthetic ideals, and gender norms
• IBCLCs working in diverse communities must use culturally sensitive language and collaborate with local leaders to reframe harmful myths
• Storytelling and elder involvement are powerful tools in shifting generational norms

4. “Seafood During Pregnancy and Lactation and Child Neurocognitive Development: A Systematic Review”

Citation: O’Connor, L. E., et al. (2025). Advances in Nutrition. https://doi.org/10.1016/j.advnut.2025.100414

• Review of 40 studies showed seafood consumption during pregnancy supports better social-emotional development and adaptability in children
• Verbal intelligence and problem-solving were positively linked to seafood intake in several studies
• No strong evidence for harm at recommended intake levels
• No studies evaluated seafood during lactation—a major research gap
• IBCLCs can reassure families about low-mercury fish and shift the narrative from “avoidance” to nutrient density

Conclusion:

These studies span the globe and affirm one clear truth—breastfeeding doesn’t exist in isolation. It’s shaped by culture, support, recovery, and belief. As IBCLCs, our job is to listen deeply, counsel wisely, and integrate evidence with empathy.

Connect with Me:

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BreastfeedingResearch #COVIDandBreastfeeding #SeafoodinPregnancy #FamilySupport #BreastfeedingConfidence #CulturalFoodBeliefs #LactationSupport

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In this episode of Behind the Latch, Margaret Salty interviews Laurel Wilson, an internationally recognized speaker, author, and perinatal specialist, about the critical role of the microbiome, epigenome, and human milk in shaping infant health. They explore how breastfeeding influences the baby's gut microbiome, the long-term effects of infant feeding choices, new research about maternal health and infant gut development, and what lactation professionals need to know about emerging science in this field.

Laurel’s Journey into the Perinatal Field

Laurel shares her three-decade journey:

• Inspired by her own challenging birth and breastfeeding experiences
• Early work as a doula, childbirth educator, and lactation educator
• Executive Director of Lactation Programs for CAPPA
• Now focused on translating research into education for lactation professionals

Understanding the Epigenome and Microbiome

Laurel explains:

• The epigenome controls gene expression based on environmental signals
• The microbiome—bacteria, fungi, viruses, and archaea—communicates with the epigenome
• Breastfeeding plays a key role in shaping the infant's lifelong microbiome and gene expression

How Breastfeeding Establishes the Infant Microbiome

Human milk provides:

• Beneficial microbes critical for gut, immune, and brain development
• Human milk oligosaccharides (HMOs) that nourish good bacteria
• Long-term health benefits, including allergy protection and improved metabolic health
• Unique endocrine functions, with microbes even influencing hormone signaling

Challenges with Infant Formula and the Microbiome

Laurel and Margaret discuss:

• Powdered infant formula can introduce pathogenic bacteria into the gut
• Even sterile liquid formula lacks critical human-specific microbes and HMOs
• Once pathogenic bacteria colonize, the gut's development path is altered
• Efforts to add HMOs to formula are limited compared to the complexity of human milk

Emerging Research on Microbiome and Long-Term Health

Laurel highlights:

• Research linking early feeding to risks of allergies, diabetes, and metabolic diseases
• Child Cohort studies investigating long-term effects of breastfeeding and formula feeding
• The role of birth mode (vaginal vs. cesarean) in microbiome development
• New interventions like oral fecal transplants for C-section born infants

The Maternal Microbiome Matters, Too

Important insights:

• Maternal gut health may influence the infant’s microbiome and allergy risk
• Probiotic supplements alone are not a guaranteed solution
• Focus on overall gut healing, diverse diet, and minimizing processed foods
• Diet during the third trimester has a significant influence on milk composition

Addressing Fear and Supporting All Feeding Choices

Laurel emphasizes:

• While diet matters, any amount of human milk provides vital health benefits
• Fear-mongering around diet and milk quality can discourage breastfeeding
• Families deserve honest, empowering education—not guilt or fear

What’s Next in Microbiome Research

Laurel shares emerging findings:

• The importance of B. infantis, a critical bacteria largely lost in modern populations
• Antibiotics, C-sections, and modern hygiene practices have reduced its presence
• Researchers at UC Davis and beyond are studying ways to restore it

Advice for Aspiring IBCLCs

Laurel offers valuable tips:

• Network with practicing IBCLCs and join study groups
• Read and discuss research articles to build critical thinking
• Stay curious and be a deep listener when supporting families

Guest Info:

Laurel Wilson, IBCLC, RLC, BSc, CLE, CLD, CCCE, is an internationally acclaimed speaker, lactation consultant, and expert on the microbiome, epigenome, and hormonal expression in perinatal health. Learn more at motherjourney.com or follow her on social media @motherjourneylaurelwilson.

Resources Mentioned in This Episode:

📌 Child Cohort Studies – Longitudinal studies of infant development and microbiome

📌 Research by Musavi et al. and Megan Azad on infant feeding and gut health

📌 UC Davis Research on B. infantis and infant gut microbiome

📌 WHO Code of Marketing of Breast Milk Substitutes

Connect with Me:

Questions, feedback, or ideas for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Laurel Wilson

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #MicrobiomeAndBreastfeeding #InfantGutHealth #BreastfeedingResearch #LactationEducation #MaternalHealth #HumanMilkScience #BInfantis

🎧 Listen now on your favorite podcast app!

Don’t forget to subscribe to Behind the Latch and leave a review!

In this episode of Behind the Latch, Margaret Salty explores five new research articles that offer clinical insight for lactation professionals. From a trauma-informed program to support breastfeeding in parents with opioid use disorder, to the impact of Ramadan fasting, sleep quality in Syrian mothers, and virtual NICU support—this evidence-based roundup helps IBCLCs expand their clinical lens and better serve diverse families.

Key Studies and Takeaways:

1. “Enhancing Breastfeeding Experience and Self-Efficacy in Opioid-Dependent Breastfeeding Mothers: Insights from the PeriWell Intervention”

Citation: Moss, D., & Busch, D. W. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0011

• Describes a 12-week trauma-informed perinatal intervention for mothers with opioid use disorder (OUD)
• Integrates the Positive Direction Model and the Tri-Core Breastfeeding Model
• Focuses on emotion regulation, trauma screening, lactation education, and self-efficacy
• Program supports MAT (medication-assisted treatment) patients and their infants with NAS/NOWS
• IBCLCs working in recovery care settings can use this model to offer holistic, ongoing support

2. “Does Ramadan Fasting Affect Breast Milk Sufficiency Perception and Maternal Functioning of Breastfeeding Mothers?”

Citation: Akça, K., Güngörmüş, Z., & Bayrakçı, E. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0020

• Cross-sectional study of 62 breastfeeding mothers during Ramadan in Turkey
• Mothers who fasted and ate the pre-dawn meal (sahur) showed improved maternal functioning and confidence in milk sufficiency
• No improvements in mothers who skipped sahur or didn’t fast
• Highlights the psychological and nutritional importance of sahur
• IBCLCs should support religious observance with individualized guidance—not blanket restrictions

3. “Effects of a Virtual Supportive Program on the Knowledge of Mothers of Preterm Infants and Their Bonding”

Citation: Pusri, S., Payakkaraung, S., & Thampanichawat, W. (2025). Infant Mental Health Journal, 1–15. https://doi.org/10.1002/imhj.70013

• Quasi-experimental study with 74 NICU mothers in Thailand
• 
  
• A 7-day virtual program improved bonding and reduced anxiety—even in mothers with medically complex infants
• Components included video calls, daily updates, cue recognition training, and emotional check-ins
• IBCLCs can advocate for virtual or hybrid support models to maintain maternal connection in NICU settings
• Preterm cue education and emotional support should be core parts of lactation care

4. “Motherhood Unveiled: Examining the Dynamic Relationship Between Sleep Quality and Breastfeeding Confidence in Postpartum Primiparous Women in Syria—A Cross-Sectional Study”

Citation: Aldairy, A., et al. (2025). BMC Public Health, 25, 1521. https://doi.org/10.1186/s12889-025-22709-0

• Survey of 316 first-time mothers in Syria
• Better sleep quality was significantly correlated with higher breastfeeding self-efficacy
• Older, wealthier mothers had more confidence; highly educated mothers had worse sleep
• IBCLCs should acknowledge sleep as a key determinant of feeding success, especially in new parents
• Integrating sleep hygiene tips and emotional support into lactation visits could improve outcomes

Conclusion:

From trauma-informed interventions to cultural and emotional factors, these studies highlight the complex web that shapes breastfeeding experiences. For IBCLCs, staying informed means being equipped to offer care that’s not only effective—but also inclusive, compassionate, and responsive to each family’s context.

Connect with Me:

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #IBCLC #LactationResearch #OpioidUseDisorder #RamadanAndBreastfeeding #NICUSupport #BreastfeedingConfidence #SleepAndLactation #PeriWellIntervention

🎧 Listen now on your favorite podcast app!

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In this episode of Behind the Latch, Margaret Salty interviews Dr. Lope Adejuyigbe, a physician and lactation specialist based in Lagos, Nigeria, who founded the first breastfeeding clinic in the country. They discuss the breastfeeding landscape in Nigeria, barriers to exclusive breastfeeding, cultural beliefs, the urgent need for lactation support, and how Dr. Adejuyigbe is building a movement to make breastfeeding help accessible to more families.

Breastfeeding in Nigeria: Barriers and Opportunities

Dr. Adejuyigbe outlines the breastfeeding challenges in Nigeria:

• Limited breastfeeding support in healthcare settings
• Widespread formula marketing and hospital distribution
• Cultural beliefs that breast milk alone is "not enough"
• The impact of short maternity leaves and lack of workplace accommodations

The Creation of Nigeria’s First Breastfeeding Clinic

Motivated by personal family experience and WHO training, Dr. Adejuyigbe launched the first dedicated breastfeeding clinic in Nigeria:

• Started with personal funds and private practice
• Faced skepticism from doctors and nurses unfamiliar with lactation specialization
• Now seeing growing community acceptance and increasing patient referrals

Challenges Mothers Face and Clinic Services

Dr. Adejuyigbe shares the key issues she sees among mothers:

• Early formula introduction encouraged even by healthcare providers
• Pressure for oversupply due to social media influence
• Lack of access to clean water making pumping challenging
• No hospital-grade pumps available in Nigerian hospitals

Her clinic addresses a wide range of cases, including:

• Latch difficulties
• Low milk supply
• Breast abscesses and mastitis
• Breastfeeding with complex medical conditions (hypothyroidism, PCOS, surrogacy, adoption)

The Power of Early Intervention

Dr. Adejuyigbe emphasizes:

• The critical window of the first 1–2 weeks postpartum for establishing breastfeeding
• The need for better prenatal and immediate postnatal education
• How early support makes breastfeeding easier and more sustainable

Addressing Cultural Beliefs Around Breastfeeding

Margaret and Dr. Adejuyigbe discuss common myths in Nigeria:

• Belief that colostrum should be discarded
• Widespread "top up" culture
• Misconceptions about breast milk "going sour" if not expressed frequently

Looking Toward the Future: Expansion and Peer Support

Dr. Adejuyigbe shares her goals:

• Expanding her virtual breastfeeding clinic to serve more countries affordably
• Building a breastfeeding peer counselor program to extend basic education at the community level
• Partnering with hospitals and government agencies to mainstream lactation support
• Publishing research on breastfeeding experiences in Nigeria

Guest Info:

Dr. Lope Adejuyigbe, MD, IBCLC Candidate, is a physician, lactation specialist, and founder of the first breastfeeding clinic in Nigeria. She is dedicated to transforming the breastfeeding support landscape across Nigeria and beyond.

Resources Mentioned in This Episode:

📌 WHO Code of Marketing of Breast Milk Substitutes

📌 La Leche League International – Peer-to-peer breastfeeding support

📌 WIC Breastfeeding Peer Counselor Program – Model for community-based breastfeeding support

📌 Lactation Education Resources (LER) – Online lactation education

Connect with Me:

Questions, feedback, or ideas for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Lope Adejuyigbe

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BreastfeedingInNigeria #LactationSupport #MaternalHealth #BreastfeedingClinic #ExclusiveBreastfeeding #BreastfeedingEquity #LactationConsultant

🎧 Listen now on your favorite podcast app!

Don’t forget to subscribe to Behind the Latch and leave a review!

In this episode of Behind the Latch, Margaret Salty reviews four recent articles from Clinical Lactation that offer powerful insights for IBCLCs. From training healthcare providers to improving exclusive breastfeeding through theory-based counseling, to comparing hand expression and pumping in the NICU, and exploring the link between nipple shields and the perception of insufficient milk—this episode translates current research into real-world clinical strategies.

Key Studies and Takeaways:

1. “Evaluation of a Breastfeeding Education Intervention for Healthcare Professionals in Idaho”

Citation: Karroum, K., & Clarkson, G. (2024). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2023-0040

• A 50-minute training significantly improved provider knowledge, confidence, and intention to improve breastfeeding support
• 60.5% of participants planned workflow changes, including improved screening and referral practices
• Training was based on Merrill’s First Principles and the Theory of Planned Behavior
• IBCLCs can play a key role in designing and implementing similar in-service education to drive systems change
• Even brief, focused interventions can shift primary care culture

2. “The Effect of Counseling Based on the Roy Adaptation Model on Mothers’ Infant Feeding Attitude and Anthropometric Measurements of the Baby: A Randomized Controlled Study”

Citation: Bilgiç, F. Ş., & Karaahmet, A. Y. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0014

• RAM-based prenatal and postpartum counseling dramatically increased exclusive breastfeeding (95% vs. 40%)
• Improved maternal feeding attitudes and reduced early weaning consideration
• Intervention included prenatal education, phone support, and in-person follow-ups
• IBCLCs can use RAM as a structured, holistic counseling model
• This theory-driven approach addressed physiological, emotional, social, and role adaptations to breastfeeding

3. “Effectiveness of Manual Expression of Breast Milk: Marmet Technique in Production of Breast Milk Among Mothers Whose Babies Are in the Neonatal Intensive Care Unit”

Citation: Kotsu, K., Nayak, S., & Sunanda, B. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2023-0013

• Marmet hand expression produced significantly more milk than manual pumping in all sessions
• Technique, not maternal characteristics, determined milk volume
• Highlights the value of teaching structured hand expression in NICU settings
• Offers a zero-cost, accessible method for parents struggling with pumps or in low-resource settings
• IBCLCs should integrate Marmet technique into both prenatal and NICU care plans

4. “Risk Factors for the Perception of Insufficient Milk: A Prospective Study”

Citation: Oliva-Pérez, J., Simonelli-Muñoz, A. J., Oliver-Roig, A., & Richart-Martínez, M. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0017

• 18.6% of mothers developed perception of insufficient milk (PIM) by 1–5 months postpartum
• Nipple shield use during the hospital stay was the strongest predictor of later PIM (OR = 4.78)
• IBCLCs should monitor shield use closely and ensure appropriate follow-up and weaning
• Education on normal feeding patterns and growth spurts is essential to prevent misinterpretation of milk supply cues
• Even low-risk dyads with strong early feeding may develop PIM without continued support

Conclusion:

These articles remind us that impactful breastfeeding support doesn’t always require complex interventions—sometimes it’s about the timing, the technique, or the tools we teach. From provider education to hospital practices to counseling models, IBCLCs can use this evidence to inform better care for every family.

Connect with Me:

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #IBCLC #LactationConsultant #BreastfeedingResearch #MarmetTechnique #RoyAdaptationModel #PerceivedInsufficientMilk #BreastfeedingEducation #NICUFeeding #NippleShields

🎧 Listen now on your favorite podcast app!

And don’t forget to subscribe to Behind the Latch and leave a review!

In this episode of Behind the Latch, Margaret Salty interviews Melissa Thurch, PhD, IBCLC, about her groundbreaking research on breast pumps in Germany. They dive into the Pumped Project, differences in insurance coverage between Germany and the United States, the challenges of regulating breast pumps, and the future of lactation research. Melissa also shares her journey from WIC nutritionist to international breastfeeding researcher, her private practice experience in Germany, and advice for aspiring IBCLCs and researchers.

Melissa’s Journey into Lactation Research

Melissa shares how her early work with the WIC program in the U.S. led her into the world of lactation, and how a personal move to Germany eventually launched her academic career in breastfeeding research.

The Pumped Project: Breast Pumps in Germany

Melissa introduces the Pumped Project, which aims to profile and understand the landscape of electric breast pumps available in Germany, including:

• The large number and wide range of pumps (over 200 designs found!)
• Differences between medical-grade and commercial pumps
• Lack of insurance coverage for many personal-use pumps
• How maternity leave policies impact pump usage

Regulation and Accessibility of Breast Pumps

Margaret and Melissa explore:

• The limited regulation of breast pumps in Germany compared to the U.S.
• Issues with missing data on product specifications
• The challenges of tracking adverse events and injuries
• How the European CE mark system works (and doesn’t)

Key Findings from the Pumped Project

Melissa highlights:

• Pump prices ranging from 19 to 350 euros
• Most pumps offering only one or two flange sizes, with a heavy bias toward 24mm
• The growing market share of wearable pumps
• The market’s volatility, making it difficult to create a consumer resource

Next Steps for the Pumped Study

Melissa discusses the future directions:

• Wrapping up data collection
• Publishing scientific papers summarizing findings
• Investigating regulation and adverse event reporting further
• Conducting complementary research on routine health data and medical-grade pump prescriptions

Private Practice Lactation Consulting in Germany

Melissa describes the landscape for IBCLCs in Germany:

• IBCLC services are mostly private pay and not widely reimbursed
• Midwives are the primary reimbursed providers for breastfeeding support
• Families often rely on midwives, La Leche League, and peer counselors for lactation care

Advice for Aspiring Lactation Researchers and IBCLCs

Melissa offers valuable advice:

• For researchers: Be prepared for funding challenges, use your networks, and stay motivated by the impact of your work.
• For future IBCLCs: Grow your network, join organizations like ILCA, and be strategic in finding mentors who inspire you.

Guest Info:

Melissa Thurch, PhD, IBCLC, is a lactation researcher and private practice IBCLC based in Munich, Germany. She has worked internationally with organizations like WHO and UNICEF and is passionate about expanding the evidence base for breastfeeding practices.

Resources Mentioned in This Episode:

📌 La Leche League – Mother-to-mother breastfeeding support worldwide

📌 ILCA – International Lactation Consultant Association for networking and resources

📌 Pay at the Pump Study (Valerie Leider) – Adverse events related to breast pumps in the U.S.

📌 The Lactation Network – An insurance billing hub for U.S. private practice IBCLCs

Connect with Me:

Questions, feedback, or ideas for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Melissa Thurch, PhD, IBCLC

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BreastfeedingResearch #BreastPumps #LactationConsultant #MaternalHealth #PumpedProject #LactationScience #BreastfeedingSupport #LactationEducation

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In this episode of The IBCLC Mentor Podcast, Margaret Salty reviews recent research findings that impact lactation consultants. From extended breastfeeding and growth outcomes in Ethiopia, to the feeding experiences of first-time mothers, and the link between loneliness and breastfeeding confidence—Margaret translates the latest studies into actionable insights for IBCLCs.

1. Extended Breastfeeding and Undernutrition in Ethiopian Children

Margaret discusses a large cross-sectional study from Ethiopia examining the relationship between breastfeeding beyond 12 months and child undernutrition.

Reference:

Hailu, A., et al. (2025). Extended breastfeeding over one year is associated with a higher likelihood of underweight and stunting among children under three years of age in Ethiopia. International Journal of Nutrition and Public Health, 14(2), 87–95. https://doi.org/10.1186/ijnph.2025.8702

Practical Takeaways:

• Extended breastfeeding was associated with higher odds of stunting and underweight—but was protective against wasting.
• The issue is not prolonged breastfeeding itself, but lack of adequate complementary foods.
• Undernutrition was also tied to illness, sanitation issues, poverty, and low parental education.
• IBCLCs must pair breastfeeding support with education on timely, nutrient-dense complementary feeding.

2. Early Initiation and Exclusive Breastfeeding Among First-Time Mothers in Ethiopia

Margaret reviews a mixed-methods study exploring breastfeeding behaviors and beliefs among Ethiopian first-time mothers.

Reference:

Tsegaye, M., et al. (2025). Early initiation of breastfeeding and exclusive breastfeeding practices and associated factors among first-time mothers attending governmental maternal and child health clinics in Ethiopia: A mixed-methods study. BMC Pregnancy and Childbirth, 25, 330. https://doi.org/10.1186/s12884-025-02275-9

Practical Takeaways:

• 74.7% of mothers initiated breastfeeding in the first hour. Vaginal delivery and colostrum feeding were strong predictors.
• Only 46.8% practiced exclusive breastfeeding to 6 months.
• Support from spouses and health workers significantly improved outcomes.
• Cultural beliefs about colostrum and prelacteal feeds (e.g., butter, water) remain barriers.
• First-time mothers need culturally sensitive, evidence-based support from birth through postpartum.

3. Loneliness and Breastfeeding Self-Efficacy in Mothers

Margaret explores a Turkish study linking maternal loneliness to breastfeeding confidence and behavior.

Reference:

Demir, Z., & Yıldız, G. (2025). The relationship between loneliness perception and breastfeeding self-efficacy in breastfeeding behaviors and mothers. Maternal and Child Health Journal, 29(2), 151–160. https://doi.org/10.1007/s10995-025-03642-7

Practical Takeaways:

• Lonelier mothers had significantly lower breastfeeding self-efficacy and shorter breastfeeding duration.
• Spousal and social support were key to confidence and breastfeeding success.
• Employed and educated mothers showed higher self-efficacy and lower loneliness scores.
• IBCLCs should screen for isolation and integrate psychosocial support into care.

From cultural feeding practices to emotional wellbeing, these studies underscore the many factors shaping breastfeeding outcomes. As IBCLCs, it’s our responsibility to meet families where they are, support the whole dyad, and advocate for systems that nourish breastfeeding success.

📷 Instagram: @margaretsalty

🎙️ Hosted by: Margaret Salty

🎵 Music by: The Magnifiers, My Time Traveling Machine

#IBCLC #LactationConsultant #BreastfeedingResearch #LactationMentor #IBCLCMentorPodcast #EvidenceBasedPractice #ComplementaryFeeding #ExtendedBreastfeeding #FirstTimeMothers #BreastfeedingSelfEfficacy #MaternalLoneliness #BreastfeedingSupport

In this episode of The IBCLC Mentor Podcast, Margaret Salty interviews Alisa Williams, RN, IBCLC, about her groundbreaking paper, Are You Knowledgeable About Breast Pump Safety and Assessment? Knowledge and Skills for Clinical Practice, published in Clinical Lactation (2024). They explore the overlooked risks of pump misuse, why lactation professionals must become more informed, and how to better support families through safe and effective pumping education.

Williams, A. (2024). Are you knowledgeable about breast pump safety and assessment? Knowledge and skills for clinical practice. Clinical Lactation, 15(2), 77–90.

Alisa shares the story of how she left hospital nursing to start her private practice, Momentum Lactation, after witnessing the lack of follow-up care for families postpartum. She now runs a thriving lactation clinic in Southern Illinois serving over 400 families a year.

Key insights include:

• The emotional toll of watching families leave the hospital without adequate lactation support
• Building a private practice from scratch to fill a critical care gap
• The growing need for outpatient lactation support in communities with high birth volume and limited access

Alisa explains the urgent need to better understand how pumps function and how misuse can cause harm.

Discussion highlights:

• The explosion of exclusive pumping during the COVID-19 pandemic
• A lack of formal training around pumps for lactation professionals and students
• Real-world observations of pump-related injuries and milk supply issues
• The absence of safety standards or meaningful FDA regulation of pumps

Alisa outlines the clinical signs of pump-related harm:

• Nipple trauma and pain
• Engorgement and localized inflammation
• Desensitization and nerve damage affecting oxytocin release
• Reduced milk output and mental health impacts
• The economic burden of buying multiple ineffective pumps

Assessing and Educating About Pump Use

Alisa walks through her protocol for evaluating pumps and educating parents:

• Conducting visual and tactile nipple assessments
• Observing the flange fit and suction cycle using traditional pumps
• Identifying signs of poor fit, pressure intolerance, or ineffective drainage
• Educating parents on safe suction levels and cycling patterns
• Using pump pressure gauges to test actual PSI and document findings

Alisa discusses how she determines the correct flange size and pressure setting:

• Using a nipple measurement tool and allowing 2–3mm for expansion
• Watching how the nipple behaves during pumping in both modes
• Measuring pain, output, and visual signs like blanching or trauma
• Teaching families to aim for the lowest effective pressure

Alisa shares how her detailed pump safety tool and hands-on process can be used in lactation education. Margaret discusses plans to integrate it into her Pathway 2 program.

Key recommendations:

• Train students to assess pumps just like a latch
• Standardize protocols using structured tools
• Teach observational skills to identify subtle signs of dysfunction
• Normalize using equipment like pressure gauges during clinical care

Margaret and Alisa discuss the ethics of recommending specific brands:

• Why “just pick a pump that fits your goals” may not be sufficient
• How to assess pumps based on safety, suction mode, and cycle adjustability
• Building ethical partnerships with manufacturers to influence safer design
• Educating families on red flags that suggest a pump isn’t working

Alisa shares key tools and resources to improve pump literacy among IBCLCs:

📌 YouTube – Alisa’s video on testing pump pressure

📌 IABLE – Flange sizing and safety resources

📌 Oregon WIC – Printable handouts on safe pumping

📌 New Little Life by Allison Tolman – Pumping gear course

📌 FDA’s Breast Pump Guide – A cautionary example of feature-based, not safety-based, guidance

📌 Babies in Common FITS Guide – Visual flange sizing tool

Alisa encourages aspiring IBCLCs to pursue mentorship and hands-on experience:

• Find a mentor who offers direct clinical exposure
• Build assessment skills through repeated observation
• Understand that lactation support includes feeding mechanics and medical safety

Alisa Williams, RN, IBCLC is the owner of Momentum Lactation in Southern Illinois. She specializes in outpatient lactation care and is a leading voice on breast pump safety and injury prevention.

📧 Email: [email protected]

Have questions or suggestions for future episodes? Reach out to Margaret at [email protected] or connect on social media:

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

🎙 Hosted by: Margaret Salty

🎧 Guest: Alisa Williams, RN, IBCLC

🎵 Music by: The Magnifiers, My Time Traveling Machine

#IBCLC #PumpingSafety #BreastPumps #LactationConsultant #Mentorship #FlangeFit #IBCLCMentorPodcast #LactationEducation #ExclusivePumping #PumpInjuryPrevention #LactationTools

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