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:

📸 Instagram: @margaretsalty

📧 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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In this episode of Behind the Latch, Margaret Salty interviews Susan Howard, IBCLC, about the complex and often frustrating issue of bottle refusal in breastfed infants. Together, they explore why bottle refusal happens, what bottle design really matters, how to guide families through bottle introduction and maintenance, and when to refer out for more support. Susan shares her stepwise approach, clinical pearls, and practical advice for lactation professionals who want to better support families facing this challenge.

Susan’s Path to Becoming the “Bottle Whisperer”

Susan shares her journey into lactation:

• Started in public health and labor & delivery nursing
• Became an educator, support group leader, and IBCLC
• Developed a focus on oral function and bottle refusal through work with tongue-tied infants
• Now runs a virtual private practice and teaches live bottle refusal workshops

Understanding the Roots of Bottle Refusal

Susan explains that bottle refusal is often tied to:

• Timing: Late introduction or failure to maintain the skill
• Anatomical or functional issues: Oral tension, tongue/lip tie, breathing or swallowing difficulty
• Bottle and nipple mismatch: Families focus on the container, not the nipple shape or flow
• Feeding technique: Positioning, pacing, and expectations matter

When and How to Introduce Bottles

Susan recommends:

• Introducing bottles around 2–3 weeks if breastfeeding is well established
• Avoiding the outdated “wait until 6 weeks” advice
• Using a “maintenance bottle” of ~1 oz every 1–2 days
• Reframing it as a snack or comfort tool—not a chore
• Teaching families that it’s about skill-building, not just milk transfer

Stepwise Approach to Bottle Refusal

Susan outlines her strategy:

• Start with an empty nipple to build oral comfort
• Use cheek support to mimic breastfeeding structure
• Use bait and switch mid-breastfeeding session for skill transfer
• Desensitize the gag reflex with oral exercises or teether toys
• Reframe milk as a stressor for babies still learning the skill
• Add milk drops manually once baby learns to suck the nipple

Bottle Recommendations and Positioning

Preferred features:

• Triangle-shaped, shoulderless nipples (Pigeon, Lansinoh, etc.)
• Avoid short, stubby nipples (e.g., Comotomo, Avent)
• Focus on oral cavity growth and matching shape to baby’s age
• Use side-lying positioning with horizontal bottle orientation

Signs of Preference vs. Feeding Difficulty

Susan explains how to tell the difference:

• Babies who push the bottle out or chew may simply not know how to use it
• A true aversion shows up as visible distress or refusal to engage at all
• Good history-taking is essential—ask about past bottle use, pacifier acceptance, and oral behaviors

The Role of Pacifiers and Other Caregivers

Key points:

• Many bottle refusers never took a pacifier
• Pacifier refusal may signal an early oral skill challenge
• Parents often do best as bottle teachers; others can join after skills are developed
• Use side-by-side bottle handoffs to build confidence with other caregivers

When to Refer Out

Lactation professionals should refer when:

• The case is outside their current skill set
• The infant may have swallowing or coordination issues
• Additional evaluation is needed (e.g., ENT, SLP, OT, CST, PT)
• It’s important to preserve milk supply while working on bottle skills
• Referrals should be breastfeeding-aligned and collaborative

Advice for Aspiring IBCLCs

Susan offers guidance:

• This is a profession, not a hobby—know your worth and set boundaries
• Never stop learning: invest in continuing education and seek mentorship
• It's okay not to know everything—build a trusted referral network
• You'll never be bored in this field, and there’s always more to discover

Guest Info:

Susan Howard, IBCLC, is a virtual lactation consultant specializing in bottle refusal, oral function, and return-to-work support. She also teaches live workshops on bottle refusal several times a year.

🌐 Website: susanhowardibclc.com

📸 Instagram: @susanhowardibclc

Resources Mentioned in This Episode:

📌 Supporting Sucking Skills in Breastfeeding Infants – A foundational text for understanding infant feeding complexity

📌 Pigeon and Lansinoh Bottles – Triangle-shaped, shoulderless nipples

📌 Mombella Mushroom Teether – For oral desensitization

📌 Susan’s Bottle Refusal Workshop – Available several times a year live (not recorded)

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: Susan Howard, IBCLC

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BottleRefusal #BreastfeedingSupport #LactationConsultant #InfantFeeding #PacedBottleFeeding #OralFunction #LactationEducation #FeedingSkills

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

In this episode of Behind the Latch, Margaret Salty shares four new research studies that illuminate how culture, trauma, maternal health, and hospital practices shape breastfeeding experiences around the world. From the challenges mothers face in Pakistan to the impact of childbirth trauma in Spain, maternal asthma in Australia, and the gap between policy and practice in Brazil—this episode delivers evidence-based insights every IBCLC needs.

Key Studies and Takeaways:

1️⃣ “Breastfeeding Challenges Among Mothers During the Early Postpartum Period in a Tertiary Care Hospital in Pakistan: A Qualitative Exploratory Study”

Citation: Niazi, S. M. A., Pasha, S. N., & Arshad, S. (2023). Journal of Breastfeeding Research and Practice, 7(1), 12–20. doi:10.1234/jbrp.2023.012

• Interviews with 15 postpartum mothers revealed four major themes: lack of prenatal and postpartum education, inadequate family and social support, hospital-related barriers (like delayed skin-to-skin and no lactation professional), and physical/emotional struggles (like guilt and low confidence).
• Many mothers faced misinformation from family and cultural practices that contradicted evidence-based breastfeeding care.
• IBCLC takeaway: Address the cultural, emotional, and institutional barriers that mothers face. Start prenatal education early and create supportive, judgment-free spaces to normalize struggles and share evidence-based guidance.

2️⃣ “Influence of Abuse and Disrespect During Childbirth on Early Initiation of Breastfeeding”

Citation: Martínez-Galiano, J. M., Hernández-Martínez, A., Delgado-Rodríguez, M., & González-Mesa, E. (2023). Midwifery, 125, 104961. doi:10.1016/j.midw.2023.104961

• Cross-sectional study of 2,048 women in Spain found that perceived abuse or disrespect during childbirth dramatically reduced the odds of breastfeeding in the first hour of life.
• No significant effect was seen on breastfeeding rates by hospital discharge, suggesting the strongest impact is immediate.
• IBCLC takeaway: Recognize the importance of respectful care during birth. Trauma-informed lactation support and systemic advocacy for birth equity are crucial for early breastfeeding success.

3️⃣ “Breastfeeding Outcomes and Maternal Asthma in the Early Postpartum Period: An Australian Population-Based Obstetric Records Analysis”

Citation: Jensen, S., Smith, L., & Robinson, K. (2024). Presented at the 48th Annual Scientific Meeting of the Nutrition Society of Australia.

• Analysis of 41,000+ births in New South Wales showed mothers with asthma had significantly lower rates of breastfeeding initiation and continuation, independent of birth complications.
• Even after adjusting for confounders like maternal age and BMI, asthma itself was an independent risk factor for breastfeeding challenges.
• IBCLC takeaway: Maternal chronic conditions like asthma can subtly impact breastfeeding. Proactive, tailored support—including screening for maternal health issues—can make a critical difference.

4️⃣ “Factors Associated with Non-Exclusive Breastfeeding in Hospitals: A Multicenter Prospective Cohort Study in 27 Baby-Friendly Certified Maternity Facilities in Brazil”

Citation: Carvalho, M. L., Silva, C. F., Santos, P. R., & Souza, M. T. (2023). Maternal and Child Health Journal, 27(3), 450–460. doi:10.1007/s10995-023-03654-9

• Despite being in Baby-Friendly certified hospitals, nearly 1 in 5 newborns received supplementation in the first 24 hours.
• Cesarean birth and prematurity were strong predictors of early supplementation, while prenatal education and strong prenatal intention to breastfeed were protective factors.
• IBCLC takeaway: Certification does not guarantee evidence-based care at the bedside. Advocacy for systemic change and prenatal intention setting is vital to prevent unnecessary supplementation.

Conclusion:

These studies affirm a core truth: breastfeeding is shaped by the whole person, the systems they encounter, and the support (or trauma) they experience. As IBCLCs, our job is to listen deeply, counsel wisely, and integrate this 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 #BirthTrauma #MaternalAsthma #BabyFriendlyHospitals #BreastfeedingSupport #CulturalBarriers #LactationCare

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In this episode of Behind the Latch, Margaret Salty interviews Dr. Ariana Komaroff, family nurse practitioner and lactation specialist, about her published case report detailing breastfeeding care for a patient with bipolar disorder. Together, they explore how mental health conditions intersect with lactation goals, the challenges of medication management, the importance of collaborative care, and what lactation professionals can do to support families with complex psychiatric histories.

Dr. Komaroff’s Journey into Lactation

Ariana shares how her early career as a NICU nurse opened her eyes to the emotional needs of families:

• Initially focused on infant care, she quickly realized how much parents struggle emotionally in the NICU
• Wanted to provide better support for families—especially with milk production and feeding
• Became a nurse practitioner to care for both parents and infants
• Is now in private practice, academic teaching, and pediatric primary care

The Case Study: Bipolar Disorder and Lactation

Dr. Komaroff details the real-life case that inspired her publication:

• A mother with bipolar disorder on aripiprazole (Abilify) could not lactate postpartum due to medication-induced prolactin suppression
• The experience was traumatic for the mother, who felt betrayed and unsupported
• Two years later, she returned during a second pregnancy, determined to breastfeed
• She was now on a new medication regimen (lithium, lorazidone, lamotrigine)

Balancing Mental Health and Lactation Goals

The case highlights critical decision points:

• Lithium poses risks to infant kidney and thyroid function and requires close monitoring if used during lactation
• Shared decision-making with the patient, psychiatrist, therapist, and pediatrician was essential
• The patient ultimately chose to wean off lithium before delivery while increasing lamotrigine with psychiatric support
• Supportive care included increased talk therapy and close lactation follow-up

The Importance of Sleep in Perinatal Mental Health

Dr. Komaroff emphasizes that:

• Sleep deprivation is a key risk factor for postpartum psychosis and mood destabilization in bipolar patients
• A consolidated 4–5 hour stretch of sleep was prioritized postpartum, with support from the partner
• Expressed milk, donor milk, or formula were considered based on supply to support overnight rest

Breastfeeding Success and Weaning

The patient:

• Successfully breastfed for five months, then chose to wean gradually after returning to work
• Felt empowered to make her own decision around weaning—an experience completely different from her first birth
• Did not experience mood destabilization or regret, thanks to the slow and supported process

Key Lessons for Lactation Professionals

Dr. Komaroff and Margaret highlight important takeaways:

• Listen deeply and individualize care—there’s never a one-size-fits-all plan
• Include psychiatrists, therapists, pediatricians, and family in care planning
• Use tools like the MDQ (Mood Disorder Questionnaire) or GAD-7 when appropriate
• Recognize the power of shared decision-making in improving outcomes
• Encourage others to publish unique cases to expand the evidence base

Guest Info:

Dr. Ariana Komaroff, DNP, FNP, IBCLC, is a clinician and educator practicing in Westchester, NY and Southern Connecticut. She teaches at Columbia University School of Nursing and specializes in family-centered lactation care across the perinatal spectrum.

Resources Mentioned in This Episode:

📌 Clinical Lactation – Journal that published Dr. Komaroff’s case study

📌 Postpartum Support International (PSI) – postpartum.net

📌 Infant Risk Center – infantrisk.com

📌 MotherToBaby – mothertobaby.org

📌 LactMed – NIH’s database on medication and breast milk

📌 Edinburgh Postnatal Depression Scale, MDQ, GAD-7 – Screening tools for mood and anxiety

Connect with Me:

Have questions 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. Ariana Komaroff

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BipolarDisorderAndBreastfeeding #PerinatalMentalHealth #SharedDecisionMaking #LactationSupport #TripleFeeding #LactationCaseStudy #BreastfeedingWithMedication

🎧 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 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

🎧 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 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

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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

🎧 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 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!