In this episode of Behind the Latch, Margaret Salty interviews Jeanne Pichoff, MS, OTR/L, IBCLC, owner of Flourish Pediatric Therapy and Lactation in Lafayette, Louisiana. Together, they explore the unique and often misunderstood role of occupational therapists in lactation care—how OT skills complement IBCLC expertise, when a referral to OT can make all the difference for a feeding dyad, and how collaborative care improves outcomes for families. Jeanne shares how her personal experience with a tongue-tied baby fueled her passion to bridge the gap between therapy and lactation, and why understanding infant development, muscle tone, and sensory integration is essential for comprehensive feeding support.

They discuss the overlap between OT, PT, and SLP roles in infant feeding, how to identify when an OT referral is warranted, and the nuances of managing tongue tie cases both before and after frenotomy. Jeanne also explains why “suck training” can fall outside the IBCLC scope if practiced without an additional license, and how to work within scope while still supporting progress.

Jeanne’s Journey into Lactation and OT Specialization

Jeanne shares how:

• Her early work in general pediatrics and early intervention revealed a major gap in lactation knowledge among OTs.
• A challenging personal breastfeeding experience with her second child, who had an obvious tongue tie, became the catalyst for pursuing IBCLC training.
• Combining her OT skill set with lactation expertise allowed her to provide more comprehensive, dyad-centered care.

The OT Role in Infant Feeding

They discuss:

• How OT scope of practice includes feeding, sensory processing, and motor skill development.
• The unique lens OTs bring to infant feeding, from muscle tone assessment to sensory integration.
• Overlap with PT and SLP roles, and why individual continuing education shapes a therapist’s feeding expertise.

When to Refer to OT

Jeanne explains:

• Key red flags—such as abnormal muscle tone, dysphagia signs, sensory processing challenges, torticollis, or developmental delays—that warrant OT involvement.
• How therapy addresses both feeding mechanics and developmental milestones.
• Why early intervention leads to better long-term outcomes.

Managing Tongue Tie Cases

They explore:

• Why not all tongue-tied babies need therapy before release—and when conservative management is best.
• How OT can support post-frenotomy recovery, from suck training to addressing body tension.
• The risks of prophylactic releases “just in case” and why function should always guide decision-making.

Scope, Collaboration, and Advocacy

Jeanne shares:

• Why IBCLCs without another license should avoid direct “suck training” and instead refer to an appropriately licensed provider.
• How billing under OT benefits families by increasing insurance coverage for feeding-related visits.
• The importance of building trust across disciplines to ensure safe, effective care for families.

Advice for IBCLCs and Perinatal Professionals

Jeanne encourages providers to:

• Learn the strengths of the OTs, PTs, and SLPs in their community.
• Focus on collaborative, dyad-centered care rather than trying to “do it all.”
• Recognize and respect scope of practice boundaries to improve outcomes and maintain professional safety.

**DISCOUNT CODE BEHINDTHELATCH for 20% off either one Jeanne's courses:

https://www.lactationot.com/tots

https://www.lactationot.com/weightgain

Guest Info:

Jeanne Pichoff, MS, OTR/L, IBCLC, is an occupational therapist and lactation consultant specializing in infant feeding, sensory integration, and developmental support. She owns Flourish Pediatric Therapy and Lactation in Lafayette, LA, and teaches courses on tongue tie and weight gain management for the Lactation OT platform.

🌐 Website: https://www.flourishptl.com/

https://jeannepichoff.podia.com/prenatal-breastfeeding-class

📸 Instagram: https://www.instagram.com/flourishpediatrictherapy/

📘 Facebook: https://www.facebook.com/profile.php?id=100063671345420

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Jeanne Pichoff, MS, OTR/L, IBCLC

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

Hashtags & Keywords:

#BehindTheLatch #OccupationalTherapy #IBCLC #LactationCare #InfantFeeding #TongueTieSupport #FeedingTherapy #OTinLactation #EvidenceBasedLactation #CollaborativeCare

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

In this episode of Behind the Latch, Margaret Salty interviews Dr. Lisa Anders, assistant professor at the University of North Carolina at Greensboro and IBCLC. Together, they explore Dr. Anders’ groundbreaking research on flange sizing for pumping parents—an area that has been historically under-researched and inconsistently practiced. Dr. Anders shares how using nipple tip diameter rather than base diameter may improve comfort, milk expression, and overall pumping experience.

They discuss the practical implications of her findings for private practice IBCLCs, how to apply the research in clinical care, and what this means for the future of pumping support.

Anders, L., Frem, J.M., & McCoy, T.P. (2024). Flange Size Matters: A Comparative Pilot Study of the Flange FITS Guide Versus Traditional Sizing Methods. Journal of Human Lactation, 41(1). https://doi.org/10.1177/08903344241296036

Lisa’s Journey into Lactation Research

Dr. Anders shares how:

• Her own experience as a mother and lactation consultant led her to question standard flange fitting guidance.
• She noticed patterns of discomfort and underperformance in pump use that weren’t being addressed in the literature.
• Her academic background in health and human sciences helped her design a pilot study to explore alternative approaches to flange sizing.

Why Flange Fit Matters

They discuss:

• How incorrect flange sizing contributes to nipple pain, reduced output, and early weaning.
• Why standard recommendations based on base diameter may not reflect the functional part of the nipple used during pumping.
• How measuring nipple tip diameter (as little as 3–5mm) and using smaller flanges improved outcomes for many of her study participants.

Clinical Application and Research Gaps

Dr. Anders explains:

• How IBCLCs in private practice can begin to implement this approach now, even before larger-scale studies are done.
• The importance of individualized care, particularly for exclusive pumpers who may struggle in silence.
• Why pump support deserves the same evidence-based attention as direct breastfeeding.

Equity and Access in Pumping Support

They explore:

• How a lack of evidence-based flange fitting disproportionately impacts marginalized communities.
• The cost and access barriers involved in finding the right flange—and how that contributes to inequities in breastfeeding outcomes.
• The need for culturally responsive, inclusive pumping support.

Looking Ahead

Dr. Anders shares:

• What future research she hopes to conduct to validate and expand her pilot findings.
• Why community-based IBCLCs play a vital role in gathering observational data and sharing clinical insights.
• Her encouragement to providers to challenge assumptions and keep asking: is this really working for our clients?

Advice for IBCLCs and Perinatal Professionals

Dr. Anders encourages providers to:

• Reconsider flange fitting practices with a focus on comfort, efficiency, and individualized care.
• Learn more about pump mechanics and nipple anatomy.
• Advocate for more inclusive and accessible tools to support all pumping parents.

Guest Info:

Dr. Lisa Anders is an assistant professor at UNC Greensboro and a board-certified lactation consultant. Her research focuses on maternal health, infant feeding, and improving care experiences through interdisciplinary and inclusive approaches.

📘 LinkedIn: Dr. Lisa Anders

📚 Read the study: Anders, L. (2024). Reconsidering Flange Sizing for Breast Pumping Parents: A Pilot Study. Journal of Human Lactation.

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Lisa Anders

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

Hashtags & Keywords:

#BehindTheLatch #FlangeFit #BreastPumpingSupport #LactationResearch #IBCLC #NipplePain #InclusiveLactationCare #PumpSupport #EvidenceBasedLactation

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

In this episode of Behind the Latch, Margaret Salty interviews Dr. Emily Little researcher and founder of Nurturely. Together, they explore how a baby’s sensory world influences their development, the impact of culture on parent-infant interactions, and why early sensory experiences—like babywearing, skin-to-skin, and gentle handling—can have profound effects on feeding, regulation, and bonding. Dr. Little shares evidence-based insights into nurturing the whole baby while advocating for a more inclusive, anti-racist model of perinatal health.

Dr. Little shares how:

• Her early research focused on infant sensory systems and regulation.
• Time spent in cross-cultural research opened her eyes to the variety of parenting norms around the globe.
• She founded Nurturely to bridge research and equity-centered community care, bringing together science, support, and systems change.

They discuss:

• How babies rely on touch, sound, movement, and smell to make sense of their world.
• How common Western parenting norms—like placing babies in containers and using less skin-to-skin—can lead to sensory mismatch and dysregulation.
• Why “fussy” behavior may be a clue to unmet sensory needs rather than a temperament issue.

Dr. Little explains:

• How colonization and racism have disrupted culturally grounded parenting practices.
• The importance of reclaiming and honoring ancestral knowledge—especially in Black, Indigenous, and Latinx communities.
• That perinatal care must move beyond individual-level support and into system-level change to be truly equitable.

They explore:

• How babywearing is often dismissed as “optional” in Western medicine—but is the norm globally.
• The developmental, emotional, and regulatory benefits of babywearing for both parents and infants.
• How Nurturely’s programs provide access to baby carriers, workshops, and community support—especially for BIPOC families.

Dr. Little describes:

• Why research alone is not enough—we need community-driven change.
• Nurturely’s model of working with BIPOC-led organizations to co-create programs that address real-world challenges.
• Why dismantling racism in perinatal health is a lifelong commitment, not a checkbox.

Dr. Little encourages providers to:

• Stay curious—question what you consider “normal” parenting practices.
• Understand the deep connection between sensory development and feeding behaviors.
• Partner with community organizations to expand access and inclusion in perinatal care.

Guest Info:

Dr. Emily Little is a researcher and the founder of Nurturely, a nonprofit dedicated to promoting equity in perinatal wellness and strengthening the connection between culture, science, and care.

🌐 www.nurturely.org

📘 LinkedIn: https://www.linkedin.com/in/emilylittlephd

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Emily Little

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

Hashtags & Keywords:

#BehindTheLatch #InfantDevelopment #PerinatalPsychology #Babywearing #SensoryNeeds #LactationSupport #EquityInPerinatalCare #CulturalHumility #Nurturely #IBCLC

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

In this episode of Behind the Latch, Margaret Salty interviews Cierra Murphy-Higgs, M.Ed, IBCLC, didactic coordinator for the Pathway 2 program at North Carolina A&T State University and a perinatal behavioral health coach. Cierra shares how her own postpartum struggles led her into the world of lactation and mental health advocacy. Drawing from her experience as a high school counselor turned lactation consultant, she offers powerful insights into the link between perinatal mental health and infant feeding—and how lactation professionals can be better equipped to recognize and support families through it.

Cierra’s Journey into Lactation and Mental Health

Cierra shares how:

• Her traumatic postpartum experience in early 2020 sparked a passion for advocacy and support.
• She found community and education through Instagram, which eventually led her to pursue the IBCLC pathway.
• Her previous work as a high school counselor naturally integrated into her lactation practice as she noticed mental health struggles at the core of many consults.

The Link Between Feeding and Mental Health

Cierra explains:

• Unmet feeding goals and infant feeding challenges can worsen symptoms of postpartum depression, anxiety, OCD, or PTSD.
• Mental health symptoms don’t always look like sadness—hypervigilance around pumping, obsessive logging, and intrusive thoughts are red flags.
• Lactation consultants must recognize how our language can affirm or harm, and why offering a bottle isn’t “just” a feeding option—it can trigger shame.

Clinical Tools and Community Connections

They discuss:

• How lactation consultants are uniquely positioned to catch early mental health symptoms—often before OBs or pediatricians do.
• Why warm handoffs to perinatal mental health providers are essential.
• The value of screening tools like the PHQ-9 and trusting your gut when a client seems overwhelmed.

Trauma-Informed, Culturally Competent Care

Cierra outlines:

• Black birthing people experience the highest rates of perinatal mental health disorders and the least access to support—due to mistrust, systemic racism, and real fear of punitive responses.
• Representation matters. So do community partnerships. Working with local churches, doula collectives, and trusted organizations helps bridge the gap.
• It’s not just about individual education—it’s about healing generational harm, rebuilding trust, and empowering entire families.

Local Impact and National Implications

Margaret and Cierra explore:

• The ripple effect of peer counseling, community classes, and representation in lactation education.
• How grassroots programs in Greensboro are building trust and increasing breastfeeding rates.
• Why workforce development and mentorship—especially for aspiring IBCLCs of color—are key to equity in lactation care.

Advice and Action for IBCLCs

Cierra encourages listeners to:

• Educate yourself on perinatal mental health—you don’t need to be a therapist, but you do need to know the signs.
• Map your referral network. Know who to call, what groups exist, and how to do warm handoffs.
• Take care of yourself. Burnout is real in this work, and we can’t pour from empty cups.

Guest Info:

Cierra Murphy-Higgs, M.Ed, IBCLC, is the didactic coordinator for the Human Lactation Pathway 2 program at North Carolina A&T and serves as a perinatal behavioral health coach with Family Well Health. She is a passionate educator, advocate, and public speaker working at the intersection of lactation, equity, and mental health.

📧 Email: [Available upon request]

🔗 LinkedIn: https://www.linkedin.com/in/cierra-murphy-higgs/

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Cierra Murphy-Higgs, M.Ed, IBCLC

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

Hashtags & Keywords:

#BehindTheLatch #PerinatalMentalHealth #IBCLC #LactationEquity #TraumaInformedCare #PostpartumSupport #FeedingAndMentalHealth #WarmHandoff #WorkforceDevelopment

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

In this episode of Behind the Latch, Margaret Salty interviews Dr. Kathryn Wouk, IBCLC and associate research scientist at the Pacific Institute for Research and Evaluation.

Dr. Wouk dives into the heart of her recent Journal of Human Lactation article, “Clinical Versus Statistical Significance: Making Sense of Research Findings,” helping lactation professionals develop research literacy and critically evaluate evidence-based practice.

Through clear, real-world examples, Dr. Wouk breaks down complex research concepts like p-values, confidence intervals, odds ratios, and effect sizes. She makes the case for why clinical significance often matters more than statistical significance—and how to spot the difference. This episode is an essential listen for any IBCLC or student looking to build confidence in reading, interpreting, and applying research in a meaningful, actionable way.

Dr. Wouk explains:

• The definition and limitations of statistical significance (p < .05 does not always mean something is meaningful).
• How clinical significance speaks to real-world impact for parents and providers.
• Why a 1.2-day increase in breastfeeding duration might be statistically significant but not clinically relevant.

They explore:

• Why confidence intervals provide richer insight than p-values alone.
• How to interpret effect size and the precision of research findings.
• How to use confidence intervals to assess whether a study’s findings are applicable to your population.

Dr. Wouk discusses:

• What an odds ratio is and how to understand it in plain language.
• How effect sizes can be distorted by sample size—and why larger samples can detect irrelevant findings.
• Why the study design should match the research question and how to assess strengths and weaknesses in different methods.

They highlight:

• Why the ability to critically read research is a core IBCLC competency.
• Strategies to build this skill even without a statistical background.
• The value of mixed methods research and how qualitative insights enrich our understanding of clinical significance.

Dr. Wouk emphasizes:

• The threat to national data collection efforts (e.g., PRAMS, NIS) and the need for IBCLC advocacy.
• How underfunding and policy changes can stall progress in maternal-child health.
• The role IBCLCs can play in contributing case studies, literature reviews, and practice insights to The Journal of Human Lactation.

They recommend:

• Starting with podcasts like Behind the Latch and Casual Inference.
• Using AI tools (with caution and good prompts!) to understand research papers.
• Reviewing population characteristics (“Table 1”) to assess generalizability to your clinical setting.

Guest Info:

Dr. Kathryn Wouk is an IBCLC, maternal and child health researcher, and associate research scientist at the Pacific Institute for Research and Evaluation. She also serves as adjunct assistant professor at UNC Chapel Hill and associate editor at the Journal of Human Lactation.

📧 Email: [Available upon request]

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Kathryn Wouk, IBCLC

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

Hashtags & Keywords:

#BehindTheLatch #LactationResearch #IBCLC #BreastfeedingSupport #ResearchLiteracy #StatisticalSignificance #ClinicalSignificance #QualitativeResearch #ConfidenceIntervals #LactationAdvocacy #JHL #MixedMethods

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

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

📘 Facebook: Margaret Salty

🎙 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

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review

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

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

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

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

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

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!

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

🎧 Listen now on your favorite podcast app—and don’t forget to subscribe and leave a review!