Behind the Latch

In this episode of Behind the Latch, Margaret Salty interviews Dr. Helen Ball, Professor of Anthropology and Director of the Infancy and Sleep Centre at Durham University in the United Kingdom.

Dr. Ball is one of the world’s leading researchers on infant sleep and parent–infant nighttime behavior. Her work bridges anthropology, public health, and clinical practice, offering an evidence-based understanding of what “normal” infant sleep truly looks like—and why so much of modern sleep advice clashes with biology.

Together, they discuss Dr. Ball’s new book, How Babies Sleep, which explores the evolution, science, and culture of infant sleep across the world. Dr. Ball challenges long-standing myths about “good sleepers,” sheds light on the risks and realities of common practices like bedsharing and sleep training, and highlights how social expectations shape parental stress and decision-making.

She also shares practical, research-based insights for lactation consultants and health professionals supporting families as they navigate infant sleep, feeding, and nighttime care—emphasizing empathy, evidence, and cultural awareness.

They discuss:

• How How Babies Sleep reframes the narrative around “normal” infant sleep
• The cultural roots of Western sleep expectations
• Why frequent night waking is biologically typical—and protective
• How breastfeeding and sleep are deeply intertwined
• What anthropological research reveals about co-sleeping across cultures
• Common misconceptions about bedsharing safety
• Supporting families to make informed, individualized sleep choices
• The importance of aligning sleep advice with human biology and family context

👩‍🏫 Guest Info

Dr. Helen L. Ball

Professor of Anthropology, Durham University

Director, Infancy and Sleep Centre

📘 Book: How Babies Sleep (Pinter & Martin, 2025)

🌐 Website: https://www.dur.ac.uk/research/institutes-and-centres/durham-infancy-sleep-centre/

📝 Connect with Margaret

📬 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙️ Podcast: Behind the Latch

Hosted by: Margaret Salty

Music by: The Magnifiers – My Time Traveling Machine

#BehindTheLatch #InfantSleep #HowBabiesSleep #HelenBall #Anthropology #LactationConsultant #IBCLC #CoSleeping #Bedsharing #Breastfeeding #ParentInfantSleep #SleepScience #LactationResearch #InfantFeeding #PublicHealthLactation

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In this episode of Behind the Latch, Margaret Salty interviews Dr. Kelsey Bianca, psychology professor at Cecil College in Maryland, whose groundbreaking research focuses on the lived experiences of exclusively pumping mothers.

Kelsey’s work shines a light on an often-overlooked population in lactation research—parents who feed their babies human milk through expression rather than at the breast. Her dissertation challenges the traditional “breast or bottle” binary and explores exclusive pumping as a legitimate, empowering, and deeply human form of infant feeding.

Together, they discuss how exclusive pumping fits within the broader breastfeeding landscape, what her qualitative research uncovered about motivation and identity, and how systemic barriers—like language, support gaps, and policy limitations—shape parents’ experiences.

Kelsey also shares her insights on how lactation professionals can better support exclusively pumping families with empathy, inclusivity, and evidence-based care.

They discuss:

• Why exclusive pumping deserves recognition as a form of breastfeeding
• How language and terminology shape support and self-perception
• The emotional and psychological experiences of exclusive pumpers
• Common challenges and identity shifts in the exclusive pumping journey
• What research reveals about resilience and motivation in pumping parents
• The gap between policy, practice, and lived experience
• How IBCLCs and educators can create inclusive spaces for all milk-feeding families
• Future directions for research in human milk expression

👩‍🏫 Guest Info

Dr. Kelsey Bianca

Professor of Psychology, Cecil College

Bianca, K.P. (2025). A narrative review of breastmilk expression. Breastfeeding Review; 33(2): 14-24.

Bianca, K. P. (2023). Framing infant feeding practices with bioecological theory: A theoretical review. Breastfeeding Review; 31(3): 6-16.

📝 Connect with Margaret

📬 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙️ Podcast: Behind the Latch

Hosted by: Margaret Salty

Guest: Dr. Kelsey Bianca

Music by: The Magnifiers – My Time Traveling Machine

#BehindTheLatch #ExclusivePumping #LactationResearch #HumanMilkFeeding #IBCLC #LactationConsultant #MaternalIdentity #PumpingJourney #BreastfeedingSupport #LactationScience #HumanMilkResearch #PublicHealthLactation

🎧 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 Jill Rabin, MA, CCC-SLP/L, IBCLC, speech-language pathologist, lactation consultant, and co-author of Your Baby Can Self-Feed, Too. Known for her pioneering work in Adapted Baby-Led Weaning (ABLW), Jill specializes in responsive feeding for infants with Down syndrome, prematurity, oral motor challenges, feeding aversion, and medical complexity.

Together, they explore how ABLW bridges the gap between traditional baby-led weaning and therapeutic feeding support—giving all babies, including those with motor delays or complex medical needs, a safe and developmentally aligned path to solids. Jill breaks down the misconceptions about gagging vs. choking, readiness cues beyond age, and why starting solids is about skill first, nutrition second. She also shares practical guidance for IBCLCs supporting families in the transition to solids while staying within scope—and how to identify when a referral to a feeding specialist is needed.

They discuss:

• What Adapted Baby-Led Weaning is and how it differs from traditional baby-led weaning
• Understanding gagging, choking risk, and oral motor development
• How chewing skills develop and why strip-shaped foods build safe feeding foundations
• Signs of developmental readiness for solids in breastfed babies
• Supporting preterm and medically complex infants during feeding transitions
• How to introduce allergenic foods safely
• Responsive feeding and avoiding pressure-based feeding practices
• When IBCLCs should refer to SLPs or feeding therapists
• Cultural and socioeconomic accessibility of responsive feeding approaches
• How ABLW promotes feeding confidence and reduces aversion

Jill Rabin, MA, CCC-SLP/L, IBCLC

🌐 Website: https://jillrabin.com

📸 Instagram: @jillrabin_ablw

📘 Book: Your Baby Can Self-Feed, Too

🎓 Transition to Solids

Adapted Baby Led Weaning

📬 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙️ Podcast: Behind the Latch

Hosted by: Margaret Salty

Guest: Jill Rabin, MA, CCC-SLP/L, IBCLC

Music by: The Magnifiers – My Time Traveling Machine

#BehindTheLatch #AdaptedBabyLedWeaning #ABLW #FeedingTherapy #IBCLC #BreastfeedingSupport #OralMotorDevelopment #ResponsiveFeeding #SLP #DownSyndromeFeeding #PediatricFeeding #LactationConsultant #FeedingAversion #EarlyIntervention

🎧 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 Gabriela Alvarado, MD, maternal health policy researcher at the RAND Corporation and current Pathway 2 student. Drawing from both her professional expertise as a physician and researcher, and her personal experience as a breastfeeding parent, Gaby shares insights from her recent qualitative study exploring Latina parents’ experiences with telelactation support—part of a larger randomized controlled trial on telehealth lactation services.

Together, they explore how telelactation fits into the broader landscape of breastfeeding support, the “breastfeeding support escalation protocol” her team identified, and what this research reveals about accessibility, cultural responsiveness, and the evolving role of IBCLCs in telehealth. Gaby also shares how her equity-centered research approach shaped the study design and offers practical takeaways for lactation professionals supporting diverse families.

They discuss:

• How Latina parents navigate different sources of breastfeeding support—from Google to family to IBCLCs—through a natural “escalation” process.
• The convenience and limitations of telelactation, including the need for “support to get support” during virtual visits.
• How messaging platforms and asynchronous communication could enhance lactation care.
• The impact of telelactation access on breastfeeding outcomes and parental confidence.
• Opportunities for pediatric practices to integrate telelactation services to improve continuity of care.
• The importance of cultural humility, linguistic accessibility, and authentic engagement in research and clinical care.
• Policy implications for equitable telelactation access and Medicaid coverage.

👩‍⚕️ Guest Info

Gabriela Alvarado, MD

🌐 RAND Corporation

💼 LinkedIn: Gaby Alvarado

https://doaj.org/article/947b3c1d6b424a2ca093e35ceb59ae5c

https://journals.sagepub.com/doi/full/10.1177/08903344241274760

https://www.liebertpub.com/doi/full/10.1089/tmj.2022.0159

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830786

📝 Connect with Margaret

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Gabriela Alvarado, MD

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #LactationResearch #Telelactation #IBCLC #BreastfeedingSupport #LatinaParents #CulturalHumility #MaternalHealth #LactationConsultant #HealthEquity #RAND

🎧 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. Jess Daigle, pediatric hospitalist, NICU physician, founder of Tiny Steps NICU Grad Care, and NICU mom. Drawing from both her professional expertise and personal experience, Dr. Daigle shares how her own NICU journey shaped her passion for supporting families through the vulnerable transition from hospital to home.

Together, they explore the emotional landscape of NICU parenting, the unique lactation challenges that arise in this setting, and how IBCLCs can play a transformative role in bridging gaps between families and the medical team. Dr. Daigle offers practical insights for improving interdisciplinary collaboration, building trust with families, and approaching care with cultural humility and genuine curiosity.

They discuss:

• The emotional toll of the NICU experience for parents, including grief, loss of control, and isolation—and how lactation consultants can approach families with sensitivity.
• How inconsistent messaging across NICU teams can confuse families, and why standardized feeding pathways and shared language are essential.
• The IBCLC’s role in educating and empowering families—especially around premature infant feeding skills, confidence-building, and preparing for discharge.
• Practical strategies for integrating lactation consultants into the NICU care team, moving from “guest” status to core collaborators.
• The importance of recognizing breastfeeding as medicine and addressing the dyad holistically, rather than through siloed disciplines.
• How cultural humility, curiosity, and individualized support can create more equitable and compassionate care for families from diverse backgrounds.
• Dr. Daigle’s vision for systemic change: embedding lactation education early in medical and allied health training to build a unified, dyad-focused model of care
• chat-with-dr-jess-daigle

Dr. Jess Daigle, MD, FAAP

🌐 Instagram: @momandme_md

💼 LinkedIn: Jess Daigle, MD

Anchored in Hope

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Jess Daigle

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #NICU #IBCLC #LactationConsultant #BreastfeedingSupport #MaternalHealth #LactationEducation #FamilyCenteredCare #CulturalHumility #NICUGradCare

🎧 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 Maya Nakamura, CNM, PhD(c)—a midwife researcher from Sapporo, Japan—about her work on nipple trauma and her recent study on silver nipple protectors. Maya shares how years of bedside experience, watching mothers struggle with painful nipple damage, pushed her into research and innovation in clinical assessment (including AI-based image analysis) and practical tools that may reduce pain and promote healing.

Together, they explore how culture, access, and methodology shape nipple-trauma research; what we do and don’t yet know about silver nipple protectors; and how IBCLCs can translate emerging evidence into compassionate, realistic care for families. Maya also talks about the realities of conducting trials in Japan (declining birth rates, ethics, and single-site constraints), and why standardized outcome measures are critical for future meta-analyses.

They discuss:

• Why study nipple trauma? Night-shift realities, mother distress, and the limits of common “friction-reduction” hacks that sparked formal inquiry.
• Silver nipple protectors 101: what they are, how they’re used postpartum, and potential mechanisms (barrier + moisture + antimicrobial silver).
• Study design trade-offs: why a non-randomized comparative design with historical controls was chosen, and steps taken to minimize bias.
• Key findings from Maya’s trial: reductions in severe nipple trauma indicators and day-4 pain—alongside a clean safety profile in the study setting.
• Real-world considerations: availability in Japan, cost barriers (≈¥10,000) and ideas like unit-level lending to improve access.
• What’s next: the call for standardized criteria, longer follow-up, comparisons with other treatments, and the promise (and limits) of AI for consistent nipple-trauma classification.

Maya emphasizes a practical, parent-centered approach: protect the nipple, relieve pain, and sustain breastfeeding—while staying honest about evidence gaps and equity barriers in accessing devices and follow-up care.

Maya Nakamura, CNM, PhD(c)

• Midwife & doctoral researcher (Sapporo, Japan)
• Focus: nipple-trauma classification, wound-care adjuncts, and AI-assisted assessment in lactation care.

Publications:

Nipple Skin Trauma in Breastfeeding Women During Postpartum Week One. , Breastfeeding Medicine, Nakamura M, Asaka Y, Ogawara T, Yorozu Y, 2018 Sep;13(7):479-484.

https://www.researchgate.net/publication/326818739_Nipple_Skin_Trauma_in_Breastfeeding_Women_During_Postpartum_Week_One

・An evaluation of the signs of nipple trauma associated with breastfeeding: A Delphi Study, Journal of human lactation, Maya Nakamura, Yoko Asaka, 2022 Feb; 38(3) 548–558. DOI: 10.1177/08903344221076527

journals.sagepub.com/home/jhl

https://journals.sagepub.com/doi/10.1177/08903344221076527

・Effectiveness of moisturizing therapy in treating nipple trauma: a systematic review protocol, BMJ Open, Nakamura M, Luo Y, Ebina Y. 2024;14:e083389. doi: 10.1136/bmjopen-2023-083389

https://bmjopen.bmj.com/content/14/9/e083389.long

・Systematic Review on the Efficacy of Moisturizing Therapy in Treating Nipple Trauma and Nipple Pain. Journal of Human Lactation. Nakamura M, Luo Y, Ebina Y. 2025;41(1):39-53. doi:10.1177/08903344241301401

https://journals.sagepub.com/doi/10.1177/08903344241301401

・Development of Nipple Trauma Evaluation System With Deep Learning. Journal of Human Lactation. Nakamura M, Sugimori H, Ebina Y. 2025;41(1):105-114. doi:10.1177/08903344241303867

https://journals.sagepub.com/doi/10.1177/08903344241303867

・Role of Silver Nipple Protectors in Treating Nipple Trauma: A Non-Randomized Comparative Trial. J Hum Lact. Nakamura M, Sugimori H, Asaka Y, Ebina Y. 2025 Aug;41(3):382-391. doi: 10.1177/08903344251342564.

https://journals.sagepub.com/doi/10.1177/08903344251342564

・Feasibility and Acceptability of a Deep-Learning-Based Nipple Trauma Assessment System for Postpartum Breastfeeding Support. Healthcare, Nakamura, M., Sugimori, H., & Ebina, Y. (2025). 13(17), 2091. https://doi.org/10.3390/healthcare13172091

Transcript:

Where are you located and where are you working?

My name is Maya Nakamura. I live in Sapporo, the capital city of Hokkaido in northern Japan.

I am a third-year doctoral student and also a midwife. Before starting my doctoral program, I worked as a nursing and midwifery faculty member, and after graduation I plan to return to academia. As a midwife, I used to work in hospitals, but now I practice independently, visiting families at home to support pregnant women, new mothers, and their babies.

What brought you to this work?

I became a midwife simply because I love babies. I am also a mother of four children, which is quite unusual in Japan where most families have only one or two. My youngest is still an infant, and I am currently breastfeeding.

Your body of research centers around nipple damage. Can you tell me where this desire to study nipple damage in breastfeeding mothers came from?

When I was working as a hospital midwife, I often saw mothers crying at night because of painful nipple damage. They wanted to continue breastfeeding but felt they had no choice but to stop. At that time, senior midwives used to give polyester film to reduce friction, but I wondered whether it really worked and what the evidence was. That curiosity led me to pursue research, and it became the reason I entered a master’s program.

Silver nipple protectors are becoming more popular in the US. I see them frequently with my patients and my students often ask about them. What led you to focus your research on silver nipple protectors, and why do you think there was a need to study them in a Japanese population?

I noticed that silver nipple protectors are common in the US. I also saw a booth for them at the last ILCA conference, which showed me how much attention they are receiving. In Japan, however, they are almost unknown. I first came across the 2015 paper by Marrazzu et al., which really surprised me because of the unique appearance of the device. I imported one, and when I gave birth myself, I tried it and felt it worked. When I introduced it at my clinic, both mothers and midwives responded positively. That experience convinced me that Japanese mothers could also benefit from them.

Your study used a non-randomized comparative design with historical controls. Can you explain why this design was chosen and how you addressed potential limitations?

The choice was practical. First, there are ethical challenges in Japan with providing different interventions to women admitted at the same time in the same hospital. Second, silver nipple protectors are not common here, and introducing them across multiple facilities is very difficult. Japan also faces declining birth rates, which makes it hard to recruit large samples. For these reasons, I conducted the study in one clinic where silver protectors had already been used, and I used historical data as the control.

To minimize bias, I collected data from facilities of similar size and with comparable quality of midwifery care.

In both this study and the study used for the control sample you classified nipple trauma into specific signs such as erythema, swelling, scabbing, and blistering. How did you determine which signs to focus on, and what did you find most challenging about measuring trauma consistently?

The classification was based on my earlier research. I collected about 750 photographs of nipple trauma over time and analyzed them, which led me to develop a seven-category system. Using this system, we evaluated erythema, swelling, scabbing, and blistering in this study. The method itself was not so difficult, but subjective judgment is always a limitation. Recently, I have also used AI-based image analysis to classify nipple trauma, which I believe reduces subjectivity.

One of your key findings was that silver protectors reduced severe trauma and nipple pain by day 4 postpartum. You mention that it’s unclear whether the benefits come from the silver itself, the moisture effect, or both. Based on your findings, what do you think might be the most important mechanism at work?

As I wrote in my paper, it is not clear whether the benefit comes from the silver itself, the moisture effect, or both. My personal view is that it is likely a combination of both.

No adverse effects were reported in your trial. Were there any concerns from participants or staff about using silver, particularly regarding safety or potential impact on breast milk?

Because the study was conducted in a clinic that had already used silver protectors for several years, staff did not express concerns. We excluded women with very sensitive skin or known metal allergies. Participants generally had no safety concerns either, although some mentioned that the protector sometimes slipped off during sleep, or that the edge could press against the breast when it was engorged.

What do you see as the next steps in studying silver nipple protectors—do you envision randomized controlled trials, long-term follow-up, or comparisons with other common treatments like lanolin or hydrogel pads?

A full randomized controlled trial may be difficult in Japan due to ethical and clinical issues. In my opinion, one of the main problems in nipple trauma research is that different studies use different evaluation criteria, which prevents meta-analysis. I believe the next step is for researchers to use a standardized classification—such as my seven-category system—so that we can build evidence together.

What is next for you in terms of research?

I am currently working on using AI to classify nipple trauma. I think this technology can be very beneficial for the next generation of mothers. At the same time, human touch and care from midwives will always be essential. My goal is to combine AI with hands-on midwifery support to provide more comprehensive care.

Where can my listeners learn more about you and the work that you're doing? 

Please take a look at my publications. I have written seven papers in English so far.

Connect with Margaret

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Maya Nakamura

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #IBCLC #NippleTrauma #BreastfeedingSupport #LactationResearch #InfantFeeding #MaternalHealth

🎧 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 Claire Eden, BA, IBCLC, author of Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother–Infant Separation. Claire shares her journey from NICU lactation consulting to statewide advocacy, and how her clinical experiences inspired her to propose a new framework for supporting families when babies are admitted to the NICU.

Together, they explore why the traditional “pump every 3 hours” model is often overwhelming for families, and how more flexible, evidence-based strategies can help parents establish and maintain their milk supply. Claire provides practical insights on supporting parents through separation, reshaping hospital policy, and rethinking how IBCLCs approach milk expression education.

They discuss:

• Why rigid pumping schedules can overwhelm families and affect both supply and mental health.
• The evidence behind the “5 × 5 rule” (expressing at least 5 times a day by Day 5) and the importance of one overnight pumping session.
• The five-step paradigm shift that emphasizes antenatal education, personalized discharge planning, and structured follow-up.
• How individualized lactation care improves outcomes for preterm and sick infants in the NICU.
• The role of hospital policy in prioritizing lactation support as a standard of care.
• Practical ways IBCLCs can empower parents while making pumping more achievable.

Claire emphasizes the importance of evidence-based, parent-centered lactation care that not only protects milk supply but also supports family well-being during the difficult experience of mother–infant separation.

Guest Info

Claire Eden, IBCLC

📚 Author: Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother–Infant Separation

🌐 Georgia Perinatal Quality Collaborative: Georgiapqc.org

Papers Discussed

Randle J. From the Field - The Case for a Paradigm Shift in Lactation Care for NICU Families: A Comprehensive Lactation Care Model. J Hum Lact. 2025 Feb;41(1):34-38. doi: 10.1177/08903344241299722. Epub 2024 Nov 26. PMID: 39588739.

Mago-Shah DD, Athavale K, Fisher K, Heyward E, Tanaka D, Cotten CM. Early pumping frequency and coming to volume for mother's own milk feeding in hospitalized infants. J Perinatol. 2023 May;43(5):629-634. doi: 10.1038/s41372-023-01662-z. Epub 2023 Apr 10. PMID: 37037987.

Parker LA, Sullivan S, Kruger C, Mueller M. Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J Perinatol. 2020 Aug;40(8):1236-1245. doi: 10.1038/s41372-020-0688-z. Epub 2020 May 27. PMID: 32461626.

Parker LA, Hoban R, Bendixen MM, Medina-Poeliniz C, Johnson TJ, Meier PP. Milk Biomarkers of Secretory Activation in Breast Pump-Dependent Mothers of Preterm Infants: An Integrative Review. Breastfeed Med. 2024 Jan;19(1):3-16. doi: 10.1089/bfm.2023.0107. PMID: 38241129; PMCID: PMC10818056.

Hoban R, McLean L, Sullivan S, Currie C. Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU. J Hum Lact. 2022 Feb;38(1):148-155. doi: 10.1177/0890334421993467. Epub 2021 Feb 13. PMID: 33586505; PMCID: PMC8814956.

Hoban R, Bigger H, Schoeny M, Engstrom J, Meier P, Patel AL. Milk Volume at 2 Weeks Predicts Mother's Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants. Breastfeed Med. 2018 Mar;13(2):135-141. doi: 10.1089/bfm.2017.0159. Epub 2018 Jan 29. PMID: 29377728; PMCID: PMC5863077.

Patel AL, Johnson TJ, Meier PP. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res. 2021 Jan;89(2):344-352. doi: 10.1038/s41390-020-01263-y. Epub 2020 Nov 13. PMID: 33188286; PMCID: PMC7662724.

Connect with Margaret

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Claire Eden

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #NICU #IBCLC #BreastfeedingSupport #InfantFeeding #MaternalHealth #LactationEducation

🎧 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 Sandra Cole, RN, IBCLC, author of Breastfeeding Challenges Made Easy for Late Preterm Infants. Sandra shares her journey from NICU nursing to lactation consulting, and how her experiences with late preterm babies inspired her to write her groundbreaking book.

Together, they explore why late preterm infants—those born between 34 and 36 6/7 weeks—are often misunderstood as “almost term” when in reality they face unique physiologic challenges that make breastfeeding especially complex. Sandra provides evidence-based insights on how to best support these dyads and practical strategies IBCLCs can apply in their daily work.

They discuss:

• Why late preterm babies are at higher risk for feeding difficulties, hypoglycemia, and jaundice.
• The role of brown fat, glycogen stores, and immature brain development in feeding challenges.
• Effective supplementation strategies, including the use of a 24 mm nipple shield with a syringe and feeding tube.
• How to balance protecting breastfeeding while ensuring adequate glucose intake and growth.
• Practical documentation tips and communication strategies for IBCLCs working with pediatricians and hospital teams.
• What to look for when weaning off supplements and supporting transition to exclusive breastfeeding.

Sandra emphasizes the importance of educating families and healthcare providers about the unique needs of late preterm infants and provides actionable advice IBCLCs can use right away.

*Important note: Re: Immature liver: immature liver. When there is no glucose to support brain function and growth, the body turns to glycogen stores to convert to glucose. But when there is no glycogen, the body starts into anearobic metabolism to obtain glucose. This is done by breaking down body tissue, leading to excess weight loss as well as increased respirations (tachypnea).

Guest Info

📚 Author: Breastfeeding Challenges Made Easy for Late Preterm Infants

🌐 Website: MilkMadeEasy.com

Applying nipple shield with tube: https://www.milkmadeeasy.com/post/how-to-apply-a-nipple-shield

Connect with Margaret

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Sandra Cole

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords

#BehindTheLatch #LatePreterm #IBCLC #BreastfeedingSupport #InfantFeeding #MaternalHealth

🎧 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 Jacob Engelsman, IBCLC and author of Lactation for the Rest of Us: A Guide for Queer and Trans Parents and Helpers.

**Special Discount: Receive 20% off until 10/31/25 on Jacob's book with code "LACTATION20" here.**

Jacob shares his journey into the lactation field, from working in restaurants to finding his calling as an IBCLC and writer. His work centers on supporting queer, trans, and non-binary families who are often left out of mainstream lactation education. His book fills a long-standing gap by providing practical information, first-person stories, and affirming guidance for families who want to chestfeed, induce lactation, or navigate infant feeding after top surgery.

Together, Margaret and Jacob explore how lactation consultants can expand their knowledge and language to better serve all families. They discuss topics such as:

• Inclusive language and recovering gracefully from missteps.
• Lactation after top surgery and the realities of chestfeeding.
• Binding while lactating and the balance between supply and mental health.
• Induced lactation for adoptive, queer, and non-gestational parents.
• The power of personal stories to reshape how we understand parenting and feeding.

Jacob also shares about his unique childbirth education program for first-time fathers, originally taught in a bar with wings and beer, and why creating approachable spaces for dads—including queer dads—can change the way families prepare for birth and early parenting. Looking ahead, he highlights the importance of more training, advocacy, and resources that affirm the diversity of today’s families.

Links:

• https://www.badoulatrainings.org/blog/5-meaningful-ways-to-be-a-gender-inclusive-provider
• https://www.badoulatrainings.org/blog/top-surgery-and-lactation-what-you-need-to-know
• https://www.lactationtraining.com/shopping/online-shop/continuing-education/gender-diverse-clinic-spaces-detail

Guest Info:

📚 Author: Lactation for the Rest of Us

🌐 Website: JacobEngelsmanIBCLC.com

📸 Instagram: @JacobIBCLC

Connect with Margaret:

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Jacob Engelsman

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #QueerParenting #IBCLC #InclusiveLactation #TransInclusiveCare #Chestfeeding #InfantFeeding

In this episode of Behind the Latch, Margaret Salty interviews Dr. Jacqueline H. Wolf, medical historian and author of Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries. Dr. Wolf is a professor at Ohio University whose research focuses on the history of breastfeeding, childbirth, and maternal-child health.

Together, they explore the historical forces that shaped infant feeding practices in the United States, how breastfeeding came to be mistrusted in the late 19th century, and what lessons today’s IBCLCs and public health professionals can draw from this history. Dr. Wolf shares insights into the rise of pediatrics, the role of wet nurses, the dangers of the early cow’s milk industry, and how “scientific feeding” transformed cultural attitudes toward women’s bodies and infant nutrition.

Dr. Wolf shares how:

• Her personal experience of motherhood during graduate school inspired her dissertation on breastfeeding history.
• She transitioned from environmental history to medical history through this research.
• Teaching at a medical school gave her the rare opportunity to influence how future doctors think about breastfeeding and maternal health.

They discuss:

• How rigid feeding schedules and cultural shifts tied to industrialization eroded breastfeeding success.
• Why mothers began reporting “not enough milk” for the first time in human history.
• How the medical community framed lactation as a disappearing biological function, legitimizing pediatricians’ growing role in infant feeding.

Dr. Wolf explains:

• The rise of wet nurse registries in Chicago and other cities.
• How poor women, often forced to abandon their own babies, sustained the lives of wealthy families’ infants.
• Why wet nurses remained invisible in history, even as they were central to infant survival.

They explore:

• How pediatricians partnered with dairy farmers to create “certified milk” and later milk laboratories.
• The origins of the term formula as mathematical prescriptions for modifying cow’s milk.
• Why formula became necessary for survival but should not be treated as a growth industry today.

Dr. Wolf reflects on:

• How formula companies continue to market by exploiting doubts about women’s ability to produce enough milk.
• Why free samples, aggressive advertising, and partnerships with IBCLCs undermine breastfeeding.
• The importance of respecting women’s choices while advocating for systemic change, like paid maternity leave and stronger formula marketing regulation.

They emphasize:

• Why public health campaigns should empower rather than shame families.
• The urgent need for paid parental leave to support breastfeeding success.
• How IBCLCs can serve as advocates by challenging formula marketing and promoting evidence-based breastfeeding education.

Dr. Jacqueline H. Wolf

📚 Author of Don’t Kill Your Baby and several books on childbirth and maternal-child health

🌐 Substack: Urgent Care: Medical Historians Respond to Attacks on Public Health

🌐Raw Milk

🌐Formula, Fries, and Fruit Loops

🎙Lifespan: Stories of Illness, Accident, and Recovery

📧 Email: [email protected]

📸 Instagram: @margaretsalty

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🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Jacqueline Wolf

🎵 Music by: The Magnifiers, My Time Traveling Machine

#BehindTheLatch #BreastfeedingHistory #IBCLC #InfantFeeding #PublicHealth #BreastfeedingSupport #MaternalHealth

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