Behind the Latch

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

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

Key findings:

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

🔍 Implications for IBCLCs:

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

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

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

Key findings:

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

🔍 Implications for IBCLCs:

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

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

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

Key findings:

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

🔍 Implications for IBCLCs:

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

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

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

Key findings:

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

🔍 Implications for IBCLCs:

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

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

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

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

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

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

Nicole shares how:

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

Nicole explains:

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

Margaret and Nicole discuss:

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

They explore:

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

Nicole offers insight on:

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

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

📱 Instagram: @motheringismedicine @radical_moms_union

🌐 Learn more: www.mothernurtureconsulting.com

#backoffbobbie

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

📌 USLCA WHO Code Committee

📌 Radical Moms Union & Global MilCom

📌 ABM Clinical Protocols

📌 Research on influencer culture in maternal health

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Nicole Longmire, IBCLC

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

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

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

1️⃣ Breastfeeding and Long-Term Renal Health

Citation:

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

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

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

2️⃣ Photobiomodulation for Nipple Injury

Citation:

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

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

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

3️⃣ Breastfeeding Network Disparities in the Deep South

Citation:

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

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

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

4️⃣ What Effective Breastfeeding Really Looks Like

Citation:

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

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

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

📸 Instagram: @margaretsalty

📧 Email: [email protected]

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

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

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

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

Rebekah shares how:

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

Rebekah explains:

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

They discuss:

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

Rebekah highlights common struggles:

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

Rebekah recommends:

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

They explore:

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

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

📱 Instagram: @caffeinatedlactation

🌐 Learn more: The Better Boob

🍼 Products: Ceres Chill

📌 Jenny Stiller’s Neurodivergent Lactation Specialist Course

📌 Research on neurodivergence in lactation care

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

📌 Tools for sensory regulation and executive functioning

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

🎙 Hosted by: Margaret Salty

🎧 Guest: Rebekah Scroggy, IBCLC

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

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

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

Key Studies and Takeaways:

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

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

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

2️⃣ Lactational Phlegmon: A Rare Clinical Entity

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

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

3️⃣ Peer Support & Community Interventions for Breastfeeding in the UK

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

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

4️⃣ Breastfeeding Education Gaps in South African Midwifery Training

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

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

Connect with Me:

📸 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

🎧 Listen now on your favorite podcast app!

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

In this episode of Behind the Latch, Margaret Salty shares 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:

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Credits:

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🎵 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

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