Behind the Latch

We were taught to keep our hands in our pockets. Maya Bolman was taught the opposite — by her great-aunt, a midwife in Belarus, who could take an engorged, aching breast and leave it soft in an hour. In this episode, I sit down with Maya to talk about the skill most of us were never trained in: what to actually do with our hands.Maya Bolman is an IBCLC in Cleveland, Ohio, with 26 years in hospital lactation care and a second home at Breastfeeding Medicine of Northeast Ohio, where she works alongside Dr. Ann Witt. She's the clinician who named Therapeutic Breast Massage in Lactation (TBML), published the research behind it, and travels the world teaching manual skills to lactation professionals. In this conversation, she breaks down the physiology of engorgement (hint: it's not just milk), why we massage milk down but swelling up, and the deceptively simple technique she calls breast gymnastics. If you've ever felt underprepared the second a parent's breast is hard, painful, and stuck, this one is going to change how you practice.What You'll Learn:Why engorgement is really "lymphodynamic edema" — and why that one distinction changes how you use your handsThe moment Maya realized massage therapists move the breast up while lactation consultants are taught to move milk down (and why both are right)What breast gymnastics actually is, why it takes 20 seconds, and why she tells every parent to start it todayHow to know when you're "done" — the outcome to feel for instead of a number to hitWhy the 2022 mastitis protocol's silence on milk expression is, in Maya's words, "a big minus"The difference between overstimulating a working duct and actually moving milk from the one that's stuckWhy she calls herself a lactation therapist, not a consultant — and what that reframe unlocksHow mindful latching flips the script: the parent doesn't latch the baby, she positions so the baby can latchWhere to find milk you're missing (it's closer to the nipple than you were taught)The case for demonstrating instead of explaining — and what mirror neurons have to do with breastfeeding successResources Mentioned in This Episode:Maya Bolman's website (workshops, free breast gymnastics & massage video, BreastKindness LLC): https://www.mayabolman.comBolman, M., Saju, L., Oganesyan, K., Kondrashova, T., & Witt, A. M. (2013). Recapturing the art of therapeutic breast massage during breastfeeding. Journal of Human Lactation, 29(3), 328–331. https://doi.org/10.1177/0890334413475527Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation, 32(1), 123–131. https://doi.org/10.1177/0890334415619439Witt, A. M., Bolman, M., & Kredit, S. (2016). Mothers value and utilize early outpatient education on breast massage and hand expression in their self-management of engorgement. Breastfeeding Medicine, 11(8), 433–439. https://doi.org/10.1089/bfm.2016.0100Your Next Steps:Learn with Me: https://margaretsalty.com/coursesRead the Blog: https://margaretsalty.com/blogEmail Me: [email protected]: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/Instagram: https://www.instagram.com/margaretsalty/Facebook: https://www.facebook.com/profile.php?id=61550829710885Music: The Magnifiers — "My Time Traveling Machine"

In this episode, Dr. Lisa Stellwagen shares the journey of establishing a hospital-based milk bank, the science behind donor milk, and the future of infant nutrition and milk banking. Discover how policies, safety standards, and community efforts are transforming neonatal care and supporting vulnerable infants.Chapters:00:00 Introduction to Milk Banking and Its Importance04:07 The Journey to Establishing a Milk Bank05:24 The Supporting Premature Infant Nutrition Program08:43 The Need for More Milk Banks in California11:45 Building a Milk Bank: Challenges and Triumphs16:52 Understanding Hambana and Milk Bank Structures20:14 Pasteurization Standards and Safety in Milk Banking23:58 Fortification of Human Milk and Its Implications30:18 The Importance of Accreditation and Safety Standards34:39 The Donor Process: Ensuring Safety and Efficiency35:33 Processing Milk: From Donation to Quality Control37:27 Nutritional Targeting: Tailoring Milk for Tiny Patients40:11 Analyzing Milk: Understanding Composition and Quality43:23 Raising Awareness: The Importance of Milk Donation44:30 Barriers to Access: Challenges in Milk Banking46:16 The Role of Nonprofit Milk Banks: A Community Approach51:58 The Cost of Donor Milk and NICU Decisions57:21 Vision for the Future of Milk Banking1:00:21 Honoring Bereaved Donors: The Cherry Blossom Program1:04:49 OutroResourcesHuman Milk Banking Association of North America (HMBANA)Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical ReportFind a Milk BankGuest LinksHMBANA-Dr. StellwagenUC Health Milk BankConnect with MargaretEmail: [email protected]: @margaretsaltyFacebook: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine

Margaret interviews, Molly Waymouth, a senior policy analyst at RAND, and they discuss her research on informal milk sharing, its prevalence, risks, and policy implications. They explores how systemic barriers and economic factors influence families' choices and what can be done to improve access to safe, affordable donor milk and lactation support.Chapters00:00 Introduction to the Conversation05:37 Molly's Background and Research Focus07:10 Exploring Milk Sharing Practices09:35 The Economics of Donor Milk11:23 Understanding the Support Gaps13:48 Equity and Access in Milk Sharing16:27 Risks of Informal Milk Sharing16:50 The Need for Comprehensive Support18:34 Innovative Approaches to Milk Sharing18:50 Designing an Ideal Support System20:27 Conclusion and Future Directions21:22 outro.mp3ResourcesJAMA Open Network Publication - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048RAND Corporation - https://www.rand.org/LinkedIn Profile of Molly Waymouth - https://www.linkedin.com/in/mollywaymouth/Connect with Margaretmail: [email protected]: @margaretsaltyFacebook: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine

In this episode of Behind the Latch, Margaret Salty interviews Victoria Fonville, MS, PhD candidate in Nutrition at UNC Greensboro, about her recent scoping review on lactation during perinatal bereavement.Together, they explore what the research actually tells us about lactation after infant loss—from the lived experiences of bereaved families to the gaps in care from healthcare providers. Victoria shares the key findings from her paper, including the four major areas studied—producing milk, support, stopping lactation, and donating milk—and the six themes that emerged: hurting, lacking, valuing, succeeding, connecting, and redeeming.They discuss how lactation can serve as a powerful source of connection and identity for grieving mothers, why suppression is often presented as the default (and why that’s problematic), and how milk donation can be experienced as a deeply meaningful and even healing process for families navigating loss.This episode challenges the way we approach bereavement care and emphasizes the importance of presenting all options—so families can make informed decisions that align with their goals and their grief.Key Takeaways for CliniciansLactation after perinatal loss is common due to normal physiology, but remains poorly addressed in clinical care.Bereaved mothers often experience both physical pain and emotional distress related to lactation, requiring compassionate and informed support.“Lacking” was a dominant theme across studies, highlighting significant gaps in provider knowledge, training, and communication.Lactation suppression is frequently presented as the only option, but this does not reflect the full range of choices available.Producing milk can help maintain maternal identity and connection to the infant after loss.Milk donation is often experienced as “redeeming,” helping families create meaning and process grief.Healthcare providers should present all options—suppression, expression, donation, and keepsakes—without bias.There is an urgent need for quantitative research to better understand care practices, outcomes, and donation patterns.Compassion, presence, and individualized care are critical when supporting bereaved families.GuestVictoria Fonville, MS, PhD Candidate in Nutrition, University of North Carolina at GreensboroLactation During Perinatal Bereavement From the Perspective of Families and Support Providers: A Scoping ReviewConnect with Margaret📬 Email: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

What We Talk AboutThe origin of the “high lipase” breastmilk myth and how it spread through the lactation community Why biologically it does not make sense that some mothers produce excess lipase in milk What lipase actually does in human milk and why it is critical for infant fat digestion What parents are actually noticing when milk smells “soapy,” “metallic,” or “rancid” How riboflavin oxidation and free radical reactions may contribute to off flavors in stored milk Why exposure to light, oxygen, and heat accelerates nutrient degradation Simple strategies for protecting expressed milk during storage The role of vitamin C and antioxidants in preventing oxidation Why scalding milk may damage valuable nutrients and enzymes How maternal diet influences the fatty acid profile of breastmilk The relationship between omega-3 and omega-6 fats in human milk Why formula cannot truly replicate human milk oligosaccharides or fatty acid complexity How breastfeeding exposes infants to diverse food flavors that shape lifelong eating patterns Why maternal nutrition matters—but breastfeeding remains resilient even with imperfect diets Future research questions about the human milk metabolome and maternal dietKey Takeaways for CliniciansThe “high lipase milk” explanation for off-smelling stored milk may not be supported biologically or experimentally.Off flavors may instead result from nutrient oxidation, particularly involving riboflavin and free radical reactions.Protecting milk from light, oxygen, and heat exposure may help reduce degradation.Scalding milk may stop some reactions but can also damage enzymes, vitamins, and bioactive components.Maternal intake of vitamin C and antioxidants may influence milk stability during storage.Maternal diet does influence certain components of milk, especially fatty acid composition and water-soluble vitamins.The fatty acid profile of milk largely reflects the mother’s dietary fat intake.Human milk oligosaccharides vary between mothers and environments, making them difficult to replicate in formula.Even when milk has an unusual smell, it is often still safe for infants, and strategies like dilution with fresh milk can help babies accept it.Human milk remains one of the most biologically protected food systems in nature, even when maternal diets are imperfect.GuestDr. Jimi Francis, PhD, RD, IBCLChttps://drjimi.net/References referred to in the discussion about Lipase in Human Milk:Allen, L. H. (2012). B vitamins in breast milk: Relative importance of maternal status and intake, and effects on infant status and function. Advances in Nutrition, 3(3), 362–369. https://doi.org/10.3945/an.111.001172 Bauman, D. E., & Bruce Currie, W. (1980). Partitioning of Nutrients During Pregnancy and Lactation: A Review of Mechanisms Involving Homeostasis and Homeorhesis. Journal of Dairy Science, 63(9), 1514–1529. https://doi.org/10.3168/jds.S0022-0302(80)83111-0 Chappell, J. E., Francis, T., & Clandinin, M. T. (1985). Vitamin A and E content of human milk at early stages of lactation. Early Human Development, 11(2), 157–167. https://doi.org/10.1016/0378-3782(85)90103-3 Daniel, A. I., Shama, S., Ismail, S., Bourdon, C., Kiss, A., Mwangome, M., Bandsma, R. H. J., & O’Connor, D. L. (2021). Maternal bmi is positively associated with human milk fat: A systematic review and meta-regression analysis. American Journal of Clinical Nutrition, 113(4), 1009–1022. https://doi.org/10.1093/ajcn/nqaa410 Demmelmair, H., & Koletzko, B. (2018). Lipids in human milk. Best Practice and Research: Clinical Endocrinology and Metabolism, 32(1), 57–68. https://doi.org/10.1016/j.beem.2017.11.002 Dickton, D., & Francis, J. (2018). Case review: food pattern effects on milk lipid profiles. J Nutr Health Food Eng, 8(6), 467–470. https://doi.org/10.15406/jnhfe.2018.08.00311 Donovan, S. M., Aghaeepour, N., Andres, A., Azad, M. B., Becker, M., Carlson, S. E., Järvinen, K. M., Lin, W., Lönnerdal, B., Slupsky, C. M., Steiber, A. L., & Raiten, D. J. (2023). Evidence for human milk as a biological system and recommendations for study design—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 4. American Journal of Clinical Nutrition, 117, S61–S86. https://doi.org/10.1016/j.ajcnut.2022.12.021 Dror, D. K., & Allen, L. H. (2018). Overview of nutrients in humanmilk. Advances in Nutrition, 9, 278S-294S. https://doi.org/10.1093/advances/nmy022 Evans, T. J., Ryley, H. C., Neale, L. M., Dodge, J. A., & Lewarne, V. M. (1978). Effect of storage and heat on antimicrobial proteins in human milk. Archives of Disease in Childhood, 53(3), 239–241. https://doi.org/10.1136/adc.53.3.239 Francis, J. (2015). Effects of Light on Riboflavin and Ascorbic Acid in Freshly Expressed Human Milk. Journal of Nutritional Health & Food Engineering, 2(6), 2–4. https://doi.org/10.15406/jnhfe.2015.02.00083 Francis, J., & Dickton, D. (2020). Feeding and refusal of expressed and stored human (FRESH) milk study - a short communication. J Nutr Health Food Eng, 8(6), 391–393. https://doi.org/10.15406/jnhfe.2018.08.00301 Francis, J., & Egdorf, R. (2020). Maternal Nutrient Metabolism and Requirements in Lactation. In B. Marriott, D. F. Birt, V. Stalling, & A. Yates (Eds.), Present Knowledge in Nutrition (11th ed., pp. 67–81). Elsevier. https://doi.org/10.1016/c2018-0-02422-6 Francis, J., Rogers, K., Brewer, P., Dickton, D., & Pardini, R. (2008). Comparative analysis of ascorbic acid in human milk and infant formula using varied milk delivery systems. International Breastfeeding Journal, 3(1), 19. https://doi.org/10.1186/1746-4358-3-19 Francis, J., Rogers, K., Dickton, D., Twedt, R., & Pardini, R. (2012). Decreasing retinol and αtocopherol concentrations in human milk and infant formula using varied bottle systems. Maternal and Child Nutrition, 8(2), 215–224. https://doi.org/10.1111/j.1740- 8709.2010.00279.x Hamosh, M., Clary, T. R., Chernick, S. S., & Scow, R. O. (1970). Lipoprotein lipase activity of adipose and mammary tissue and plasma triglyceride in pregnant and lactating rats. Biochimica et Biophysica Acta (BBA)/Lipids and Lipid Metabolism, 210(3), 473–482. https://doi.org/10.1016/0005-2760(70)90044-5 Hampel, D., Shahab-Ferdows, S., Islam, M. M., Peerson, J. M., & Allen, L. H. (2017). Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and singledose supplementation. Journal of Nutrition, 147(4), 603–611. https://doi.org/10.3945/jn.116.242941 Jensen, D. R., Gavigan, S., Sawicki, V., Witsell, D. L., Eckel, R. H., & Neville, M. C. (1994). Regulation of lipoprotein lipase activity and mRNA in the mammary gland of the lactating mouse. Biochemical Journal, 298(2), 321–327. https://doi.org/10.1042/bj2980321 Krebs, N. F., Belfort, M. B., Meier, P. P., Mennella, J. A., O’Connor, D. L., Taylor, S. N., & Raiten, D. J. (2023). Infant factors that impact the ecology of human milk secretion and composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 3. American Journal of Clinical Nutrition, 117, S43–S60. https://doi.org/10.1016/j.ajcnut.2023.01.021 Lackey, K. A., Williams, J. E., Meehan, C. L., Zachek, J. A., Benda, E. D., Price, W. J., Foster, J. A., Sellen, D. W., Kamau-Mbuthia, E. W., Kamundia, E. W., Mbugua, S., Moore, S. E., Prentice, A. M., K, D. G., Kvist, L. J., Otoo, G. E., García-Carral, C., Jiménez, E., Ruiz, L., … McGuire, M. K. (2019). What’s normal? Microbiomes in human milk and infant feces are related to each other but vary geographically: The inspire study. Frontiers in Nutrition, 6. https://doi.org/10.3389/fnut.2019.00045 Lee, H., Padhi, E., Hasegawa, Y., Larke, J., Parenti, M., Wang, A., Hernell, O., Lönnerdal, B., & Slupsky, C. (2018). Compositional dynamics of the milk fat globule and its role in infant development. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00313 Lemons, J. A., Moye, L., Hall, D., & Simmons, M. (1982). Differences in the composition of preterm and term human milk during early lactation. Pediatric Research, 16(2), 113–117. https://doi.org/10.1203/00006450-198202000-00007 Mitoulas L.R.*, Kent, J. C., Cox, D. B., Owens, R. A., Sherriff, J. L., & Hartmann, P. E. (2002). Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. British Journal of Nutrition, 88(1), 29–37. https://doi.org/10.1079/bjnbjn2002579 Nommsen, L. A., Lovelady, C. A., Heinig, M. J., Lönnerdal, B., & Dewey, K. G. (1991). Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: The DARLING Study. American Journal of Clinical Nutrition, 53(2), 457–465. https://doi.org/10.1093/ajcn/53.2.457 Nommsen-Rivers, L., Black, M. M., Christian, P., Groh-Wargo, S., Heinig, M. J., Israel-Ballard, K., Obbagy, J., Palmquist, A. E. L., Stuebe, A., Barr, S. M., Proaño, G. V., Moloney, L., Steiber, A., & Raiten, D. J. (2023). An equitable, community-engaged translational framework for science in human lactation and infant feeding—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 5. American Journal of Clinical Nutrition,...

In this episode of Behind the Latch, Margaret sits down with Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES, professor at the University of Texas at Tyler, to discuss her powerful qualitative study exploring the perceptions, barriers, and facilitators to obtaining the IBCLC certification among U.S. healthcare practitioners.Margaret first encountered this research as a poster presentation at the ILCA Conference in Tampa — and immediately knew it was a conversation the field needed to hear.Dr. Golman’s study, expected to be published later this year, examines who is able to enter the IBCLC pathway — and who is not — through a public health and equity lens. With 19,000 IBCLCs serving the United States and 93% identifying as white, the findings raise important questions about access, mentorship, compensation, and structural barriers within our profession.Together, Margaret and Dr. Golman unpack what the data reveal — and what must change.🔍 What We Talk AboutHow Dr. Golman’s background in maternal-child health and public health shaped this researchWhy workforce diversity in lactation care is a public health issueThe perception that the IBCLC credential “adds weight” professionally — but often without financial returnWhy many hospital-based IBCLCs are required to certify without institutional financial supportThe persistent bias that IBCLCs must also be RNs to be considered “legitimate”Financial barriers beyond tuition — unpaid clinical hours, childcare, lost wages, transportationWhy indirect costs often delay certification for yearsMentorship as the central bottleneck in the IBCLC pipelineThe lack of standardized mentorship processes and consistent training experiencesWhy “mass emailing IBCLCs” to find a mentor reflects a broken systemWhat a centralized, structured mentorship model could look likeThe role of state coalitions, professional organizations, and grant fundingMedicaid reimbursement challenges and why payment structures matter for accessHow passion alone cannot sustain a workforce without structural supportWhat meaningful reform could look like — starting with mentorship🧠 Key Takeaways for IBCLCs & StudentsThe IBCLC credential is highly valued — but the pathway remains structurally inequitable.Indirect costs (lost wages, unpaid hours, childcare) are often more prohibitive than exam fees.Mentorship access is inconsistent and frequently the biggest barrier to certification.Without structural support and compensation reform, the field risks burnout and limited diversity.Improving mentorship infrastructure could significantly expand access and representation.Workforce diversity is foundational to culturally responsive lactation care and trust-building.Public health advocacy must include strengthening the IBCLC pipeline — not just improving breastfeeding rates.👩‍🏫 GuestDr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES Professor, University of Texas at Tyler📝 Connect with Margaret📬 Email: [email protected] 📸 Instagram: @margaretsalty 📘 Facebook: Margaret Salty Music by: The Magnifiers – My Time Traveling Machine

As more people pursue the IBCLC credential, mentorship has become one of the most critical—and misunderstood—components of lactation education. In this episode, Kristina and I take a close look at Pathway 2 and Pathway 3 mentorship, clarifying what mentors are actually responsible for and why mentorship must go beyond observation and paperwork.Kristina explains that effective mentorship is engaged, relational, and intentional. We discuss how mentors model professionalism, communication, boundaries, and ethical care—not just clinical skills. We also talk openly about the fears many IBCLCs have about becoming mentors, including concerns about readiness, time, liability, and “doing it right,” and why those fears shouldn’t stop experienced clinicians from stepping into mentorship roles.This conversation also highlights the structural supports built into Pathway 2 programs, the additional lift often required in Pathway 3 mentorship, and why access to high-quality mentorship remains a major barrier to growing and diversifying the IBCLC workforce. Throughout the episode, Kristina shares practical, experience-based strategies for both mentors and mentees—and a hopeful vision for how mentorship could be better supported and valued across the profession.🔍 What We Talk AboutThe difference between mentoring vs. supervising clinical hoursWhat IBCLC mentors are truly responsible for in Pathway 2 and Pathway 3How students should be gradually and ethically integrated into hands-on careCommon gaps students face when transitioning from coursework to clinical practiceTools that support mentorship, including IBLCE outlines and LEAARC skill checklistsWhy learning from multiple mentors can strengthen clinical competenceLiability, affiliation agreements, and student protections in Pathway 2 programsThe professional and personal benefits of becoming a mentorCharging for mentorship: ethics, equity, and value exchangeWhy mentorship is part of our professional obligation as IBCLCsWhat Kristina hopes the future of lactation mentorship will look like🧠 Key TakeawaysMentorship is an active teaching relationship, not passive oversight.Students need meaningful, hands-on experience—not observation alone.You do not need to be a “perfect” IBCLC to be an effective mentor.Mentorship strengthens clinical skills, confidence, and professional growth.Supporting mentors is essential to the future of the lactation profession.👩‍🏫 GuestKristina Chamberlain, CNM, ARNP, IBCLCClinical Instruction in Lactation: https://www.amazon.com/Clinical-Instruction-Lactation-Teaching-Generation/dp/1939807948LEAARC Criteria for Endorsed Courses: https://leaarc.org/docs/2022%20Endorsed%20Courses%20Core%20Curricula%20FINAL%201.pdf📝 Connect with Margaret📬 Email: [email protected]📸 Instagram: @margaretsalty📘 Facebook: Margaret SaltyHosted by: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine

In this episode of Behind the Latch, Margaret sits down with former student and practicing IBCLC Maya Lott to explore culturally responsive lactation care through the lens of working with Jewish families. Drawing from Maya’s clinical experience, academic background in Jewish philosophy and law, and her widely shared paper on counseling Jewish families, this conversation offers practical guidance for IBCLCs seeking to build trust, reduce friction, and deliver truly family-centered care.Maya shares how cultural norms, religious practices, and community structures can shape breastfeeding decisions—and how IBCLCs can approach these dynamics with curiosity rather than assumptions. From baby naming practices and modesty considerations to Shabbat, donor milk logistics, and the role of rabbis in healthcare decision-making, this episode provides concrete, respectful strategies clinicians can use immediately in practice.🔍 What We Talk AboutMaya’s path to becoming an IBCLC through Pathway 2—and why it worked well for her as a parentWhy cultural humility matters in lactation care (and what it looks like in real visits)Breastfeeding as a cultural norm in many Jewish communities—and the pressures that can createBaby naming practices in observant Jewish families and why asking “Does your baby have a name yet?” mattersModesty, family roles, and how they can influence in-home lactation visitsPreparing infants for circumcision (bris) and how this can intersect with feeding supportShabbat, milk removal, and how IBCLCs can collaborate respectfully without practicing religious lawThe role of rabbis in health-related decisions—and why this can be empowering for familiesDonor milk, milk sharing, and kosher kitchen logisticsHow informal milk sharing functions in tight-knit communitiesParallels with other cultural and religious practices (including Muslim milk-kinship laws)Practical language IBCLCs can use to avoid alienation and build rapportWhy curiosity—not expertise in religious law—is the key clinical skill🧠 Key Takeaways for CliniciansCultural competence starts at the doorstep—small language choices can shape the entire visit.You don’t need to be an expert in religious law to provide excellent care; awareness of considerations is enough.Asking open, respectful questions helps families integrate lactation care with lifelong values.Rabbis (and other faith leaders) often serve as supportive collaborators, not barriers, in healthcare decisions.Donor milk use may be less about theology and more about household logistics—problem-solving builds trust.Many cultural “rules” can feel rigid from the outside but are experienced as empowering within the community.These principles apply far beyond Jewish families—this is a framework for all culturally responsive lactation care.👩‍🏫 GuestMaya Lott, IBCLCWhat IBCLCs Need to Know About Counseling Jewish Families: A Lactation Consultant's Guide to Cultural Competence When Working with Dyads who Practice Judaismmayalottibclc.comTamari Jacob: https://www.instagram.com/onewiththepump/Miriam Ezagui: https://www.instagram.com/miriam.ezagui/📝 Connect with Margaret📬 Email: [email protected]📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙️ Podcast: Behind the LatchHosted by: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine🎧 Listen now on your favorite podcast app — and don’t forget to subscribe, share, and leave a review to help other lactation professionals find the show.#BehindTheLatch #IBCLC #CulturalCompetence #CulturallyResponsiveCare #JewishFamilies #LactationEducation #BreastfeedingSupport #DEIInHealthcare #PublicHealthLactation

Lactation Exam Mastery Course! Master the IBCLC Exam Today!In this episode of Behind the Latch, Margaret interviews Dr. Valérie Verhasselt, Professor of Immunology at the University of Western Australia and Head of the LRF Centre for Immunology and Breastfeeding. Dr. Verhasselt discusses her groundbreaking research on colostrum and food allergy prevention, focusing on her recent study demonstrating that partial colostrum feeding in the first 72 hours of life increases the risk of peanut allergy, while exclusive colostrum feeding appears profoundly protective. Her findings offer a powerful reframing of early postpartum lactation care: the risk may not stem solely from early cow’s milk exposure, but from reduced colostrum intake during the critical adaptation period when the newborn’s gut, immune system, and microbiota are being programmed. She explains how colostrum’s unique concentration of growth factors, IgA, vitamin A, and immune-modulating bioactive components help seal the gut, seed the microbiome, strengthen the skin barrier, and establish immune tolerance—laying the foundation for lifelong resilience. Dr. Verhasselt also shares insights from mouse models, discusses why donor mature milk is not a substitute for colostrum, and explores future directions including donor colostrum banks, colostrum-derived therapeutics, and new research on colostrum’s role in brain development. https://pubmed.ncbi.nlm.nih.gov/40968490/🔍 What We Talk AboutHow Dr. Verhasselt entered lactation immunology after a “flash” inspiration during her early research career Why the transition from intrauterine to extrauterine life makes newborns uniquely vulnerable to allergy developmentHow colostrum supports gut closure, immune regulation, microbiota seeding, and skin barrier maturationWhy giving formula in the first days displaces colostrum intake rather than simply “topping up” Evidence showing a five-fold increase in peanut allergy among infants who received partial colostrum feedingThe striking finding that no infants who received ≥9 colostrum feeds developed peanut allergy by 12–18 monthsWhat early formula exposure does to the infant microbiome weeks and months laterHow parental allergy risk influences—but does not override—the protective effect of colostrumWhy exclusive breastfeeding data often overlook the critical first 72 hoursThe interplay between infant skin permeability, environmental exposure, detergent use, and allergy sensitizationWhat mouse models teach us about colostrum, mature milk, and developmental programmingWhy donor milk does not replicate colostrum’s early immunological functionThe concept of exclusive colostrum feeding as a distinct clinical and public health priorityFuture research avenues: colostrum-derived metabolites, donor colostrum banks, and early-life allergy prevention strategies🧠 Key Takeaways for CliniciansColostrum’s immunological role is unique and time-sensitive—its composition cannot be replicated by mature milk, donor milk, or formula.Supplementation in the first days displaces colostrum volume, which may be the primary mechanism increasing allergy risk.As few as nine colostrum feeds in the first 72 hours appear profoundly protective against peanut allergy.Early formula exposure—even brief—can alter the infant gut microbiota for months.The newborn’s gut and skin barriers are uniquely permeable, making early antigen exposure highly consequential.Parents who partially colostrum feed may benefit from earlier peanut introduction, while exclusively colostrum-fed infants may have more flexibility.The language we use (“milk coming in”) can unintentionally undermine parents’ confidence; reframing colostrum as “the milk for those days” is more accurate and supportive.Research supports reframing early postpartum care around exclusive colostrum feeding, not just exclusive breastfeeding.👩‍🏫 GuestDr. Valérie Verhasselt, MD, PhDProfessor, University of Western AustraliaHead, LRF Centre for Immunology and BreastfeedingPerth Children’s Hospital, Telethon Kids Institute📝 Connect with Margaret📬 Email: [email protected]📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Podcast: Behind the LatchHosted by: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine#BehindTheLatch #Colostrum #BreastfeedingResearch #FoodAllergyPrevention #PeanutAllergy #Immunology #BreastmilkScience #LactationResearch #HumanMilk #ColostrumIsLiquidGold #InfantFeeding #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 Dr. Anita Lugo, Pediatric Nurse Practitioner, IBCLC, researcher, and Assistant Professor at Moravian University in Pennsylvania.Dr. Lugo’s work focuses on one of the most critical—and often overlooked—components of breastfeeding success: outpatient lactation care after hospital discharge. Her recent review highlights the powerful impact of early, skilled IBCLC support on breastfeeding exclusivity and duration, and shines a light on the persistent gaps families face when navigating the postpartum period.Together, they explore the evidence behind outpatient IBCLC interventions, the systemic barriers that prevent equitable access to care, and the urgent need for stronger policies, better reimbursement models, and more consistent pathways for families to receive the level of support they truly need.Dr. Lugo also discusses how timing, frequency, and modality of lactation care—whether in-person, outpatient clinic, in-home, or telehealth—shape outcomes, and what future research should focus on to strengthen breastfeeding support across diverse communities.They discuss:Why many breastfeeding challenges intensify after families leave the hospitalEvidence showing that IBCLC support at 3 days and 2 weeks postpartum yields the best outcomesGaps in outpatient access, especially for families with Medicaid or grandfathered plansGeographic disparities in IBCLC availability and why they matterThe limitations of relying solely on prenatal classes or hospitalization supportThe role of telelactation and what parents find helpful—or challenging—about virtual consultsThe need for clearer distinctions between lactation credentials and their scopes of practiceHow policy, insurance reform, and better public awareness could improve breastfeeding equityFuture research needed on optimal visit numbers, timing, and support models👩‍🏫 Guest InfoDr. Anita Lugo, DNP, PNP, IBCLCAn integrative review of the impact of International Board Certifed Lactation Consultants in outpatient postnatal settings in the United StatesAssistant Professor, Moravian UniversityPediatric Nurse Practitioner & IBCLCPrenatal Educator, St. Luke’s University HospitalLinkedIn: Anita Lugo📝 Connect with Margaret📬 Email: [email protected]📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙️ Podcast: Behind the LatchHosted by: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine#BehindTheLatch #BreastfeedingSupport #LactationResearch #OutpatientLactation #IBCLC #PostpartumCare #BreastfeedingEquity #MaternalHealth #LactationPolicy #PublicHealthLactation #Telolactation #BreastfeedingOutcomes #InfantFeeding #NewParentSupport🎧 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. 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 breastfeedingHow language and terminology shape support and self-perceptionThe emotional and psychological experiences of exclusive pumpersCommon challenges and identity shifts in the exclusive pumping journeyWhat research reveals about resilience and motivation in pumping parentsThe gap between policy, practice, and lived experienceHow IBCLCs and educators can create inclusive spaces for all milk-feeding familiesFuture directions for research in human milk expression👩‍🏫 Guest InfoDr. Kelsey BiancaProfessor of Psychology, Cecil CollegeBianca, 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 LatchHosted by: Margaret SaltyGuest: Dr. Kelsey BiancaMusic 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 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 InfoGabriela Alvarado, MD🌐 RAND Corporation 💼 LinkedIn: Gaby Alvaradohttps://doaj.org/article/947b3c1d6b424a2ca093e35ceb59ae5chttps://journals.sagepub.com/doi/full/10.1177/08903344241274760https://www.liebertpub.com/doi/full/10.1089/tmj.2022.0159https://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 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. Guest InfoMaya 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: 10.1177/08903344221076527journals.sagepub.com/home/jhlhttps://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-2023-083389https://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:10.1177/08903344241301401https://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:10.1177/08903344241303867https://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/healthcare13172091Transcript: 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...