Behind the Latch

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.👩‍🏫 Guest

In this episode of Behind the Latch, Margaret sits down with Ellen Chetwynd, IBCLC, PhD, and longtime Editor-in-Chief of the Journal of Human Lactation, to explore a fundamentally different way of understanding breastfeeding challenges: body-led breastfeeding and the Infant Suck Strength Exam (ISSE).Dr. Chetwynd shares how years of clinical practice—and noticing what wasn’t explained by common diagnoses like thrush, Raynaud’s, or tongue-tie—led her to focus more closely on the infant’s body, neurology, and suck function. Together, Margaret and Ellen unpack how the ISSE helps clinicians move beyond appearance-based latch assessment to identify where suck strength is weak, how the tongue is functioning at the breast, and how infant compensation patterns often drive pain, inefficiency, and feeding struggles.This conversation bridges lactation science, cranial nerve physiology, and gentle body-based intervention, offering clinicians practical tools while challenging reductionist approaches to infant oral dysfunction.🔍 What We Talk AboutHow Ellen entered the field of lactation through nursing and public healthWhy “bucket diagnoses” (yeast, Raynaud’s, tongue-tie) persist in lactation careWhat body-led breastfeeding means—and why the baby is often the primary driverThe clinical gap that inspired development of the Infant Suck Strength Exam (ISSE)Why digital oral exams miss what’s happening at the breastHow the ISSE is performed and what each pull-back reveals about suck strengthWhy the ISSE often functions as both assessment and treatmentInfant compensation patterns: jaw movement, lip use, body tension, and asymmetryThe role of cranial nerves and the cranial base in feeding functionWhy asymmetric latch and “guppy pose” can sometimes worsen dysfunctionGentle, parent-taught techniques to support infant regulation and suck strengthHow bottle-feeding strategies must align with breastfeeding goalsWhen to consider referral for craniosacral or body-based therapyWhy frenotomy alone may destabilize function if body tension isn’t addressedWhat future research is needed to validate and study the ISSE🧠 Key Takeaways for CliniciansA visually “good” latch can hide significant internal dysfunction.Infant suck strength and tongue function must be assessed during active feeding.Many breastfeeding problems originate in infant neuromuscular coordination—not...

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.

Lactation Exam Mastery Course! Master the IBCLC Exam Today!In this episode of Behind the Latch, Margaret interviews Meaghan Beames, Registered Massage Therapist, educator, and infant craniosacral therapy specialist based in Toronto. Meaghan shares her journey into craniosacral therapy following her own early breastfeeding struggles and explains how this gentle, hands-on modality can support infants experiencing feeding difficulties, poor latch, weak suck, reflux, tension patterns, and post-birth dysregulation.Together, Margaret and Meaghan unpack what craniosacral therapy actually is—and what it is not—moving beyond common misconceptions of it as “woo” or energy work. Meaghan offers a clear, physiology-based explanation grounded in fascia, cranial nerve function, nervous system regulation, and developmental biomechanics, helping clinicians understand how subtle tension patterns from gestation and birth can profoundly affect infant feeding and behavior.Throughout the conversation, they explore the clinical intersections between lactation care and bodywork, including the role of cranial nerves in suck function, the relationship between birth mechanics and oral dysfunction, and how craniosacral therapy may improve outcomes before and after frenotomy. Meaghan also provides practical language clinicians can use with families, guidance on practitioner training and safety, and insight into when referrals to other disciplines are appropriate.🔍 What We Talk AboutHow Meaghan entered infant craniosacral therapy after her own postpartum and breastfeeding experienceWhat craniosacral therapy is, how it works, and how it differs from chiropractic, osteopathy, and physical therapyFascia, tension patterns, and why the body must be viewed as a single integrated systemThe role of cranial nerves in infant feeding, suck strength, and oral coordinationHow gestational positioning, birth interventions, and delivery mechanics influence feeding outcomesWhy babies may feed well on one side but struggle on the otherWeak suck, poor oral sensation, and why some infants “can’t feel” the nippleThe limitations of appearance-based tongue-tie assessment and why function must come firstHow craniosacral therapy may improve frenotomy outcomes and reduce reattachment riskWhy cutting a dysfunctional tongue without addressing body tension can worsen feedingWhat a typical infant craniosacral session looks like, including assessment and treatment flowHow many sessions are typically needed and why “snapback” can occurHow craniosacral therapy supports nervous system regulation and reflex integrationWhat families may notice after treatment, including emotional release and behavior changesHow to talk with parents about craniosacral therapy in clear, non-alarming languageSafety considerations, training standards, and how to identify qualified practitionersWhat the current research does—and does not—tell us about craniosacral therapyOptions for families who cannot access or afford bodywork services🧠 Key Takeaways for CliniciansInfant feeding difficulties are often rooted in whole-body tension patterns, not isolated oral anatomy.Cranial nerve dysfunction can impair suck, coordination, and sensation even when oral anatomy appears “normal.”Craniosacral therapy uses extremely light touch to identify and release fascial restrictions affecting function.Birth mechanics, including fetal position and obstetric interventions, can significantly impact feeding.Frenotomy without addressing underlying body tension...

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...

LACTATION EXAM MASTERY COURSE- Stop Guessing How to Study for the IBCLC Exam. In this episode of Behind the Latch, Margaret interviews Dr. Zoya Gridneva, Research Fellow with the Geddes–Hartmann Human Lactation Research Group. Zoya discusses her research exploring maternal adiposity, glandular tissue distribution, breast anatomy, milk production, puberty timing, parity, and breast development across lactations, using ultrasound imaging to examine the lactating breast in a way few studies have before Her findings help illuminate why some parents experience low supply despite doing “everything right,” and demonstrate how maternal factors—especially adiposity—may influence glandular tissue development, breast storage capacity, and milk removal efficiency. She also shares emerging tools that may help clinicians screen for lactation risk prenatally and why early identification may matter profoundly for parental experience and outcomes.🔍 What We Talk AboutHow Zoya entered lactation research after her own breastfeeding experience Why adiposity is emerging as a central factor in milk production outcomes What ultrasound can tell us about ductal branching, glandular volume, and breast storage capacity Why more ductal development doesn’t always equal meaningful clinical increase in supply The relationship between puberty timing, parity, contraception, adiposity & milk output — what we know and what we don’t Why breast size ≠ glandular volume, and why small breasts may produce normal volumes The need for better screening for primary low supply and insufficient glandular tissue (IGT)A new 5-minute lactation risk screening tool used in Western Australia & its clinical promise Why single-feed weights are not enough — and why 24-hour production is more meaningful Where research must go next: larger samples, longitudinal data, and early-life glandular development🧠 Key Takeaways for CliniciansAdiposity may influence breast growth, glandular proportion, and storage capacity, mediating supply outcomes.Ultrasound can visualize breast structure but requires skill, training, and access — not yet feasible for routine care.We may be able to identify high-risk parents prenatally using simple clinical screening tools, improving early intervention timing.Puberty, hormonal exposure, and menarche timing could play a significant role in final glandular development — a research area wide open for exploration.24-hour test-weighing is one of the most reliable ways to identify low production early, long before a “weight problem” appears.Clinically, risk awareness + early frequent milk removal support may be key for at-risk families.👩‍🏫 GuestDr. Zoya Gridneva, PhDMaternal Factors, Breast Anatomy & Milk Production — An Ultrasound-Based Look Inside LactationResearch Fellow, Geddes–Hartmann Human Lactation Research GroupUniversity of Western Australia📝 Connect with Margaret📬 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙️ Podcast: Behind the LatchHosted by: Margaret...

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: hello@margaretsalty.com📸 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. 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 sleepThe cultural roots of Western sleep expectationsWhy frequent night waking is biologically typical—and protectiveHow breastfeeding and sleep are deeply intertwinedWhat anthropological research reveals about co-sleeping across culturesCommon misconceptions about bedsharing safetySupporting families to make informed, individualized sleep choicesThe importance of aligning sleep advice with human biology and family context👩‍🏫 Guest InfoDr. Helen L. BallProfessor of Anthropology, Durham UniversityDirector, 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: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙️ Podcast: Behind the LatchHosted by: Margaret SaltyMusic by: The Magnifiers – My Time Traveling Machine#BehindTheLatch #InfantSleep #HowBabiesSleep #HelenBall #Anthropology #LactationConsultant #IBCLC #CoSleeping #Bedsharing #Breastfeeding #ParentInfantSleep #SleepScience #LactationResearch #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. 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: hello@margaretsalty.com📸 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 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 weaningUnderstanding gagging, choking risk, and oral motor developmentHow chewing skills develop and why strip-shaped foods build safe feeding foundationsSigns of developmental readiness for solids in breastfed babiesSupporting preterm and medically complex infants during feeding transitionsHow to introduce allergenic foods safelyResponsive feeding and avoiding pressure-based feeding practicesWhen IBCLCs should refer to SLPs or feeding therapistsCultural and socioeconomic accessibility of responsive feeding approachesHow ABLW promotes feeding confidence and reduces aversion👩‍⚕️ Guest InfoJill Rabin, MA, CCC-SLP/L, IBCLC🌐 Website: https://jillrabin.com📸 Instagram: @jillrabin_ablw📘 Book: Your Baby Can Self-Feed, Too🎓 Transition to SolidsAdapted Baby Led Weaning📝 Connect with Margaret📬 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙️ Podcast: Behind the LatchHosted by: Margaret SaltyGuest: Jill Rabin, MA, CCC-SLP/L, IBCLCMusic 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 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: hello@margaretsalty.com📸 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 carechat-with-dr-jess-daigle👩‍⚕️ Guest InfoDr. Jess Daigle, MD, FAAP🌐 Instagram: @momandme_md💼 LinkedIn: Jess Daigle, MDAnchored in Hope📝 Connect with Margaret📧 Email: hello@margaretsalty.com📸 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. 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-2023-083389

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 InfoClaire Eden, IBCLC📚 Author: Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother–Infant Separation🌐 Georgia Perinatal Quality Collaborative: Georgiapqc.orgPapers DiscussedRandle 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

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.comApplying nipple shield with tube: https://www.milkmadeeasy.com/post/how-to-apply-a-nipple-shieldConnect with Margaret📧 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Sandra Cole🎵 Music by: The Magnifiers, My Time Traveling MachineHashtags & 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-providerhttps://www.badoulatrainings.org/blog/top-surgery-and-lactation-what-you-need-to-knowhttps://www.lactationtraining.com/shopping/online-shop/continuing-education/gender-diverse-clinic-spaces-detailGuest Info:📚 Author: Lactation for the Rest of Us🌐 Website: JacobEngelsmanIBCLC.com📸 Instagram: @JacobIBCLCConnect with Margaret:📧 Email: hello@margaretsalty.com📸 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’s Journey into Medical HistoryDr. 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.Why Breastfeeding DeclinedThey 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.Wet Nurses, Class, and ExploitationDr. 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.The Birth of Infant FormulaThey 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.Lingering Mistrust of Women’s BodiesDr. 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.Lessons for Today’s Public Health LeadersThey 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.Guest InfoDr. 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🌐

In this episode of Behind the Latch, Margaret Salty interviews Dana Obleman, creator of the Sleep Sense program and founder of the Sleep Sense Certification, where she trains sleep consultants worldwide. Dana has been a pioneer in the field of infant and toddler sleep for more than two decades, helping families find rest through practical, age-appropriate strategies.Together, they explore how sleep and feeding are deeply intertwined, why parents often struggle to discern hunger cues from fatigue, and how small changes can set families on the path to better rest. Dana shares her own journey into this work—born out of exhaustion and necessity with her first child—and explains the philosophy behind Sleep Sense, which emphasizes teaching babies healthy, independent sleep habits while still respecting their needs.Dana’s Journey into Sleep WorkDana shares how:Her own struggles with her first baby’s sleep sparked a passion for finding solutions.Research and trial led her to see how independent sleep skills transformed not only her child’s rest, but his temperament.Spreading this knowledge became a mission to fill a missing piece in parenting support.The Sleep Sense PhilosophyThey discuss:Why waking at night is normal—but needing parental rescue every time is not.How guiding babies early helps them develop lifelong healthy sleep patterns.Why a positive relationship with sleep is essential for both children and families.Supporting Breastfeeding FamiliesDana explains:How sleep guidance complements breastfeeding and avoids “cry it out” approaches for newborns.Why discerning hunger vs. fatigue is one of the hardest skills for new parents—and how to pause and assess before assuming hunger.The importance of bedtime routines and how introducing a bottle at the right time can empower families while protecting breastfeeding.Sleep Challenges and SolutionsThey explore:Why common sleep struggles aren’t necessarily “normal”—and how to spot when help is needed.Why older babies and toddlers who aren’t sleeping well benefit from structured, age-appropriate approaches.The balance between teaching skills and respecting family values around sleep.Sleep Sense Certification and EducationDana shares:How the Sleep Sense Certification trains consultants with mentorship, practicums, and global community support.Why sleep coaching is a natural complement to other perinatal roles like lactation consultants, doulas, and therapists.A new education course designed specifically for IBCLCs who want foundational knowledge about newborn sleep without becoming certified coaches.Guest InfoDana Obleman🌐 Website: sleepsense.net📸 Instagram: @sleepsenseFree resource: 7 Best Sleep Tips for Lactation Consultants http://sleepsense.net/lactationConnect with Margaret📧 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Dana Obleman🎵 Music by: The Magnifiers, My Time Traveling...

In this episode of Behind the Latch, Margaret Salty interviews Jasmine Creighton, owner of Yaya's Hands Perinatal and Lactation Services in Southern California. Jasmine is also president-elect of the Inland Empire Breastfeeding Coalition, leader of its Black Breastfeeding Task Force, a board member for the California Breastfeeding Coalition, and a perinatal health specialist at a local hospital.Together, they explore lactation equity, advocacy, and mentorship—and why representation and culturally relevant care are vital for families. Jasmine shares her powerful story of birth and breastfeeding, including her hospital birth, her home water birth, and how those experiences inspired her to support families navigating barriers to care.They also discuss systemic racism in healthcare, the historic and current challenges Black families face with breastfeeding, and how predatory formula marketing continues to impact communities of color. Jasmine explains how equity means more than equal access—it means care and resources tailored to each family’s needs.Jasmine’s Journey into Lactation and AdvocacyJasmine shares how:Her own birth and breastfeeding experiences shaped her passion for this work.She found community during the COVID pandemic that connected her to birth workers and advocates.Navigating her IBCLC pathway revealed inequities in access to mentorship, hours, and certification support—and why she now mentors others to make the journey easier.Lactation Equity as a Core ValueThey discuss:How systemic racism and bias still shape perinatal care experiences.Why Black women are often offered formula more frequently than other groups in hospitals—and how this impacts breastfeeding duration.The importance of reclaiming breastfeeding as both a health issue and a form of reproductive justice.Barriers and SolutionsJasmine highlights:The lack of culturally responsive care and providers who reflect the communities they serve.Economic and insurance barriers that limit families’ access to lactation support.The need for advocacy, scholarships, mentorship, and coalition-building to change systems and increase representation.Advice for Aspiring IBCLCsJasmine encourages providers to:Network intentionally—both online and in person.Find mentors and be a resource in return, making relationships reciprocal.Persevere despite barriers, remembering that mentorship and community are key to success.Guest InfoJasmine Creighton🌐 Website: jasminecreighton.com📸 Instagram: @jasminecreighton💼 LinkedIn: Jasmine CreightonConnect with Margaret📧 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Jasmine Creighton🎵 Music by: The Magnifiers, My Time Traveling MachineHashtags & Keywords#BehindTheLatch #LactationEquity #IBCLC #BlackBreastfeeding #MentorshipMatters #PerinatalHealth #CulturallyResponsiveCare #ReproductiveJustice🎧 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 Jeanne Pichoff, MS, OTR/L, IBCLC, owner of Flourish Pediatric Therapy and Lactation in Lafayette, Louisiana. Together, they explore the unique and often misunderstood role of occupational therapists in lactation care—how OT skills complement IBCLC expertise, when a referral to OT can make all the difference for a feeding dyad, and how collaborative care improves outcomes for families. Jeanne shares how her personal experience with a tongue-tied baby fueled her passion to bridge the gap between therapy and lactation, and why understanding infant development, muscle tone, and sensory integration is essential for comprehensive feeding support.They discuss the overlap between OT, PT, and SLP roles in infant feeding, how to identify when an OT referral is warranted, and the nuances of managing tongue tie cases both before and after frenotomy. Jeanne also explains why “suck training” can fall outside the IBCLC scope if practiced without an additional license, and how to work within scope while still supporting progress.Jeanne’s Journey into Lactation and OT SpecializationJeanne shares how:Her early work in general pediatrics and early intervention revealed a major gap in lactation knowledge among OTs.A challenging personal breastfeeding experience with her second child, who had an obvious tongue tie, became the catalyst for pursuing IBCLC training.Combining her OT skill set with lactation expertise allowed her to provide more comprehensive, dyad-centered care.The OT Role in Infant FeedingThey discuss:How OT scope of practice includes feeding, sensory processing, and motor skill development.The unique lens OTs bring to infant feeding, from muscle tone assessment to sensory integration.Overlap with PT and SLP roles, and why individual continuing education shapes a therapist’s feeding expertise.When to Refer to OTJeanne explains:Key red flags—such as abnormal muscle tone, dysphagia signs, sensory processing challenges, torticollis, or developmental delays—that warrant OT involvement.How therapy addresses both feeding mechanics and developmental milestones.Why early intervention leads to better long-term outcomes.Managing Tongue Tie CasesThey explore:Why not all tongue-tied babies need therapy before release—and when conservative management is best.How OT can support post-frenotomy recovery, from suck training to addressing body tension.The risks of prophylactic releases “just in case” and why function should always guide decision-making.Scope, Collaboration, and AdvocacyJeanne shares:Why IBCLCs without another license should avoid direct “suck training” and instead refer to an appropriately licensed provider.How billing under OT benefits families by increasing insurance coverage for feeding-related visits.The importance of building trust across disciplines to ensure safe, effective care for families.Advice for IBCLCs and Perinatal ProfessionalsJeanne encourages providers to:Learn the strengths of the OTs, PTs, and SLPs in their community.Focus on collaborative, dyad-centered care rather than trying to “do it all.”Recognize and respect scope of practice boundaries to improve outcomes and maintain professional safety.**DISCOUNT CODE BEHINDTHELATCH for 20% off either one Jeanne's courses:https://www.lactationot.com/totshttps://www.lactationot.com/weightgainGuest Info:Jeanne Pichoff, MS, OTR/L, IBCLC, is...