Behind the Latch

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...

In this episode of Behind the Latch, Margaret Salty interviews Dr. Lisa Anders, assistant professor at the University of North Carolina at Greensboro and IBCLC. Together, they explore Dr. Anders’ groundbreaking research on flange sizing for pumping parents—an area that has been historically under-researched and inconsistently practiced. Dr. Anders shares how using nipple tip diameter rather than base diameter may improve comfort, milk expression, and overall pumping experience.They discuss the practical implications of her findings for private practice IBCLCs, how to apply the research in clinical care, and what this means for the future of pumping support.Anders, L., Frem, J.M., & McCoy, T.P. (2024). Flange Size Matters: A Comparative Pilot Study of the Flange FITS Guide Versus Traditional Sizing Methods. Journal of Human Lactation, 41(1). https://doi.org/10.1177/08903344241296036Lisa’s Journey into Lactation ResearchDr. Anders shares how:Her own experience as a mother and lactation consultant led her to question standard flange fitting guidance.She noticed patterns of discomfort and underperformance in pump use that weren’t being addressed in the literature.Her academic background in health and human sciences helped her design a pilot study to explore alternative approaches to flange sizing.Why Flange Fit MattersThey discuss:How incorrect flange sizing contributes to nipple pain, reduced output, and early weaning.Why standard recommendations based on base diameter may not reflect the functional part of the nipple used during pumping.How measuring nipple tip diameter (as little as 3–5mm) and using smaller flanges improved outcomes for many of her study participants.Clinical Application and Research GapsDr. Anders explains:How IBCLCs in private practice can begin to implement this approach now, even before larger-scale studies are done.The importance of individualized care, particularly for exclusive pumpers who may struggle in silence.Why pump support deserves the same evidence-based attention as direct breastfeeding.Equity and Access in Pumping SupportThey explore:How a lack of evidence-based flange fitting disproportionately impacts marginalized communities.The cost and access barriers involved in finding the right flange—and how that contributes to inequities in breastfeeding outcomes.The need for culturally responsive, inclusive pumping support.Looking AheadDr. Anders shares:What future research she hopes to conduct to validate and expand her pilot findings.Why community-based IBCLCs play a vital role in gathering observational data and sharing clinical insights.Her encouragement to providers to challenge assumptions and keep asking: is this really working for our clients?Advice for IBCLCs and Perinatal ProfessionalsDr. Anders encourages providers to:Reconsider flange fitting practices with a focus on comfort, efficiency, and individualized care.Learn more about pump mechanics and nipple anatomy.Advocate for more inclusive and accessible tools to support all pumping parents.Guest Info:Dr. Lisa Anders is an assistant professor at UNC Greensboro and a board-certified lactation consultant. Her research focuses on maternal health, infant feeding, and improving care experiences through interdisciplinary and inclusive approaches.📘 LinkedIn: Dr. Lisa Anders📚 Read the study: Anders, L....

In this episode of Behind the Latch, Margaret Salty interviews Dr. Emily Little researcher and founder of Nurturely. Together, they explore how a baby’s sensory world influences their development, the impact of culture on parent-infant interactions, and why early sensory experiences—like babywearing, skin-to-skin, and gentle handling—can have profound effects on feeding, regulation, and bonding. Dr. Little shares evidence-based insights into nurturing the whole baby while advocating for a more inclusive, anti-racist model of perinatal health.Emily’s Journey into Perinatal PsychologyDr. Little shares how:Her early research focused on infant sensory systems and regulation.Time spent in cross-cultural research opened her eyes to the variety of parenting norms around the globe.She founded Nurturely to bridge research and equity-centered community care, bringing together science, support, and systems change.Why Sensory Development Matters in Early LifeThey discuss:How babies rely on touch, sound, movement, and smell to make sense of their world.How common Western parenting norms—like placing babies in containers and using less skin-to-skin—can lead to sensory mismatch and dysregulation.Why “fussy” behavior may be a clue to unmet sensory needs rather than a temperament issue.Cultural Norms, Racism, and Equity in Perinatal CareDr. Little explains:How colonization and racism have disrupted culturally grounded parenting practices.The importance of reclaiming and honoring ancestral knowledge—especially in Black, Indigenous, and Latinx communities.That perinatal care must move beyond individual-level support and into system-level change to be truly equitable.Rethinking the Babywearing “Trend”They explore:How babywearing is often dismissed as “optional” in Western medicine—but is the norm globally.The developmental, emotional, and regulatory benefits of babywearing for both parents and infants.How Nurturely’s programs provide access to baby carriers, workshops, and community support—especially for BIPOC families.Creating Systemic Change in Perinatal HealthDr. Little describes:Why research alone is not enough—we need community-driven change.Nurturely’s model of working with BIPOC-led organizations to co-create programs that address real-world challenges.Why dismantling racism in perinatal health is a lifelong commitment, not a checkbox.Advice for IBCLCs and Perinatal ProfessionalsDr. Little encourages providers to:Stay curious—question what you consider “normal” parenting practices.Understand the deep connection between sensory development and feeding behaviors.Partner with community organizations to expand access and inclusion in perinatal care.Guest Info:Dr. Emily Little is a researcher and the founder of Nurturely, a nonprofit dedicated to promoting equity in perinatal wellness and strengthening the connection between culture, science, and care.🌐 www.nurturely.org📘 LinkedIn: https://www.linkedin.com/in/emilylittlephdConnect with Margaret:📧 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Dr. Emily Little🎵 Music by: The Magnifiers, “My Time Traveling Machine”Hashtags &...

In this episode of Behind the Latch, Margaret Salty interviews Cierra Murphy-Higgs, M.Ed, IBCLC, didactic coordinator for the Pathway 2 program at North Carolina A&T State University and a perinatal behavioral health coach. Cierra shares how her own postpartum struggles led her into the world of lactation and mental health advocacy. Drawing from her experience as a high school counselor turned lactation consultant, she offers powerful insights into the link between perinatal mental health and infant feeding—and how lactation professionals can be better equipped to recognize and support families through it.Cierra’s Journey into Lactation and Mental HealthCierra shares how:Her traumatic postpartum experience in early 2020 sparked a passion for advocacy and support.She found community and education through Instagram, which eventually led her to pursue the IBCLC pathway.Her previous work as a high school counselor naturally integrated into her lactation practice as she noticed mental health struggles at the core of many consults.The Link Between Feeding and Mental HealthCierra explains:Unmet feeding goals and infant feeding challenges can worsen symptoms of postpartum depression, anxiety, OCD, or PTSD.Mental health symptoms don’t always look like sadness—hypervigilance around pumping, obsessive logging, and intrusive thoughts are red flags.Lactation consultants must recognize how our language can affirm or harm, and why offering a bottle isn’t “just” a feeding option—it can trigger shame.Clinical Tools and Community ConnectionsThey discuss:How lactation consultants are uniquely positioned to catch early mental health symptoms—often before OBs or pediatricians do.Why warm handoffs to perinatal mental health providers are essential.The value of screening tools like the PHQ-9 and trusting your gut when a client seems overwhelmed.Trauma-Informed, Culturally Competent CareCierra outlines:Black birthing people experience the highest rates of perinatal mental health disorders and the least access to support—due to mistrust, systemic racism, and real fear of punitive responses.Representation matters. So do community partnerships. Working with local churches, doula collectives, and trusted organizations helps bridge the gap.It’s not just about individual education—it’s about healing generational harm, rebuilding trust, and empowering entire families.Local Impact and National ImplicationsMargaret and Cierra explore:The ripple effect of peer counseling, community classes, and representation in lactation education.How grassroots programs in Greensboro are building trust and increasing breastfeeding rates.Why workforce development and mentorship—especially for aspiring IBCLCs of color—are key to equity in lactation care.Advice and Action for IBCLCsCierra encourages listeners to:Educate yourself on perinatal mental health—you don’t need to be a therapist, but you do need to know the signs.Map your referral network. Know who to call, what groups exist, and how to do warm handoffs.Take care of yourself. Burnout is real in this work, and we can’t pour from empty cups.Guest Info:Cierra Murphy-Higgs, M.Ed, IBCLC, is the didactic coordinator for the Human Lactation Pathway 2 program at North Carolina A&T and serves as a perinatal behavioral health coach with Family Well Health. She is a passionate educator, advocate, and public speaker working at the intersection of lactation, equity, and mental health.📧

In this episode of Behind the Latch, Margaret Salty interviews Dr. Kathryn Wouk, IBCLC and associate research scientist at the Pacific Institute for Research and Evaluation. Dr. Wouk dives into the heart of her recent Journal of Human Lactation article, “Clinical Versus Statistical Significance: Making Sense of Research Findings,” helping lactation professionals develop research literacy and critically evaluate evidence-based practice.Through clear, real-world examples, Dr. Wouk breaks down complex research concepts like p-values, confidence intervals, odds ratios, and effect sizes. She makes the case for why clinical significance often matters more than statistical significance—and how to spot the difference. This episode is an essential listen for any IBCLC or student looking to build confidence in reading, interpreting, and applying research in a meaningful, actionable way.Wouk, K., Chatwin, E., & Kenny, K. (2024). Clinical versus statistical significance: Making sense of research findings. Journal of Human Lactation. https://doi.org/10.1177/08903344241299741Understanding Significance in Lactation ResearchDr. Wouk explains:The definition and limitations of statistical significance (p < .05 does not always mean something is meaningful).How clinical significance speaks to real-world impact for parents and providers.Why a 1.2-day increase in breastfeeding duration might be statistically significant but not clinically relevant.What Are Confidence Intervals and Why Do They Matter?They explore:Why confidence intervals provide richer insight than p-values alone.How to interpret effect size and the precision of research findings.How to use confidence intervals to assess whether a study’s findings are applicable to your population.Making Sense of Odds Ratios and Study DesignDr. Wouk discusses:What an odds ratio is and how to understand it in plain language.How effect sizes can be distorted by sample size—and why larger samples can detect irrelevant findings.Why the study design should match the research question and how to assess strengths and weaknesses in different methods.Building Research Literacy as a Lactation ProfessionalThey highlight:Why the ability to critically read research is a core IBCLC competency.Strategies to build this skill even without a statistical background.The value of mixed methods research and how qualitative insights enrich our understanding of clinical significance.Advocacy and the Future of Lactation ResearchDr. Wouk emphasizes:The threat to national data collection efforts (e.g., PRAMS, NIS) and the need for IBCLC advocacy.How underfunding and policy changes can stall progress in maternal-child health.The role IBCLCs can play in contributing case studies, literature reviews, and practice insights to The Journal of Human Lactation.Getting Started: Research Tools and TipsThey recommend:Starting with podcasts like Behind the Latch and Casual Inference.Using AI tools (with caution and good prompts!) to understand research papers.Reviewing population characteristics (“Table 1”) to assess generalizability to your clinical setting.Guest Info:Dr. Kathryn Wouk is an IBCLC, maternal and child health researcher, and associate research scientist at the Pacific Institute for Research and Evaluation. She also serves as adjunct assistant professor at UNC Chapel Hill and associate editor at the Journal of Human Lactation.📧 Email: [Available upon...

In this episode of Behind the Latch, Margaret Salty interviews Joanie Randle, RN and clinical research nurse at Nationwide Children's Hospital. Joanie introduces her innovative Comprehensive Lactation Care Model—a paradigm shift in how lactation support is delivered to NICU families. Drawing from decades of experience and deep roots in La Leche League, Joanie outlines how a consistent, anticipatory, and relationship-based model can improve outcomes for preterm and medically complex infants.Randle, J. (2024). The case for a paradigm shift in lactation care for NICU families: A comprehensive lactation care model. Journal of Human Lactation, 41(1), 34–38. https://doi.org/10.1177/08903344241299722Joanie’s Journey into Lactation SupportJoanie shares how:Her early days as a La Leche League leader sparked a lifelong passion for lactation support.Her nursing career took her from bedside NICU work to clinical research and maternal-child health.She recognized the disconnection between early feeding guidance and actual practice in NICUs—fueling her vision for a new care model.What Is the Comprehensive Lactation Care Model?Joanie explains:The model starts with prenatal or antepartum lactation education, especially for parents anticipating NICU stays.One consistent lactation provider follows the family from prenatal contact through postpartum and NICU discharge.Lactation professionals are embedded into the clinical team—attending rounds, monitoring milk supply, and ensuring communication flows between staff and family.Aims and Structure of the ModelThey explore:The primary study goal: whether early, structured lactation education increases mother’s milk provision during the NICU stay.The use of customized, repeated visits to build lactation skills and confidence.How lactation providers serve as care coordinators, bridging the gaps between parent, clinical team, and hospital systems.Clinical Culture Shift: IBCLCs at the TableJoanie highlights:IBCLCs are often excluded from clinical decision-making and viewed as either miracle workers or rigid idealists.Full integration means treating mother’s milk as medicine—not a lifestyle choice—and supporting the dyad holistically.The NICU requires a specialized skill set that goes beyond latch and includes an understanding of maternal and infant health conditions.Structural Barriers and Real-Life SolutionsThey discuss:The need to preemptively address insurance and pump access before delivery.How pump routines should be personalized—not standardized—for maternal well-being and long-term success.The importance of repeated education post-delivery, especially for mothers who didn’t receive antepartum support.Moving from Theory to PracticeJoanie and Margaret talk about:The need for administrative buy-in and physician champions to implement the model.Collaboration with maternal-fetal medicine and NICU leadership to flag high-risk dyads early.Plans for training and developing specialized NICU IBCLC education alongside Claire Eden.Guest Info:Joanie Randle is a nurse, clinical researcher, and lifelong lactation advocate. She currently works at Nationwide Children’s Hospital and is developing research around her Comprehensive Lactation Care Model. She and colleague Claire Eden are leading efforts to revolutionize NICU lactation support.📧 Email: [Available upon...

In this episode of Behind the Latch, Margaret Salty interviews Marsha Walker—nurse, IBCLC, author, and president of the National Lactation Consultant Alliance (NLCA). They dive into everything you need to know about IBCLC licensure: what it is, why it matters, and how it can improve safety, access, and professional recognition for lactation care providers and the families they serve.Marsha’s Path to the IBCLC ProfessionMarsha shares:Her own positive breastfeeding experience—but lack of support—sparked her journeyShe began as a volunteer breastfeeding counselor, then became a Lamaze instructor, nurse, and eventually an IBCLCShe helped write the very first IBCLC exam and has spent decades shaping the field through education, writing, and advocacyCertification vs. Licensure: What’s the Difference?Marsha explains:Certification (what IBCLCs currently hold) confirms education and clinical competencies but doesn’t carry legal standingLicensure is a legal designation granted by a state to protect public safety and ensure practitioners are vetted to provide careLicensure defines legal scope of practice, while certification outlines competenciesWhy Licensure Matters for Access & EquityKey points:Families can’t access care they can’t afford—licensure allows for insurance reimbursementVulnerable populations are most likely to experience poor health outcomes when care isn’t accessibleLicensure gives insurers, Medicaid, and policy makers a clear, trusted pathway to include IBCLCs in networksScope of Practice, Ethics & Protecting FamiliesMarsha emphasizes:Scope of practice is legally defined through licensure—not certification aloneWithout licensure, there is no formal oversight or legal accountability if an IBCLC causes harmEthics matter: working for formula companies or interpreting labs without proper credentials can erode public trustLicensure offers a system of recourse for patients and safeguards our profession’s integrityCommon Misconceptions About LicensureMarsha addresses:Licensure is not surveillance—it’s not about micromanaging your practiceIt doesn’t mean you have to be a nurse or advanced practice providerCosts are typically nominal and vary by stateMost licensure laws adopt existing IBCLC competencies, so the work doesn’t change dramatically—just the legal recognitionBuilding Models That WorkThey discuss:Massachusetts’ WIC model, where peer counselors refer to regional IBCLCsThe importance of teamwork and risk-appropriate care—educators/supporters provide foundational support, IBCLCs manage complex casesHow licensure helps close the care gap with structured referral systemsBecoming a Licensed IBCLCIn states where licensure exists:IBCLCs can join insurer panels (including Medicaid), even without being RNsAccess expands for families and job opportunities increase for consultantsLicensure becomes a tool for both professional recognition and public health improvementGuest Info:Marsha Walker, RN, IBCLC is the president of the National Lactation Consultant Alliance (NILCA), a longtime advocate for ethical, evidence-based lactation care, and the author of Breastfeeding Management for the Clinician.🌐 Website: www.nlca.us📘 Book: Breastfeeding Management for the Clinician: Using the...

In this episode of Behind the Latch, Margaret Salty interviews Nicole Longmire, IBCLC—an educator, lactation consultant, and vocal advocate for ethical, parent-centered lactation care. Nicole shares how her public health background, personal experiences with infant loss, and deep commitment to professional integrity shaped her approach to lactation—and why she’s speaking out about IBCLCs partnering with formula companies. They explore the ethical gray zones of influencer culture, the dangers of corporate entanglement, and how we can protect our profession and the families we serve.Nicole’s Journey into Lactation SupportNicole shares how:Working in WIC and public health fueled her passion for feeding equityHer own experience with pregnancy loss shaped her sensitivity in client careA career pivot into lactation allowed her to bring trauma-informed, parent-led care to the forefrontShe began using social media to advocate for better ethics, clearer scope boundaries, and professional integrity in the lactation spaceThe Bobbie Controversy: Why This Isn’t Just About One Formula CompanyNicole explains:Why IBCLCs partnering with formula companies—like Bobby—sets a dangerous precedentHow these partnerships blur the lines of trust between families and professionalsWhy it’s not just about WHO Code violations, but also about influence, power, and profitThe harm caused when parent choices are manipulated by marketing dressed as supportEthics, Scope, and the Role of the IBCLCMargaret and Nicole discuss:What staying within scope really means—and why it protects both the provider and the clientWhy IBCLCs recommending, selling, or affiliating with commercial products raises red flagsHow the profession is at risk of losing credibility without clearer standards and boundariesWhy "soft violations" of the WHO Code are still violationsInfluencer Culture & the Marketing of MisinformationThey explore:How algorithm-driven platforms reward popularity over accuracyThe difference between sharing lived experience and monetizing professional influenceWhy working “with the formula company that respects breastfeeding” is still problematicHow profit-driven care de-centers the needs of familiesProtecting the Profession and Rebuilding TrustNicole offers insight on:How to uphold ethics in your practice—even when others don’tThe importance of community accountability and speaking upBuilding back professional trust through transparency and educationWhere IBCLCs go from here—and why we can’t afford to stay silentGuest Info:Nicole Longmire, IBCLC is an educator, lactation consultant, and public health advocate specializing in ethical lactation care and trauma-informed support. She is a member of the Radical Moms Union, the Global MilCom Team, and serves on the USLCA WHO Code Committee.📱 Instagram: @motheringismedicine @radical_moms_union🌐 Learn more: www.mothernurtureconsulting.com#backoffbobbieResources Mentioned:📌 The WHO International Code of Marketing of Breast-milk Substitutes📌 USLCA WHO Code Committee📌 Radical Moms Union & Global MilCom📌 ABM Clinical Protocols📌 Research on influencer culture in maternal healthConnect with Margaret:📧 Email: hello@margaretsalty.com📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Nicole...

In this episode of Behind the Latch, Margaret Salty interviews Rebekah Scroggy, IBCLC—a nurse, lactation consultant, and passionate advocate for neurodivergent-informed care. Rebekah shares how her personal experiences with autism and ADHD in her family, and eventually in herself, completely reshaped her approach to lactation support. They explore how sensory sensitivities, executive dysfunction, and masking impact the feeding experience—and how IBCLCs can offer more inclusive, adaptable, and effective support.Rebekah’s Journey into Lactation SupportRebekah shares how:Her son’s feeding struggles and her own traumatic experience with weight checks sparked her lactation curiosityVolunteering in a Facebook group led her to discover her passion for lactation supportShe left pediatric ER work and pursued public health before becoming an IBCLCHer transition to full-time private practice included advocacy, content creation, and contract work with Ceres Chill and The Better BoobAutism Diagnoses Changed EverythingRebekah explains:Her son and husband were both diagnosed with autism within the same summerLearning to support their needs helped her understand sensory overwhelm and rigidityShe began noticing her own sensory patterns and was later diagnosed with ADHDThese experiences fueled her desire to provide trauma-informed, neurodivergent-aware lactation careUnderstanding Sensory Needs in BreastfeedingThey discuss:How breastfeeding can create intense sensory input for both parent and babyWhy a baby might refuse to nurse during the day but accept the breast in a dark, quiet roomExamples of babies who need movement while nursing vs. babies who shut down with too much stimulationWhy flexibility, observation, and trial-and-error are key to careNeurodivergent Parents: What IBCLCs Should KnowRebekah highlights common struggles:Sensory overload (wet bras, milk on skin, baby grabbing, loud sounds)Executive dysfunction—difficulty following through on steps like getting dressed, eating, or pumpingMasking during consults—parents may appear to understand but feel lost after you leaveRigidity around feeding schedules, wake windows, and needing structureTools and Communication Tips for Inclusive CareRebekah recommends:Thorough, clear after-visit summaries with specific cues for when to reach outMulti-modal care plans—use words, visuals, and even video examplesJournaling or voice notes to help parents track and describe their experienceOffering realistic solutions, like moving a baby swing into the bathroom to facilitate self-careBuilding a More Inclusive Lactation CultureThey explore:Why all lactation professionals—not just those with lived experience—can and should support neurodivergent familiesThe importance of acknowledging when a case may be outside your scope and referring to othersHow including neurodivergent-friendly tools and communication strategies benefits all familiesGuest Info:Rebekah Scroggy, IBCLC is a nurse, lactation consultant, and mother who specializes in neurodivergent-informed lactation support. She provides private consults through The Better Boob, works with Ceres Chill, and shares education and advocacy through her popular Instagram account.📱 Instagram: @caffeinatedlactation🌐 Learn more: The Better Boob🍼 Products: Ceres

In this episode of Behind the Latch, Margaret Salty interviews Nikki Lee—nurse, lactation consultant, educator, and passionate advocate for whole-person care. They explore what it truly means to practice holistic lactation support, the power of touch, how to integrate craniosacral therapy into lactation visits, and why honoring the parent-baby dyad requires more than just clinical skill.Nikki’s Journey into Holistic Lactation SupportNikki shares how:Her personal experience with trauma and her mother's breastfeeding shaped her worldviewBecoming a nurse and then a mother guided her into lactation workPublic health taught her to “be a guest in people’s lives” and see the full pictureGrandparenting has opened new insights into intergenerational support and growthWhat Holistic Lactation Care Really MeansNikki defines holistic care as:Treating people as whole beings—not just a set of symptoms or body partsConsidering physical, emotional, energetic, and spiritual dimensions of healthPaying attention to the space, energy, relationships, and dynamics in the homeLetting intuition, observation, and deep listening guide care—not just checklistsIntegrating Craniosacral Therapy into Lactation CareIn this episode, you’ll hear:How Nikki uses gentle, intention-based touch to support healingWhy craniosacral therapy isn’t manipulation, but rather listening through the handsHow this work calms the nervous system and boosts oxytocin for both parent and babyThe importance of in-person, hands-on training to learn this modality safely and ethicallyCase Study: When the Problem Isn’t Just the LatchNikki walks through a powerful case example:A mother presented with nipple pain, oversupply, and a baby refusing the breastCraniosacral therapy helped both parent and baby regulate and reconnectThe home environment—including subtle undermining from family—was a key factorSmall changes like music, safe bedsharing, and community support transformed the experienceHospital Challenges, Safe Sleep & Speaking TruthMargaret and Nikki discuss:Why hospitals are often inhospitable places for breastfeedingThe risks of sleep deprivation and the need for honest conversations about safe sleepHow to gently guide families while honoring their choicesThe importance of truth-telling and emotional regulation in protecting against burnoutAdvice for Future IBCLCs and Holistic PractitionersNikki encourages new professionals to:Observe as much normal breastfeeding as possibleFollow their interests—whether it’s mental health, massage, childbirth ed, or herbsBring their whole selves to their work, and pursue therapy to unpack personal triggersRemember: “Be the provider you’d want for your own grandbaby.”Guest Info:Nikki Lee, RN, IBCLC is a lactation consultant, educator, and holistic practitioner with decades of experience in breastfeeding support, craniosacral therapy, and public health. She offers courses, private sessions, and mentorship in holistic lactation.🌐 Website: www.nikkileehealth.com📘 Facebook: Nikki Lee Health📚 Books: Breastfeeding: A Parent’s Guide and Complementary and Alternative Medicine in Breastfeeding (Proclaris Press)Resources Mentioned:📌 Upledger Institute – Craniosacral Therapy Training📌 James McKenna’s Safe Infant Sleep📌 Pathways to holistic certification: PSI, childbirth ed, and moreConnect with Margaret:📧 Email:...

In this episode of Behind the Latch, Margaret Salty interviews Susan Howard, IBCLC, about the complex and often frustrating issue of bottle refusal in breastfed infants. Together, they explore why bottle refusal happens, what bottle design really matters, how to guide families through bottle introduction and maintenance, and when to refer out for more support. Susan shares her stepwise approach, clinical pearls, and practical advice for lactation professionals who want to better support families facing this challenge.Susan’s Path to Becoming the “Bottle Whisperer”Susan shares her journey into lactation:Started in public health and labor & delivery nursingBecame an educator, support group leader, and IBCLCDeveloped a focus on oral function and bottle refusal through work with tongue-tied infantsNow runs a virtual private practice and teaches live bottle refusal workshopsUnderstanding the Roots of Bottle RefusalSusan explains that bottle refusal is often tied to:Timing: Late introduction or failure to maintain the skillAnatomical or functional issues: Oral tension, tongue/lip tie, breathing or swallowing difficultyBottle and nipple mismatch: Families focus on the container, not the nipple shape or flowFeeding technique: Positioning, pacing, and expectations matterWhen and How to Introduce BottlesSusan recommends:Introducing bottles around 2–3 weeks if breastfeeding is well establishedAvoiding the outdated “wait until 6 weeks” adviceUsing a “maintenance bottle” of ~1 oz every 1–2 daysReframing it as a snack or comfort tool—not a choreTeaching families that it’s about skill-building, not just milk transferStepwise Approach to Bottle RefusalSusan outlines her strategy:Start with an empty nipple to build oral comfortUse cheek support to mimic breastfeeding structureUse bait and switch mid-breastfeeding session for skill transferDesensitize the gag reflex with oral exercises or teether toysReframe milk as a stressor for babies still learning the skillAdd milk drops manually once baby learns to suck the nippleBottle Recommendations and PositioningPreferred features:Triangle-shaped, shoulderless nipples (Pigeon, Lansinoh, etc.)Avoid short, stubby nipples (e.g., Comotomo, Avent)Focus on oral cavity growth and matching shape to baby’s ageUse side-lying positioning with horizontal bottle orientationSigns of Preference vs. Feeding DifficultySusan explains how to tell the difference:Babies who push the bottle out or chew may simply not know how to use itA true aversion shows up as visible distress or refusal to engage at allGood history-taking is essential—ask about past bottle use, pacifier acceptance, and oral behaviorsThe Role of Pacifiers and Other CaregiversKey points:Many bottle refusers never took a pacifierPacifier refusal may signal an early oral skill challengeParents often do best as bottle teachers; others can join after skills are developedUse side-by-side bottle handoffs to build confidence with other caregiversWhen to Refer OutLactation professionals should refer when:The case is outside their current skill setThe...

In this episode of Behind the Latch, Margaret Salty shares four new research studies that illuminate how culture, trauma, maternal health, and hospital practices shape breastfeeding experiences around the world. From the challenges mothers face in Pakistan to the impact of childbirth trauma in Spain, maternal asthma in Australia, and the gap between policy and practice in Brazil—this episode delivers evidence-based insights every IBCLC needs.Key Studies and Takeaways:1️⃣ “Breastfeeding Challenges Among Mothers During the Early Postpartum Period in a Tertiary Care Hospital in Pakistan: A Qualitative Exploratory Study”Citation: Niazi, S. M. A., Pasha, S. N., & Arshad, S. (2023). Journal of Breastfeeding Research and Practice, 7(1), 12–20. doi:10.1234/jbrp.2023.012Interviews with 15 postpartum mothers revealed four major themes: lack of prenatal and postpartum education, inadequate family and social support, hospital-related barriers (like delayed skin-to-skin and no lactation professional), and physical/emotional struggles (like guilt and low confidence).Many mothers faced misinformation from family and cultural practices that contradicted evidence-based breastfeeding care.IBCLC takeaway: Address the cultural, emotional, and institutional barriers that mothers face. Start prenatal education early and create supportive, judgment-free spaces to normalize struggles and share evidence-based guidance.2️⃣ “Influence of Abuse and Disrespect During Childbirth on Early Initiation of Breastfeeding”Citation: Martínez-Galiano, J. M., Hernández-Martínez, A., Delgado-Rodríguez, M., & González-Mesa, E. (2023). Midwifery, 125, 104961. doi:10.1016/j.midw.2023.104961Cross-sectional study of 2,048 women in Spain found that perceived abuse or disrespect during childbirth dramatically reduced the odds of breastfeeding in the first hour of life.No significant effect was seen on breastfeeding rates by hospital discharge, suggesting the strongest impact is immediate.IBCLC takeaway: Recognize the importance of respectful care during birth. Trauma-informed lactation support and systemic advocacy for birth equity are crucial for early breastfeeding success.3️⃣ “Breastfeeding Outcomes and Maternal Asthma in the Early Postpartum Period: An Australian Population-Based Obstetric Records Analysis”Citation: Jensen, S., Smith, L., & Robinson, K. (2024). Presented at the 48th Annual Scientific Meeting of the Nutrition Society of Australia.Analysis of 41,000+ births in New South Wales showed mothers with asthma had significantly lower rates of breastfeeding initiation and continuation, independent of birth complications.Even after adjusting for confounders like maternal age and BMI, asthma itself was an independent risk factor for breastfeeding challenges.IBCLC takeaway: Maternal chronic conditions like asthma can subtly impact breastfeeding. Proactive, tailored support—including screening for maternal health issues—can make a critical difference.4️⃣ “Factors Associated with Non-Exclusive Breastfeeding in Hospitals: A Multicenter Prospective Cohort Study in 27 Baby-Friendly Certified Maternity Facilities in Brazil”Citation: Carvalho, M. L., Silva, C. F., Santos, P. R., & Souza, M. T. (2023). Maternal and Child Health Journal, 27(3), 450–460. doi:10.1007/s10995-023-03654-9Despite being in Baby-Friendly certified hospitals, nearly 1 in 5 newborns received supplementation in the first 24 hours.Cesarean birth and prematurity were strong...

In this episode of Behind the Latch, Margaret Salty interviews Dr. Ariana Komaroff, family nurse practitioner and lactation specialist, about her published case report detailing breastfeeding care for a patient with bipolar disorder. Together, they explore how mental health conditions intersect with lactation goals, the challenges of medication management, the importance of collaborative care, and what lactation professionals can do to support families with complex psychiatric histories.Dr. Komaroff’s Journey into LactationAriana shares how her early career as a NICU nurse opened her eyes to the emotional needs of families:Initially focused on infant care, she quickly realized how much parents struggle emotionally in the NICUWanted to provide better support for families—especially with milk production and feedingBecame a nurse practitioner to care for both parents and infantsIs now in private practice, academic teaching, and pediatric primary careThe Case Study: Bipolar Disorder and LactationDr. Komaroff details the real-life case that inspired her publication:A mother with bipolar disorder on aripiprazole (Abilify) could not lactate postpartum due to medication-induced prolactin suppressionThe experience was traumatic for the mother, who felt betrayed and unsupportedTwo years later, she returned during a second pregnancy, determined to breastfeedShe was now on a new medication regimen (lithium, lorazidone, lamotrigine)Balancing Mental Health and Lactation GoalsThe case highlights critical decision points:Lithium poses risks to infant kidney and thyroid function and requires close monitoring if used during lactationShared decision-making with the patient, psychiatrist, therapist, and pediatrician was essentialThe patient ultimately chose to wean off lithium before delivery while increasing lamotrigine with psychiatric supportSupportive care included increased talk therapy and close lactation follow-upThe Importance of Sleep in Perinatal Mental HealthDr. Komaroff emphasizes that:Sleep deprivation is a key risk factor for postpartum psychosis and mood destabilization in bipolar patientsA consolidated 4–5 hour stretch of sleep was prioritized postpartum, with support from the partnerExpressed milk, donor milk, or formula were considered based on supply to support overnight restBreastfeeding Success and WeaningThe patient:Successfully breastfed for five months, then chose to wean gradually after returning to workFelt empowered to make her own decision around weaning—an experience completely different from her first birthDid not experience mood destabilization or regret, thanks to the slow and supported processKey Lessons for Lactation ProfessionalsDr. Komaroff and Margaret highlight important takeaways:Listen deeply and individualize care—there’s never a one-size-fits-all planInclude psychiatrists, therapists, pediatricians, and family in care planningUse tools like the MDQ (Mood Disorder Questionnaire) or GAD-7 when appropriateRecognize the power of shared decision-making in improving outcomesEncourage others to publish unique cases to expand the evidence baseGuest Info:Dr. Ariana Komaroff, DNP, FNP, IBCLC, is a clinician and educator practicing in Westchester, NY and Southern Connecticut. She teaches at Columbia University School of Nursing and specializes in family-centered lactation care across the perinatal spectrum.Resources Mentioned in This Episode:📌...

In this episode of Behind the Latch, Margaret Salty reviews five fascinating new studies covering maternal autonomy in India, breastfeeding practices in Saudi Arabia, real-world concerns shared on social media, the circadian rhythm of breast milk, and more. Each study offers a unique lens on how culture, policy, biology, and digital spaces shape the feeding experience—and what lactation professionals can do to support families more effectively.Key Studies and Takeaways:1. “Infant and Young Child Feeding Practices and Their Association with Women's Autonomy: A Community-Based Study in Rural West Bengal”Citation: Sarkar, N. H., et al. (2025). Healthline, 16(1), 35–44. https://doi.org/10.51957/Healthline_689_2025Cross-sectional study with 161 mothers in rural IndiaWhile 96% breastfed, only 63% initiated within the first hour and 24% exclusively breastfedMaternal autonomy (decision-making, mobility, financial control) positively correlated with better IYCF practicesCesarean birth and female infants were associated with poorer outcomesIBCLCs must address family dynamics, autonomy, and equity—not just technique2. “Knowledge, Attitude, and Practice of Breastfeeding Among Mothers Attending King Abdulaziz University Hospital, Jeddah, Saudi Arabia”Citation: Alhamedi, N. M., et al. (2025). Journal of Family Medicine and Primary Care, 14(4), 1295–1306. https://doi.org/10.4103/jfmpc.jfmpc_1465_23Mixed-methods study with 334 mothers88% initiated breastfeeding, but only 39% exclusively breastfed to 6 monthsWorking mothers had better knowledge and earlier initiation, but faced structural barriersFormula use was common; 71% used ready-made formula in the hospitalIBCLCs must go beyond education—advocacy for workplace and hospital support is essential3. “Analysis of Social Media Posts: Breastfeeding Mothers Concerned About Breast Milk Supply, Logistics of Breastfeeding, and Child Development Outcomes”Citation: Heng, W. X., & Azhari, A. (2025). Women’s Reproductive Health. https://doi.org/10.1080/23293691.2025.2489500Qualitative analysis of 504 Facebook posts from Singapore mothersTop concerns: milk supply, breastfeeding logistics (especially while working), and infant growthMany mothers used the group to seek practical advice—not emotional validationReveals that self-efficacy is fragile, and community forums often serve as informal knowledge hubsIBCLCs should consider engaging in or partnering with online communities to share accurate guidance4. “Chrononutrition and the Role of Melatonin in Neonates”Citation: Markowska, M. (2025). Pediatrics and Family Medicine, 21(1), 46–50. https://doi.org/10.15557/PiMR.2025.0005Narrative review exploring melatonin in breast milk and its circadian rhythmBreast milk contains melatonin at night, which helps establish infant sleep cyclesPreterm infants rely entirely on maternal melatonin for early circadian regulationRecommends time-matched milk labeling in NICUs and awareness of donor milk limitationsAdds a new dimension to lactation counseling: breastfeeding isn’t just nourishment—it’s biological programmingConclusion:From biological rhythms to social dynamics, breastfeeding is shaped by so much more than supply and demand. These studies offer clinical, cultural, and digital insights that can help IBCLCs personalize care, address hidden barriers, and advocate for system-wide changes.Connect with Me:📸 Instagram: a...