How Mina’s grandmother’s experience as a wet nurse shaped her path into lactation

Why “hospital-grade” doesn’t actually mean anything in marketing—and what truly defines a multi-user pump

The critical first 7 days postpartum and why delayed access to an effective pump can permanently impact supply

Why wearable pumps and personal-use pumps often fail NICU mothers trying to establish supply

The surprising insurance paradox: why WIC families often receive pumps faster than privately insured hospital employees

How some insurance plans (including certain HMOs and United Healthcare) do not recognize hospital-grade pumps as a covered benefit

The behind-the-scenes work required to secure an E0604 pump rental through a DME supplier

Why case management buy-in was one of the biggest roadblocks—and how Mina overcame resistance

How embedding a lactation-specific workflow into Epic improved communication and reduced delays

Why some hospitals profit from pump rentals—and why that raises ethical concerns

How her hospital partnered with WIC to house 10 loaner hospital-grade pumps onsite

The importance of prenatal pump planning when a NICU admission is anticipated

What still isn’t fixed—and why the work continues

The first 7 days postpartum are physiologically critical for establishing milk supply. Delays in effective milk removal can make supply difficult to recover later.

Not all pumps are equal. Wearable pumps and personal-use pumps may not provide adequate stimulation for separated NICU mothers.

Insurance status can directly affect pump access timing, functioning as a social determinant of lactation success.

Securing a hospital-grade pump typically requires:

1. A prescription
2. Diagnosis coding (NICU admission)
3. Coordination with a DME supplier
4. Case management involvement

Standardizing communication within the EHR can dramatically improve workflow and reduce lost time.

Patients should not bear the burden of navigating DME suppliers while managing a critically ill infant.

Advocacy is within the scope of the hospital lactation consultant role—even when it requires challenging institutional norms.

One practical first step: map your current NICU pump access process and identify where delays occur.

Mina Ognianovich, IBCLC

https://minalactation.com/

📬 Email: hello@margaretsalty.com

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

Hosted by: Margaret Salty

Music by: The Magnifiers – My Time Traveling Machine

#BehindTheLatch #NICULactation #HospitalGradePump #BreastfeedingEquity #IBCLC #LactationAdvocacy #MaternalHealth #PublicHealthLactation #NICUParents #BreastmilkIsMedicine

In this episode of Behind the Latch, Margaret sits down with Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES, professor at the University of Texas at Tyler, to discuss her powerful qualitative study exploring the perceptions, barriers, and facilitators to obtaining the IBCLC certification among U.S. healthcare practitioners.

Margaret first encountered this research as a poster presentation at the ILCA Conference in Tampa — and immediately knew it was a conversation the field needed to hear.

Dr. Golman’s study, expected to be published later this year, examines who is able to enter the IBCLC pathway — and who is not — through a public health and equity lens. With 19,000 IBCLCs serving the United States and 93% identifying as white, the findings raise important questions about access, mentorship, compensation, and structural barriers within our profession.

Together, Margaret and Dr. Golman unpack what the data reveal — and what must change.

How Dr. Golman’s background in maternal-child health and public health shaped this research

Why workforce diversity in lactation care is a public health issue

The perception that the IBCLC credential “adds weight” professionally — but often without financial return

Why many hospital-based IBCLCs are required to certify without institutional financial support

The persistent bias that IBCLCs must also be RNs to be considered “legitimate”

Financial barriers beyond tuition — unpaid clinical hours, childcare, lost wages, transportation

Why indirect costs often delay certification for years

Mentorship as the central bottleneck in the IBCLC pipeline

The lack of standardized mentorship processes and consistent training experiences

Why “mass emailing IBCLCs” to find a mentor reflects a broken system

What a centralized, structured mentorship model could look like

The role of state coalitions, professional organizations, and grant funding

Medicaid reimbursement challenges and why payment structures matter for access

How passion alone cannot sustain a workforce without structural support

What meaningful reform could look like — starting with mentorship

The IBCLC credential is highly valued — but the pathway remains structurally inequitable.

Indirect costs (lost wages, unpaid hours, childcare) are often more prohibitive than exam fees.

Mentorship access is inconsistent and frequently the biggest barrier to certification.

Without structural support and compensation reform, the field risks burnout and limited diversity.

Improving mentorship infrastructure could significantly expand access and representation.

Workforce diversity is foundational to culturally responsive lactation care and trust-building.

Public health advocacy must include strengthening the IBCLC pipeline — not just improving breastfeeding rates.

Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES

Professor, University of Texas at Tyler

📬 Email: hello@margaretsalty.com

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty

Music by: The Magnifiers – My Time Traveling Machine

In this episode of Behind the Latch, Margaret interviews Indira Lopez-Bassols, IBCLC, educator, and PhD candidate based in London, about her journey from clinical lactation consultant to published author in the Journal of Human Lactation.

Indira shares the story behind her case study, “Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate” and her recent reflection piece, “Three Seeds of Inspiration: How I Published My First Case Study Without a PhD” .

Together, they unpack what holds IBCLCs back from publishing, how to move from clinical wonder to academic writing, and why research must become more accessible to practicing clinicians.

1. Indira’s work in a specialist NHS breastfeeding clinic in the UK
2. Teaching future lactation consultants and pursuing a PhD in breastfeeding education
3. The three “seeds of inspiration” that moved her from reader to author
4. Why attending a JHL writing session at ILCA changed everything
5. What an editor told her when she doubted whether her case was “spicy” enough
6. Why you do not need a PhD to write and publish a case study
7. How she structured her first case study by studying medical literature methodology
8. The powerful cleft lip and palate case that became her first JHL publication
9. Assisted nursing using a nipple shield and NG tube to support direct breastfeeding
10. Why cleft lip and palate infants are often assumed unable to breastfeed — and how this case challenged that assumption
11. The emotional dimension of clinical practice: witnessing the “impossible”
12. Why wonder is the essential ingredient for writing
13. Burnout, mechanistic care, and losing the capacity to recognize awe
14. Making research accessible for non-academic IBCLCs
15. Her creation of the international Research Hub through the Centre for Breastfeeding Education and Research

Indira describes three pivotal moments:

1. Reading a Case Study

A published case study on biological nurturing sparked the realization: “Maybe I could do this too.”

2. Attending a JHL Writing Session

At ILCA, editors clearly explained manuscript types and encouraged non-academic clinicians to submit. When Indira expressed doubt, she was told simply:

“Just write them.”

3. Witnessing the Impossible

Supporting a mother determined to breastfeed her infant with a complete unilateral cleft lip and palate became the turning point. The dyad exclusively fed mother’s own milk, used no bottles, and later transitioned to direct breastfeeding without assistance after surgeries.

That clinical experience — rooted in creativity,...