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,...

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.

1. The difference between mentoring vs. supervising clinical hours
2. What IBCLC mentors are truly responsible for in Pathway 2 and Pathway 3
3. How students should be gradually and ethically integrated into hands-on care
4. Common gaps students face when transitioning from coursework to clinical practice
5. Tools that support mentorship, including IBLCE outlines and LEAARC skill checklists
6. Why learning from multiple mentors can strengthen clinical competence
7. Liability, affiliation agreements, and student protections in Pathway 2 programs
8. The professional and personal benefits of becoming a mentor
9. Charging for mentorship: ethics, equity, and value exchange
10. Why mentorship is part of our professional obligation as IBCLCs
11. What Kristina hopes the future of lactation mentorship will look like

1. Mentorship is an active teaching relationship, not passive oversight.
2. Students need meaningful, hands-on experience—not observation alone.
3. You do not need to be a “perfect” IBCLC to be an effective mentor.
4. Mentorship strengthens clinical skills, confidence, and professional growth.
5. Supporting mentors is essential to the future of the lactation profession.

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.

1. How Ellen entered the field of lactation through nursing and public health
2. Why “bucket diagnoses” (yeast, Raynaud’s, tongue-tie) persist in lactation care
3. What body-led breastfeeding means—and why the baby is often the primary driver
4. The clinical gap that inspired development of the Infant Suck Strength Exam (ISSE)
5. Why digital oral exams miss what’s happening at the breast
6. How the ISSE is performed and what each pull-back reveals about suck strength
7. Why the ISSE often functions as both assessment and treatment
8. Infant compensation patterns: jaw movement, lip use, body tension, and asymmetry
9. The role of cranial nerves and the cranial base in feeding function
10. Why asymmetric latch and “guppy pose” can sometimes worsen dysfunction
11. Gentle, parent-taught techniques to support infant regulation and suck strength
12. How bottle-feeding strategies must align with breastfeeding goals
13. When to consider referral for craniosacral or body-based therapy
14. Why frenotomy alone may destabilize function if body tension isn’t addressed
15. What future research is needed to validate and study the ISSE

1. A visually “good” latch can hide significant internal dysfunction.
2. Infant suck strength and tongue function must be assessed during active feeding.
3. 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.

1. Maya’s path to becoming an IBCLC through Pathway 2—and why it worked well for her as a parent
2. Why cultural humility matters in lactation care (and what it looks like in real visits)
3. Breastfeeding as a cultural norm in many Jewish communities—and the pressures that can create
4. Baby naming practices in observant Jewish families and why asking “Does your baby have a name yet?” matters
5. Modesty, family roles, and how they can influence in-home lactation visits
6. Preparing infants for circumcision (bris) and how this can intersect with feeding support
7. Shabbat, milk removal, and how IBCLCs can collaborate respectfully without practicing religious law
8. The role of rabbis in health-related decisions—and why this can be empowering for families
9. Donor milk, milk sharing, and kosher kitchen logistics
10. How informal milk sharing functions in tight-knit communities
11. Parallels with other cultural and religious practices (including Muslim milk-kinship laws)
12. Practical language IBCLCs can use to avoid alienation and build rapport
13. Why curiosity—not expertise in religious law—is the key clinical skill

1. Cultural competence starts at the doorstep—small language choices can shape the entire visit.
2. You don’t need to be an expert in religious law to provide excellent care; awareness of considerations is enough.
3. Asking open, respectful questions helps families integrate lactation care with lifelong values.
4. 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 About

• How Meaghan entered infant craniosacral therapy after her own postpartum and breastfeeding experience
• What craniosacral therapy is, how it works, and how it differs from chiropractic, osteopathy, and physical therapy
• Fascia, tension patterns, and why the body must be viewed as a single integrated system
• The role of cranial nerves in infant feeding, suck strength, and oral coordination
• How gestational positioning, birth interventions, and delivery mechanics influence feeding outcomes
• Why babies may feed well on one side but struggle on the other
• Weak suck, poor oral sensation, and why some infants “can’t feel” the nipple
• The limitations of appearance-based tongue-tie assessment and why function must come first
• How craniosacral therapy may improve frenotomy outcomes and reduce reattachment risk
• Why cutting a dysfunctional tongue without addressing body tension can worsen feeding
• What a typical infant craniosacral session looks like, including assessment and treatment flow
• How many sessions are typically needed and why “snapback” can occur
• How craniosacral therapy supports nervous system regulation and reflex integration
• What families may notice after treatment, including emotional release and behavior changes
• How to talk with parents about craniosacral therapy in clear, non-alarming language
• Safety considerations, training standards, and how to identify qualified practitioners
• What the current research does—and does not—tell us about craniosacral therapy
• Options for families who cannot access or afford bodywork services

🧠 Key Takeaways for Clinicians

• Infant 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/

• How 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 development
• How colostrum supports gut closure, immune regulation, microbiota seeding, and skin barrier maturation
• Why 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 feeding
• The striking finding that no infants who received ≥9 colostrum feeds developed peanut allergy by 12–18 months
• What early formula exposure does to the infant microbiome weeks and months later
• How parental allergy risk influences—but does not override—the protective effect of colostrum
• Why exclusive breastfeeding data often overlook the critical first 72 hours
• The interplay between infant skin permeability, environmental exposure, detergent use, and allergy sensitization
• What mouse models teach us about colostrum, mature milk, and developmental programming
• Why donor milk does not replicate colostrum’s early immunological function
• The concept of exclusive colostrum feeding as a distinct clinical and public health priority
• Future research avenues: colostrum-derived metabolites, donor colostrum banks, and early-life allergy prevention strategies

• Colostrum’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...