Behind the Latch

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

What We Talk About
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
Key Takeaways for Clinicians
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:
A prescription
Diagnosis coding (NICU admission)
Coordination with a DME supplier
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.
👩‍🏫 Guest
Mina Ognianovich, IBCLC
https://minalactation.com/
📝 Connect with Margaret
📬 Email: [email protected]
📸 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.
🔍 What We Talk About
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
🧠 Key Takeaways for IBCLCs & Students
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.
👩‍🏫 Guest
Dr. Mandy Golman, PhD, MS, RN, IBCLC, MCHES
Professor, University of Texas at Tyler
📝 Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

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

The Three Seeds of Inspiration
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, persistence, and humility — demanded to be shared.
Key Takeaways for IBCLCs
You do not need a PhD to publish.
Case studies are about documenting what you witnessed, not proving expertise.
If you are already reading journals, you are closer than you think.
Study the structure of published case studies — they provide your map and compass.
Wonder is a clinical skill — but burnout can dull it.
Research must be accessible to frontline clinicians.
Our field is still young — there is enormous opportunity for contribution.

The Research Hub
Indira created the International Research Hub through the Centre for Breastfeeding Education and Research (CBER):
Free monthly online research discussion
Open to IBCLCs worldwide
Safe space to say “I don’t understand this statistic”
Designed to make research approachable and collaborative

Her mission: make research less intimidating and more joyful.
Guest
Indira Lopez-Bassols, BA (Hons), MSc, IBCLC
Founder, Centre for Breastfeeding Education and Research (CBER)
Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate
Three Seeds of Inspiration: How I Published My First Case Study Without a PhD

Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine

As more people pursue the IBCLC credential, mentorship has become one of the most critical—and misunderstood—components of lactation education. In this episode, Kristina and I take a close look at Pathway 2 and Pathway 3 mentorship, clarifying what mentors are actually responsible for and why mentorship must go beyond observation and paperwork.
Kristina explains that effective mentorship is engaged, relational, and intentional. We discuss how mentors model professionalism, communication, boundaries, and ethical care—not just clinical skills. We also talk openly about the fears many IBCLCs have about becoming mentors, including concerns about readiness, time, liability, and “doing it right,” and why those fears shouldn’t stop experienced clinicians from stepping into mentorship roles.
This conversation also highlights the structural supports built into Pathway 2 programs, the additional lift often required in Pathway 3 mentorship, and why access to high-quality mentorship remains a major barrier to growing and diversifying the IBCLC workforce. Throughout the episode, Kristina shares practical, experience-based strategies for both mentors and mentees—and a hopeful vision for how mentorship could be better supported and valued across the profession.
🔍 What We Talk About
The difference between mentoring vs. supervising clinical hours
What IBCLC mentors are truly responsible for in Pathway 2 and Pathway 3
How students should be gradually and ethically integrated into hands-on care
Common gaps students face when transitioning from coursework to clinical practice
Tools that support mentorship, including IBLCE outlines and LEAARC skill checklists
Why learning from multiple mentors can strengthen clinical competence
Liability, affiliation agreements, and student protections in Pathway 2 programs
The professional and personal benefits of becoming a mentor
Charging for mentorship: ethics, equity, and value exchange
Why mentorship is part of our professional obligation as IBCLCs
What Kristina hopes the future of lactation mentorship will look like

🧠 Key Takeaways
Mentorship 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
Kristina Chamberlain, CNM, ARNP, IBCLC
Clinical Instruction in Lactation: https://www.amazon.com/Clinical-Instruction-Lactation-Teaching-Generation/dp/1939807948
LEAARC Criteria for Endorsed Courses: https://leaarc.org/docs/2022%20Endorsed%20Courses%20Core%20Curricula%20FINAL%201.pdf
📝 Connect with Margaret
📬 Email: [email protected]
📸 Instagram: @margaretsalty
📘 Facebook: Margaret Salty
Hosted by: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine