Behind the Latch

• A Paradigm Shift for Lactation Care in the NICU with Joanie Randle

  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...

  --------  

  41:15

  --------

  41:15
• The Research Recap: 43-Breast Milk Microbiome, NICU Self-Efficacy, Milk Donation & Medication Use

  In this episode of Behind the Latch, Margaret Salty reviews four recent studies covering the power of the breast milk microbiome, maternal confidence in NICU milk expression, cultural insights into human milk donation, and the reality of prescription drug use during lactation. Each study offers timely, practical takeaways to inform how IBCLCs support families in clinical and community settings.Study 1: The Breast Milk Microbiome and Infant ImmunityCitation: Rebello, S. J., et al. (2025). Journal of Pure and Applied Microbiology, 19(2), 902–913. https://doi.org/10.22207/JPAM.19.2.51🔍 What They Studied:A literature review of the breast milk microbiome’s impact on gut colonization, immune development, and disease prevention in infants—especially in preterm populations.🧠 Key Findings:Breast milk contains active strains like Lactobacillus and BifidobacteriumBreastfed infants have healthier microbiota than formula-fed infantsMilk microbes help prevent NEC, infections, colic, and eczemaSupplemental probiotics (when used appropriately) are generally safe and effective✅ Implications for IBCLCs:Reinforces that breast milk is immunologically active—not just nutritionIBCLCs can educate families and advocate for milk as medicineUnderstanding probiotic research supports informed collaboration in NICU careStudy 2: Maternal Self-Efficacy & Donor Milk in the NICUCitation: Kheawlamyong, R., et al. (2025). Journal of Health Research, 39(3), 244–252. https://doi.org/10.56808/2586-940X.1138🔍 What They Studied:Which maternal perceptions (based on the Health Belief Model) best predict breastfeeding preparation behaviors in mothers of preterm infants receiving donor milk.🧠 Key Findings:Only self-efficacy significantly predicted positive lactation behaviorsRisk awareness, benefits, and barriers weren’t correlated with milk expression effortsMothers who believed in their ability to succeed were more likely to store and prepare milk✅ Implications for IBCLCs:Building confidence, not just providing education, is key in NICU supportDonor milk can reduce urgency—so reinforce the value of MOM (mother’s own milk)Effective support includes hands-on help, emotional validation, and tailored plansStudy 3: Global Voices on Milk DonationCitation: Mahdikhani, Z., et al. (2025). International Breastfeeding Journal, 20(50). https://doi.org/10.1186/s13006-025-00740-6🔍 What They Studied:A meta-synthesis of 36 qualitative studies exploring the lived experiences of milk donors, recipients, and healthcare providers worldwide.🧠 Key Findings:Donating milk can be healing, especially after infant lossCultural beliefs, stigma, and religion heavily influence donor milk decisionsHealthcare provider encouragement increases milk bank participationSystemic barriers—like transport, lack of access, and misinformation—limit engagement✅ Implications for IBCLCs:We play a central role in normalizing donor milk and offering trauma-informed supportCultural sensitivity and...

  --------  

  17:55

  --------

  17:55
• IBCLC Licensure and the Future of Our Profession with Marsha Walker, RN, IBCLC

  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...

  --------  

  46:58

  --------

  46:58
• The Research Recap: 42-NICU Strategies, Pain Relief, Music Therapy & Mobile Clinics

  In this episode of Behind the Latch, Margaret Salty reviews four new studies with big implications for hospital, NICU, and community-based lactation care. From evidence-based pain relief strategies to debunked interventions and mobile clinic models that build breastfeeding confidence, this Research Recap delivers practical takeaways for IBCLCs working across settings.Study 1: Breast Milk Smell/Taste Exposure Before Tube FeedsThis randomized controlled trial examined whether exposing very preterm infants to the smell and/or taste of breast milk before tube feeds improves growth or reduces length of hospital stay.Key findings:No significant difference in weight gain or time to dischargeIntervention group: 715g weight gain vs. 657g in control (p = 0.60)No impact on secondary outcomes like NEC or breastfeeding at discharge🔍 Implications for IBCLCs:Be cautious about implementing new NICU interventions without strong evidencePrioritize time and resources toward proven strategies (skin-to-skin, milk supply protection, cue-based readiness)Set realistic expectations with NICU families about evidence-based supportCitation: Fonseca, L. G. R., et al. (2025). The lack of benefit of exposing the premature infant to breast milk smell and/or taste before tube feeding: A double-blind randomized clinical trial. Breastfeeding Medicine. https://doi.org/10.1089/bfm.2025.0042Study 2: Breastfeeding as Pain Relief During Blood DrawsA quasi-experimental study evaluated the effect of breastfeeding during blood sampling in infants under one year old.Key findings:FLACC pain scores were 2.6 in breastfed infants vs. 6.7 in controlsBreastfed infants had more stable vitals, less crying, and quicker recovery63% of non-breastfed infants experienced severe pain—compared to 0% in the breastfeeding group🔍 Implications for IBCLCs:Advocate for breastfeeding during minor procedures like heel sticks and venipunctureUse this study to educate hospital staff about non-pharmacologic pain reliefReinforce for families: breastfeeding isn’t just for nutrition—it reduces painCitation: Sharbat, R., et al. (2025). Effect of breastfeeding on pain intensity among infants during blood sampling. Minia Scientific Nursing Journal, 17(2), 46–62.Study 3: Music Therapy & Milk Supply in NICU MothersThis study explored the effects of music therapy on milk volume and stress in NICU mothers using Indian classical ragas.Key findings:Milk volume was slightly higher in the non-music groupBut the music therapy group showed significant reductions in stress and cortisol levelsSuggests music may improve milk supply indirectly via stress reduction🔍 Implications for IBCLCs:Music therapy may not boost output directly—but it supports maternal well-beingLower stress = better lactation outcomes long-termRecommend calming music as a low-cost, adaptable intervention in NICU or home settingsCitation: Dixit, S., & Singh, B. (2017). Impact of music therapy on amount of breast milk secretion among mothers of premature newborns. International Journal of Life Sciences, Biotechnology and Pharma Research, 6(12), 5–8.Study 4: Nurse-Led Breastfeeding Mobile Clinics in IndiaThis community-based study evaluated a nurse-led mobile lactation clinic serving postpartum families in Gurugram,...

  --------  

  14:10

  --------

  14:10
• IBCLC Ethics, Formula Partnerships & Protecting Our Scope with Nicole Longmire, IBCLC

  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: [email protected]📸 Instagram: @margaretsalty📘 Facebook: Margaret Salty🎙 Hosted by: Margaret Salty🎧 Guest: Nicole...

  --------  

  42:11

  --------

  42:11

More Education podcasts

Trending Education podcasts

About Behind the Latch