Behind the Latch

In this episode of Behind the Latch, Margaret Salty interviews Victoria Fonville, MS, PhD candidate in Nutrition at UNC Greensboro, about her recent scoping review on lactation during perinatal bereavement.
Together, they explore what the research actually tells us about lactation after infant loss—from the lived experiences of bereaved families to the gaps in care from healthcare providers. Victoria shares the key findings from her paper, including the four major areas studied—producing milk, support, stopping lactation, and donating milk—and the six themes that emerged: hurting, lacking, valuing, succeeding, connecting, and redeeming.
They discuss how lactation can serve as a powerful source of connection and identity for grieving mothers, why suppression is often presented as the default (and why that’s problematic), and how milk donation can be experienced as a deeply meaningful and even healing process for families navigating loss.
This episode challenges the way we approach bereavement care and emphasizes the importance of presenting all options—so families can make informed decisions that align with their goals and their grief.
Key Takeaways for Clinicians
Lactation after perinatal loss is common due to normal physiology, but remains poorly addressed in clinical care.
Bereaved mothers often experience both physical pain and emotional distress related to lactation, requiring compassionate and informed support.
“Lacking” was a dominant theme across studies, highlighting significant gaps in provider knowledge, training, and communication.
Lactation suppression is frequently presented as the only option, but this does not reflect the full range of choices available.
Producing milk can help maintain maternal identity and connection to the infant after loss.
Milk donation is often experienced as “redeeming,” helping families create meaning and process grief.
Healthcare providers should present all options—suppression, expression, donation, and keepsakes—without bias.
There is an urgent need for quantitative research to better understand care practices, outcomes, and donation patterns.
Compassion, presence, and individualized care are critical when supporting bereaved families.

Guest
Victoria Fonville, MS, PhD Candidate in Nutrition, University of North Carolina at Greensboro
Lactation During Perinatal Bereavement From the Perspective of Families and Support Providers: A Scoping Review
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Music by: The Magnifiers – My Time Traveling Machine

Dr. Bode shares his journey into human milk research and the founding of the Human Milk Institute—the only institute in the world dedicated entirely to studying human milk in all its complexity. Together, they explore how human milk research is evolving from isolated disciplines into a collaborative, systems-based science that integrates molecular biology, clinical care, and public health.
The conversation dives deep into human milk oligosaccharides (HMOs), the limitations of reductionist thinking in lactation science, and the urgent need to translate research into real-world clinical impact. Dr. Bode also shares his vision for the future, including the development of “lactology” as a formal field of study and what it would take to truly normalize breastfeeding on a global scale.
Key Takeaways for Clinicians
Human milk is far more than nutrition—it is a dynamic system of signaling, protection, and communication.
HMOs play multiple roles beyond the microbiome, including direct immune and systemic effects.
Donor milk retains key bioactive components like HMOs even after pasteurization.
Variation in milk composition across individuals and time is expected and biologically meaningful.
Clinical care must align with real-world problems—research must start with the needs of families.
Multidisciplinary collaboration is essential to advancing both science and clinical outcomes.
Maternal health directly influences milk production and composition.
Breastfeeding provides significant long-term health benefits for both infants and mothers.
Formula can improve—but it cannot replicate the adaptive, responsive nature of human milk.
Early identification of barriers and inequities is critical to improving breastfeeding outcomes.
The future of lactation care depends on bridging research, clinical care, and public health systems.

Guest
Dr. Lars Bode, PhD
Director, Human Milk Institute
Human Milk Institute
Triton Giving Day 04.29.2026

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Music by: The Magnifiers – My Time Traveling Machine

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/
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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
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Music by: The Magnifiers – My Time Traveling Machine