Behind the Latch

We were taught to keep our hands in our pockets. Maya Bolman was taught the opposite — by her great-aunt, a midwife in Belarus, who could take an engorged, aching breast and leave it soft in an hour. In this episode, I sit down with Maya to talk about the skill most of us were never trained in: what to actually do with our hands.
Maya Bolman is an IBCLC in Cleveland, Ohio, with 26 years in hospital lactation care and a second home at Breastfeeding Medicine of Northeast Ohio, where she works alongside Dr. Ann Witt. She's the clinician who named Therapeutic Breast Massage in Lactation (TBML), published the research behind it, and travels the world teaching manual skills to lactation professionals. In this conversation, she breaks down the physiology of engorgement (hint: it's not just milk), why we massage milk down but swelling up, and the deceptively simple technique she calls breast gymnastics. If you've ever felt underprepared the second a parent's breast is hard, painful, and stuck, this one is going to change how you practice.
What You'll Learn:
Why engorgement is really "lymphodynamic edema" — and why that one distinction changes how you use your hands
The moment Maya realized massage therapists move the breast up while lactation consultants are taught to move milk down (and why both are right)
What breast gymnastics actually is, why it takes 20 seconds, and why she tells every parent to start it today
How to know when you're "done" — the outcome to feel for instead of a number to hit
Why the 2022 mastitis protocol's silence on milk expression is, in Maya's words, "a big minus"
The difference between overstimulating a working duct and actually moving milk from the one that's stuck
Why she calls herself a lactation therapist, not a consultant — and what that reframe unlocks
How mindful latching flips the script: the parent doesn't latch the baby, she positions so the baby can latch
Where to find milk you're missing (it's closer to the nipple than you were taught)
The case for demonstrating instead of explaining — and what mirror neurons have to do with breastfeeding success

Resources Mentioned in This Episode:
Maya Bolman's website (workshops, free breast gymnastics & massage video, BreastKindness LLC): https://www.mayabolman.com
Bolman, M., Saju, L., Oganesyan, K., Kondrashova, T., & Witt, A. M. (2013). Recapturing the art of therapeutic breast massage during breastfeeding. Journal of Human Lactation, 29(3), 328–331. https://doi.org/10.1177/0890334413475527
Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation, 32(1), 123–131. https://doi.org/10.1177/0890334415619439
Witt, A. M., Bolman, M., & Kredit, S. (2016). Mothers value and utilize early outpatient education on breast massage and hand expression in their self-management of engorgement. Breastfeeding Medicine, 11(8), 433–439. https://doi.org/10.1089/bfm.2016.0100

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Music: The Magnifiers — "My Time Traveling Machine"

Low milk supply might be the most common concern we field—and one of the hardest things in lactation to actually measure. In this episode I sit down with researcher Dr. Katie Kivlighan to separate what we can quantify from what we're guessing at, and to look at the tools and technologies that are about to change how we assess it.
Episode Summary
"Low milk supply" gets used as a catch-all, but it isn't one thing—and treating it like one thing is part of why families get the wrong support. Dr. Katie Kivlighan, co-author of Measuring Low Milk Supply: Methods and Implications for Lactation Research and Clinical Practice (Journal of Human Lactation, 2026), joins me to walk through the difference between primary, secondary, and perceived low supply, and why our measurement methods have never fully caught up with the problem.
We get into what the evidence actually supports right now: test weights, milk transfer, and biomarkers like sodium and conductance—plus the emerging technologies (bioimpedance, at-home milk sodium testing) that could give us objective data we've never had at the bedside. We also talk honestly about the flip side: how devices and social media can feed parental anxiety, how normal infant behavior gets misread as a supply problem, and where clinical judgment still has to lead. If you support families navigating supply concerns, this one is about sharpening how you assess, how you reassure, and how you decide when a number actually matters.
What You'll Learn
The real difference between primary, secondary, and perceived low milk supply—and why the distinction changes your entire plan of care
Why milk supply is so hard to measure accurately, and what that means for how we interpret research
What biomarkers like sodium and conductance can (and can't) tell you about secretory activation
Where bioimpedance and at-home milk sodium testing are headed, and how to think about them before they land in your practice
The infant behaviors that get misread as low supply—so you can spot them and reframe them for families
How feeding technology and social media are driving parental anxiety, and your role in cutting through the noise
Why milk intake "standards" deserve a second look, and how normal supply variability fits in
When to bring in a breastfeeding medicine provider, and how that collaboration strengthens care
How to hold objective tools and clinical judgment together instead of letting one override the other

Chapters
00:00 — Introduction and Dr. Kivlighan's research background
05:53 — Low milk supply: types and challenges
08:12 — The role of perception in supply concerns
10:31 — Evaluating milk supply: tools and techniques
13:11 — Common misinterpretations of infant behavior
15:46 — How technology feeds parental anxiety
18:16 — Collaborating with lactation professionals
20:40 — Reassessing milk intake standards
26:39 — Understanding milk supply variability
27:20 — Emerging technologies in lactation
32:23 — Bioimpedance and milk measurement innovations
34:58 — Addressing delayed secretory activation
41:27 — The case for comprehensive lactation support
43:02 — Closing thoughts

Resources Mentioned
Kivlighan, K. T., & Demirci, J. R. (2026). Measuring low milk supply: Methods and implications for lactation research and clinical practice. Journal of Human Lactation, 42(1), 126–134. https://doi.org/10.1177/08903344261426744
Dr. Katie Kivlighan:
Faculty page
Research profile

Your Next Steps
Learn with Me: https://margaretsalty.com/courses
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Music: The Magnifiers — "My Time Traveling Machine"

In this episode, Dr. Lisa Stellwagen shares the journey of establishing a hospital-based milk bank, the science behind donor milk, and the future of infant nutrition and milk banking. Discover how policies, safety standards, and community efforts are transforming neonatal care and supporting vulnerable infants.
Chapters:
00:00 Introduction to Milk Banking and Its Importance
04:07 The Journey to Establishing a Milk Bank
05:24 The Supporting Premature Infant Nutrition Program
08:43 The Need for More Milk Banks in California
11:45 Building a Milk Bank: Challenges and Triumphs
16:52 Understanding Hambana and Milk Bank Structures
20:14 Pasteurization Standards and Safety in Milk Banking
23:58 Fortification of Human Milk and Its Implications
30:18 The Importance of Accreditation and Safety Standards
34:39 The Donor Process: Ensuring Safety and Efficiency
35:33 Processing Milk: From Donation to Quality Control
37:27 Nutritional Targeting: Tailoring Milk for Tiny Patients
40:11 Analyzing Milk: Understanding Composition and Quality
43:23 Raising Awareness: The Importance of Milk Donation
44:30 Barriers to Access: Challenges in Milk Banking
46:16 The Role of Nonprofit Milk Banks: A Community Approach
51:58 The Cost of Donor Milk and NICU Decisions
57:21 Vision for the Future of Milk Banking
1:00:21 Honoring Bereaved Donors: The Cherry Blossom Program
1:04:49 Outro

Resources
Human Milk Banking Association of North America (HMBANA)
Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical Report
Find a Milk Bank
Guest Links
HMBANA-Dr. Stellwagen
UC Health Milk Bank
Connect with Margaret
Email: hello@margaretsalty.com
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Music by: The Magnifiers – My Time Traveling Machine

In this conversation, Dr. Elizabeth Kar discusses her research on breastfeeding promotion and the challenges faced by breastfeeding families during the COVID-19 pandemic, particularly the impact of reduced lactation support and the infant formula shortage. She emphasizes the importance of lactation consultants and community support in successful breastfeeding, critiques the marketing strategies of formula companies, and calls for better policies to protect and promote breastfeeding. In this conversation, Margaret Saltysiak and Elizabeth Kar discuss the complexities surrounding infant feeding choices, particularly the challenges of breastfeeding and formula feeding. They highlight the fragility of the infant feeding infrastructure in the U.S., the lessons learned from the pandemic regarding breastfeeding support, and the critical need for paid family leave to support new parents. The discussion also emphasizes the importance of addressing the needs of vulnerable populations and ensuring equitable access to breastfeeding support and resources.

Chapters
00:00 Introduction to Elizabeth Kar and Her Work
03:03 Exploring the Triple Threat to Breastfeeding Families
06:00 The Impact of COVID-19 on Lactation Support
09:02 The Role of Lactation Consultants
11:59 The Formula Shortage and Its Effects
14:58 The Marketing Influence of Formula Companies
18:06 The Need for Better Infant Feeding Policies
21:43 The Challenges of Infant Feeding Choices
24:15 Fragility of Infant Feeding Infrastructure
27:20 Lessons from the Pandemic on Breastfeeding Support
30:25 The Need for Paid Family Leave
33:48 Addressing Vulnerable Populations in Breastfeeding Support

Guest
Elizabeth Kar, RDN, PhD, IBCLC
Triple Threat or Mere Inconvenience? Exploring the Effect of COVID-19
Precautions, Lack of Access to Lactation Care, and the Infant Formula
Shortage on Breastfeeding Behavior of Parents in the Midwest of the
United States

Connect with Margaret
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Music by: The Magnifiers – My Time Traveling Machine

Margaret interviews, Molly Waymouth, a senior policy analyst at RAND, and they discuss her research on informal milk sharing, its prevalence, risks, and policy implications. They explores how systemic barriers and economic factors influence families' choices and what can be done to improve access to safe, affordable donor milk and lactation support.
Chapters
00:00 Introduction to the Conversation
05:37 Molly's Background and Research Focus
07:10 Exploring Milk Sharing Practices
09:35 The Economics of Donor Milk
11:23 Understanding the Support Gaps
13:48 Equity and Access in Milk Sharing
16:27 Risks of Informal Milk Sharing
16:50 The Need for Comprehensive Support
18:34 Innovative Approaches to Milk Sharing
18:50 Designing an Ideal Support System
20:27 Conclusion and Future Directions
21:22 outro.mp3

Resources
JAMA Open Network Publication - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048
RAND Corporation - https://www.rand.org/
LinkedIn Profile of Molly Waymouth - https://www.linkedin.com/in/mollywaymouth/

Connect with Margaret
mail: hello@margaretsalty.com
Instagram: @margaretsalty
Facebook: Margaret Salty
Music by: The Magnifiers – My Time Traveling Machine