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  • Rethinking the Lactating Breast with Dr. Donna Geddes

    Rethinking the Lactating Breast with Dr. Donna Geddes
    2026/09/16
    What if some of what we still teach about breast anatomy, milk supply, pumping, and milk ejection is based on an outdated understanding of how the lactating breast actually works?In this episode of Behind the Latch, Margaret sits down with internationally recognized human lactation researcher Dr. Donna Geddes to explore what more than two decades of imaging the living, lactating breast has taught us.Dr. Geddes’s groundbreaking ultrasound research challenged anatomical models that had remained largely unchanged for more than 160 years. Her work has helped demonstrate that the lactating breast is far more variable—and far more complex—than the simplified diagrams many clinicians were originally taught.Together, Margaret and Dr. Geddes discuss how these discoveries translate into real clinical practice.Margaret and Dr. Geddes discuss:How Dr. Geddes went from radiography and ultrasound to human lactation researchThe history behind the traditional anatomical models of the lactating breastWhat ultrasound revealed that older breast anatomy diagrams got wrongWhy the concept of large “lactiferous sinuses” does not match what we see in the living breastHow widely milk duct anatomy can vary between individualsWhy some people can hand express milk easily while others struggleWhether having fewer lobes necessarily means a person will have low milk productionWhat we currently understand—and still don't understand—about mammary hypoplasiaWhy breast size alone tells us very little about milk-making capacityBreast changes during pregnancy and what clinicians should be asking about prenatallyThe relationship between blood flow to the breast and milk productionPregnancy complications such as gestational diabetes, preeclampsia, and fetal growth restriction as potential clues to later lactation challengesMetabolic health, inflammation, and their possible relationship to milk productionWhy identifying risk does not mean predicting failureThe importance of anticipatory guidance for families at increased risk for low milk productionWhy intensive feeding plans such as triple feeding should have clear goals and endpointsWhat ultrasound has taught us about the milk ejection reflexWhy many people do not actually feel their milk ejectionsWhy watching milk flow—or watching the baby—may tell us more than asking whether a parent “felt a letdown”Why some babies choke, sputter, or struggle with fast milk flowThe difference between anatomy-driven fast flow and true oversupplyWhy automatically trying to decrease milk production can sometimes create a new problemHow milk storage capacity differs dramatically from one person to anotherWhy frequent feeding does not automatically indicate low milk supplyWhy infant growth, behavior, milk transfer, maternal experience, and the whole clinical picture matter more than feeding frequency aloneWhy the right and left breast should not necessarily be expected to function identicallyHow researchers estimate the percentage of available milk removed from the breastWhy simply comparing pumping volumes between people can be misleadingA Bigger Lesson for Lactation ProfessionalsThroughout the conversation, one theme keeps returning:Human lactation does not fit neatly into a checklist.Breasts vary between people. The two breasts of the same person can behave differently. Milk production is influenced by anatomy, development, metabolic health, blood flow, hormones, inflammation, infant behavior, milk removal, and many other interacting factors.Understanding the science should help us individualize care—not create another rigid set of rules.What’s Coming Next?Dr. Geddes also shares some of the research underway within her team, including work examining:Flange and breast shield sizingInfant body compositionBiomarkers associated with low milk productionProteomics and metabolomicsClinical measures that could help identify low milk production earlierAntenatal and early postpartum screening toolsGestational diabetes and lactation outcomesBundled-care interventionsUltrasound phenotypingAI-supported prediction tools that may eventually help clinicians identify patterns and risk factorsThe goal is not simply to understand lactation better—it is to translate that science into tools clinicians can actually use.About Dr. Donna GeddesDr. Donna Geddes is a leading researcher in human lactation based at The University of Western Australia in Perth, Western Australia. Her research has used technologies including ultrasound, Doppler imaging, human milk analysis, and other advanced laboratory techniques to investigate breast anatomy, milk production, milk ejection, infant feeding, and lactation physiology.Her work has played a major role in reshaping our understanding of the anatomy and function of the lactating breast.Learn MoreDonna Geddes — University of Western Australia profile: UWA Research Profile This is a great primary link because it includes her biography, research projects, ...
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    1 時間 6 分
  • It's Not Magic, It's Skill: Therapeutic Breast Massage with Maya Bolman, IBCLC

    It's Not Magic, It's Skill: Therapeutic Breast Massage with Maya Bolman, IBCLC
    2026/07/08
    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 handsThe 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 todayHow to know when you're "done" — the outcome to feel for instead of a number to hitWhy 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 stuckWhy she calls herself a lactation therapist, not a consultant — and what that reframe unlocksHow mindful latching flips the script: the parent doesn't latch the baby, she positions so the baby can latchWhere 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 successResources Mentioned in This Episode:Maya Bolman's website (workshops, free breast gymnastics & massage video, BreastKindness LLC): https://www.mayabolman.comBolman, 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/10.1177/0890334413475527Witt, 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/10.1177/0890334415619439Witt, 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.2016.0100Your Next Steps:Learn with Me: https://margaretsalty.com/coursesRead the Blog: https://margaretsalty.com/blogEmail Me: hello@margaretsalty.comLinkedIn: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/Instagram: https://www.instagram.com/margaretsalty/Facebook: https://www.facebook.com/profile.php?id=61550829710885Music: The Magnifiers — "My Time Traveling Machine"
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    47 分
  • What Counts as Low Milk Supply? Measurement, Biomarkers, and What's Next with Dr. Katie Kivlighan

    What Counts as Low Milk Supply? Measurement, Biomarkers, and What's Next with Dr. Katie Kivlighan
    2026/07/02

    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
    • Read the Blog: https://margaretsalty.com/blog
    • Email Me: hello@margaretsalty.com
    • LinkedIn: https://www.linkedin.com/in/margaret-salty-drph-ibclc-ches-0133451b/
    • Instagram: https://www.instagram.com/margaretsalty/
    • Facebook: https://www.facebook.com/profile.php?id=61550829710885

    Music: The Magnifiers — "My Time Traveling Machine"

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    43 分
  • Inside the Milk Bank: Donor Milk, NEC Prevention, and the Myths That Hold Us Back with Dr. Lisa Stellwagen

    Inside the Milk Bank: Donor Milk, NEC Prevention, and the Myths That Hold Us Back with Dr. Lisa Stellwagen
    2026/06/17

    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

    Instagram: @margaretsalty

    Facebook: Margaret Salty

    Music by: The Magnifiers – My Time Traveling Machine
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    1 時間 5 分
  • What COVID and the Formula Shortage Taught Us About Breastfeeding Support with Dr. Elizabeth Kar

    What COVID and the Formula Shortage Taught Us About Breastfeeding Support with Dr. Elizabeth Kar
    2026/05/28

    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

    📬 Email: hello@margaretsalty.com

    📸 Instagram: @margaretsalty

    📘 Facebook: Margaret Salty

    Music by: The Magnifiers – My Time Traveling Machine
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    40 分
  • Informal Milk Sharing in the U.S. with Molly Waymouth

    Informal Milk Sharing in the U.S. with Molly Waymouth
    2026/05/06

    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
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    22 分
  • Rethinking Elimination Diets in Breastfeeding: What the Research Actually Shows with Dr. Trillitye Paullin

    Rethinking Elimination Diets in Breastfeeding: What the Research Actually Shows with Dr. Trillitye Paullin
    2026/04/22

    In this episode of Behind the Latch, Margaret Salty interviews Trillitye Paullin, CEO and co-founder of Free to Feed, who shares her groundbreaking work translating emerging research on food reactivity in breastfeeding into practical clinical guidance.

    Together, they unpack one of the most misunderstood topics in lactation: how dietary proteins transfer into breast milk and what that actually means for managing elimination diets. Trillitye explains why the long-standing belief that proteins remain in breast milk for weeks is not supported by current evidence—and how confusing “transfer timing” with “healing timing” has led to unnecessary dietary restriction and early weaning.

    They also explore the realities of non-IgE-mediated food allergies, why traditional allergy testing often fails these families, and how IBCLCs can more effectively assess, manage, and refer these cases.

    This conversation offers a practical, evidence-based framework that has the potential to change how clinicians support breastfeeding dyads navigating food reactivity.

    Key Takeaways for Clinicians
    • Food proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeks
    • The timeline we see clinically is often driven by infant healing, not ongoing exposure
    • Elimination diets should be reassessed early (around 5 days) to determine effectiveness
    • Not all symptoms warrant elimination—rule out more common causes first
    • Most infants with food reactivity will have symptoms emerge between 2–4 months
    • Cow’s milk and soy are the most common triggers, but other foods may be involved
    • Reintroduction is critical to avoid unnecessary long-term restriction
    • Severe symptoms or lack of improvement beyond dairy/soy elimination should prompt referral
    • Non-IgE-mediated allergies cannot be diagnosed with standard allergy testing
    • Supporting parental mental health is essential—elimination diets are a significant burden

    Guest

    Trillitye Paullin, PhD, CEO & Co-Founder, Free to Feed

    Free to Feed

    Supporting Families as They Navigate Infant Food Allergies

    Connect with Margaret

    📬 Email: hello@margaretsalty.com

    📸 Instagram: @margaretsalty

    📘 Facebook: Margaret Salty

    Music by: The Magnifiers – My Time Traveling Machine
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    1 時間 1 分
  • Lactation During Bereavement with Victoria Fonville: A Research Review

    Lactation During Bereavement with Victoria Fonville: A Research Review
    2026/04/15

    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

    Connect with Margaret

    📬 Email: hello@margaretsalty.com

    📸 Instagram: @margaretsalty

    📘 Facebook: Margaret Salty

    Music by: The Magnifiers – My Time Traveling Machine
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    26 分