A myriad of factors influence the sub-optimal breastfeeding rates in the U.S. Among these factors is maternal obesity (BMI > 30 kg/m²), which has been found to negatively impact breastfeeding initiation and duration for some women. Obesity increases women’s risk for various complications throughout the perinatal period, which may impact breastfeeding and the long-term health and well-being of women and their children. However, adequate lactation support that upholds a respectful consciousness regarding the potential breastfeeding challenges of women with obesity can assist these women to successfully meet their breastfeeding goals. This review summarizes the literature on the impact of maternal BMI on breastfeeding duration, and maternal and infant risk factors that may complicate lactation for women with obesity. Recommendations for assessing and supporting the needs of mothers with obesity to best achieve their breastfeeding goals are provided.

After losing an infant, grieving mothers may still have to cope with postpartum issues, including lactation. This article reviews and addresses care options for lactation concerns after pregnancy, neonatal, or infant loss. Currently, lactation care and advice after loss varies greatly. Lactation consultants are instrumental in providing mothers with anticipatory guidance and evidence-based care. Implementing system-wide training and education regarding this topic will help families receive the information they need to deal with the physiological aftermath of infant loss.

Breastfeeding should be encouraged for every baby with few exceptions, classic galactosemia being one of them. Classic galactosemia causes death in newborns and can be identified early with newborn screening, or through the careful assessments of physicians, midwives, and lactation consultants in the first 4 days of life. All practitioners that assess newborns within the first 4 days of life should have a clear understanding of when to halt breastfeeding and when to support continuation of breastfeeding while keeping babies safe.

If a tongue-tie is to be revised, what is the best technique for accomplishing that? There is some debate in the field about whether scissors or laser is most effective. Both techniques seem efficacious. This section also addresses which professionals should be performing the revision. Our panelists represent a wide range of disciplines, so some refer, and others perform the revisions themselves.

The clinical guidance for human milk (HM) feeding for sick and premature babies in Thailand was developed in 2013 to help improve their breastfeeding rates.

Editor’s note: One of the editorial goals for Clinical Lactation was to provide a forum where IBCLCs could respectfully discuss emerging, and sometimes controversial, issues that arise in our field. The issue of peer-to-peer milk sharing is one such issue. Social media has greatly facilitated this practice. Given the rise in milk-sharing behavior, it is appropriate for IBCLCs to acknowledge its existence, understand why it occurs, and decide on an appropriate course of action. This article presents a roundtable discussion of Karleen Gribble’s recent article, Biomedical Ethics and Peer-to-Peer Milk Sharing.

The use of peer support as a tool to increase breastfeeding exclusivity and duration can be facilitated by innovative community strategies. This is especially important in a binational environment where healthcare clients are served by providers on both sides of the U. S.–Mexico border. A successful adoption of the Baby Café model of peer-to-peer breastfeeding support, developed in the U.K., has been carried out by the El Paso Baby Café and its sister Baby Cafés in Ciudad Juárez and Northern Chihuahua, Mexico.

When we asked for mothers to tell us their stories of tongue-tie, responses flooded in. A theme in many of these stories is health-care providers not listening when mothers said they were in pain. The mothers’ related stories of painful nipples, babies breastfeeding “all the time,” and failure to thrive because of low milk production. Mothers’ voices were not heard because health-care providers minimized their concerns. Most of these mothers persisted with breastfeeding despite the problems. Eventually, the tongue-ties were correctly identified and revised, and the difficulties resolved. Other mothers were not able to continue breastfeeding. A smaller percentage of mothers described revisions that had harmful effects on their babies and that did not fix the breastfeeding problems. (Editor’s Note: We, unfortunately, received too many stories to include in this issue, but we will include all of them in the Clinical Lactation Monograph.)

Parents often perceive infant gastroesophageal reflux (GER) as a serious problem. Frequently, GER is explained as a normal process, but there are instances where parents’ concerns are valid. Provided are 3 case studies from the private practice of an IBCLC. Each case initially presented with what sounded like normal infant GER. Upon further evaluation, with close follow-up and more detailed history taking, each case required advanced medical attention. These cases highlight the unique role of the IBCLC in helping to assess GER, the value of working as a team member with baby’s physicians, and the importance of listening carefully to parental instincts and concerns.