The Research Recap: 34-Staff Training, Roy Model, Marmet Technique, and Insufficient Milk Supply

Behind the Latch

In this episode of Behind the Latch, Margaret Salty reviews four recent articles from Clinical Lactation that offer powerful insights for IBCLCs. From training healthcare providers to improving exclusive breastfeeding through theory-based counseling, to comparing hand expression and pumping in the NICU, and exploring the link between nipple shields and the perception of insufficient milk—this episode translates current research into real-world clinical strategies.

Key Studies and Takeaways:

1. “Evaluation of a Breastfeeding Education Intervention for Healthcare Professionals in Idaho”

Citation: Karroum, K., & Clarkson, G. (2024). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2023-0040

• A 50-minute training significantly improved provider knowledge, confidence, and intention to improve breastfeeding support
• 60.5% of participants planned workflow changes, including improved screening and referral practices
• Training was based on Merrill’s First Principles and the Theory of Planned Behavior
• IBCLCs can play a key role in designing and implementing similar in-service education to drive systems change
• Even brief, focused interventions can shift primary care culture

2. “The Effect of Counseling Based on the Roy Adaptation Model on Mothers’ Infant Feeding Attitude and Anthropometric Measurements of the Baby: A Randomized Controlled Study”

Citation: Bilgiç, F. Ş., & Karaahmet, A. Y. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0014

• RAM-based prenatal and postpartum counseling dramatically increased exclusive breastfeeding (95% vs. 40%)
• Improved maternal feeding attitudes and reduced early weaning consideration
• Intervention included prenatal education, phone support, and in-person follow-ups
• IBCLCs can use RAM as a structured, holistic counseling model
• This theory-driven approach addressed physiological, emotional, social, and role adaptations to breastfeeding

3. “Effectiveness of Manual Expression of Breast Milk: Marmet Technique in Production of Breast Milk Among Mothers Whose Babies Are in the Neonatal Intensive Care Unit”

Citation: Kotsu, K., Nayak, S., & Sunanda, B. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2023-0013

• Marmet hand expression produced significantly more milk than manual pumping in all sessions
• Technique, not maternal characteristics, determined milk volume
• Highlights the value of teaching structured hand expression in NICU settings
• Offers a zero-cost, accessible method for parents struggling with pumps or in low-resource settings
• IBCLCs should integrate Marmet technique into both prenatal and NICU care plans

4. “Risk Factors for the Perception of Insufficient Milk: A Prospective Study”

Citation: Oliva-Pérez, J., Simonelli-Muñoz, A. J., Oliver-Roig, A., & Richart-Martínez, M. (2025). Clinical Lactation, 15(3–4), 231–239. https://doi.org/10.1891/CL-2024-0017

• 18.6% of mothers developed perception of insufficient milk (PIM) by 1–5 months postpartum
• Nipple shield use during the hospital stay was the strongest predictor of later PIM (OR = 4.78)
• IBCLCs should monitor shield use closely and ensure appropriate follow-up and weaning
• Education on normal feeding patterns and growth spurts is essential to prevent misinterpretation of milk supply cues
• Even low-risk dyads with strong early feeding may develop PIM without continued support

Conclusion:

These articles remind us that impactful breastfeeding support doesn’t always require complex interventions—sometimes it’s about the timing, the technique, or the tools we teach. From provider education to hospital practices to counseling models, IBCLCs can use this evidence to inform better care for every family.

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Credits:

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