About the Speaker

Jarold “Tom” Johnston is a midwife and lactation consultant. He obtained his Bachelor’s degree in Nursing at Austin Peay State University in Clarksville, Tennessee, his Masters Degree in Midwifery at the University of Rhode Island in Kingston, and his Doctorate in Nursing Practice at Francis Payne Bolton School of Nursing at Case Western Reserve University, Cleveland OH. He served 27 years in the US Army and retired as the Chief of Midwifery Services for Womack Army Medical Center, the largest Maternal-Child service in the Department of Defense.  Since retiring Tom has spent his time as an Assistant Professor of Nursing at Methodist University where he teaches undergraduate nurses, specializing in Maternal-Child Nursing and Nutrition. Tom is uniquely placed as a man in both Midwifery and Human Lactation and the father of eight breastfed children. He has spent his career advocating for the rights of fathers in the perinatal arena and has spoken on a variety of topics at conferences around the world, to include the GOLD Lactation and GOLD Perinatal, but also at several conferences around the country and abroad.  In his written work he routinely addresses fatherhood and the role of the father in the breastfeeding relationship, has advocated for better science in the field of bedsharing and has authored a chapter on the role of the father in breastfeeding for “Breastfeeding in Combat Boots: A survival guide to breastfeeding in the military”.  If you are looking for some good night time reading to help you sleep, you might also want to read his work on Self-Efficacy in the Encyclopedia of Nursing Research or the Clinical aspects of breastfeeding in the Encyclopedia of Clinical Nursing.  He is a board member for the Lactation Education Accreditation and Approval Committee (LEAARC) and the chair of the International task-force for the three pillars of the lactation profession (ILCA, IBLCE, and LEAARC).

Official Bio for Brochure

Tom Johnston is unique as a midwife and lactation consultant and the father of eight breastfed children.  Recently retired after 27 years in the US Army, he is now an Assistant Professor of Nursing at Methodist University where he teaches, among other things, Maternal-Child Nursing and Nutrition. You may have heard him at a number of conferences at the national level, to include the Association of Woman’s Health and Neonatal Nurses (AWHONN), the International Lactation Consultant’s Association (ILCA), or perhaps at dozens of other conferences across the country. In his written work he routinely addresses fatherhood and the role of the father in the breastfeeding relationship and has authored a chapter on the role of the father in breastfeeding for “Breastfeeding in Combat Boots: A survival guide to breastfeeding in the military”.

Bio for Introduction

Tom Johnston obtained his Bachelor’s degree in Nursing at Austin Peay State University in Clarksville, TN and his Masters in Midwifery at the University of Rhode Island in Kingston, RI, and his Doctorate in Nursing Practice at Francis Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OH.   He retired from the Army as the Chief of Midwifery Services for Womack Army Medical Center in Fort Bragg NC after 27 years of service. He now uses his unique perspective to instill information and enthusiasm about Maternal-Child nursing to undergraduate nursing students at Methodist University in Fayetteville North Carolina. Tom is an frequent speaker on such topics as the father’s role in breastfeeding, the molecular biology of human lactation, and the Microbiome. He is the author of various publications on breastfeeding, nursing, and self-efficacy, and even has a blog to answer questions called “Sage Homme’s Breastfeeding Blog”


Developing Clinical Skills in Lactation

Time-frame: 60
CERP: yes

The field of Human Lactation is a new profession.  Much of what we use comes from apprenticeship programs and hard learned lessons from a mother’s own personal experience.  The lactation profession needs to investigate several of their practices and policies to discover what is evidence based and what is anecdotal evidence.  This presentation explores the practices commonly employed in breastfeeding (growth monitoring, infant positioning, the use of assisted feeding devices, and counseling skills) to determine which are evidence based and which will require further study if they are to be used in clinical practice.

Promoting provider self-efficacy in breastfeeding support

Time-frame: 60 minutes
CERP: yes

40 years of public health messaging has worked tremendously.  We have met the HP2020 goals of >80% breastfeeding initiation, you are to be congratulated.  Unfortunately, what we have missed is providing clinical skills training to our health care providers.  We now have a majority of new families initiating breastfeeding and very few people prepared to care for them when there is trouble.  Research shows that 80% of new families experience clinically significant breastfeeding problems in the first two months of lactation, and physicians and nurses are woefully unprepared to help.  This leaves the families without care and unprepared for what may be a difficult and painful struggle.  This presentation discusses the research regarding health care provider education and reports on studies that may demonstrate and effective way to encourage provider self-efficacy in breastfeeding support.

The Perinatal Microbiome

Time-frame: 60-90 minutes
CERP: yes

There is much to learn about the perinatal microbiome, What is it? What can it do? What do we do about it? How do our practices in the birth arena affect the long term health of women and their children? This presentation will scratch the surface of this exciting new area of research.

The Maternal-Newborn Microbiome or The “Oro-boobular” axis: What do we know and what does it mean?

Time-frame: 60 minutes
CERP: yes

Did you know that a mother who breastfeeds her child is more likely to “match” as an organ donor than a mother who does not breastfeed her child? How does that happen?  The answer may lie in the Maternal-Newborn Microbiome, AKA “The Oro-boobular” axis.  The scientific world is exploding with excitement over the discovery of the microbiome. While it appears clear that suckling infant’s intestinal microbiome communicates with the mother’s lactocyte and perhaps beyond, little is known about the effects of this communication in practical terms.  This presentation will review what is known and attempt to explain what it means, both now and in the future.

Preventing the First Cesarean Section

Time-frame: 60
CERP: no

Despite the known risk factors, Cesarean Delivery rates continue to climb in much of the western world.  Yet, the risk of cesarean delivery varies as much as 10 fold from hospital to hospital in America.  It seems clear that individual provider and hospital practices has more to do with cesarean rates than maternal-fetal wellness.  This presentation will discuss practices shown to decrease the risk of cesarean section and will discuss what the Labor and Delivery nurse can do to help prevent cesarean section within their facilities.

Human Milk Production: Just when you thought you knew

Time-frame: 60 minutes
CERP: yes

“I didn’t make enough milk!” We hear it on a regular basis from heartbroken new mothers.  In fact, this is the number one factor contributing to breastfeeding failure after two weeks of age is a perception of inadequate milk production.  This phenomenon of sudden onset lactation failure is widely accepted as a common occurrence among breastfeeding mothers.  This topic has been the subject of a number of quality studies that have yielded a conflicting mix of responses from primary health care providers and lactation consultants alike. This discussion will attempt to shed light on the very different concepts of “Milk Production” vs. “Milk Synthesis” and will demonstrate how confusion between those two concepts have clouded the study of milk production, promote the fallacy of “insufficient milk production syndrome”, and contribute to the failure of breastfeeding.  This presentation will also attempt to provide a preliminary course of action to begin anew in milk production research and perhaps even provide a framework for helping the new mothers facing the milk supply challenge.

Still Swimming Upstream: Breastfeeding in a Formula feeding world

Time-frame: 60 minutes
CERP: yes

In 1995 Chris Mulford published a timely article on the difficulties faced by breastfeeding mothers in a formula feeding culture.  That article was as accurate then as it is today.  This discussion will focus on continued difficulties faced by breastfeeding mothers in a society that is still decidedly focused on the formula feeding.  We will discuss the concept of “culture” and how it impacts breastfeeding, discuss the routine actions in the hospital that contribute to the formula feeding culture, and identify the prejudices of both society in general and the average American mother-baby unit against breastfeeding.

Iatrogenic Breastfeeding Complications

Time-frame: 60 minutes

This presentation discusses the common nursing role types in the hospital and how these character traits (which most nurses recognize either in themselves or their colleagues) lead to many of the most common breastfeeding complications seen in the first months of life. Note: This session is a humorous look at ourselves and those we work with. Most who see this presentation laugh at their own weaknesses and point at colleagues that they see represented in the stories I tell.  This presentation focuses primarily on nurses.

A Father’s Role in Breastfeeding (newly updated for 2020)

Time-frame: 60-90 minutes
CERP: yes

Fathers are an undervalued resource in breastfeeding, often ignored or treated with indifference. This presentation highlights the unique role of fathers as both the Co-Parent of the child and the mother’s primary care giver upon discharge from the hospital.  We will discuss the literature regarding the impact that fathers have on breastfeeding and how they can be used more effectively to support breastfeeding.  The presenter will also provide an insight into the male mind and how to effectively communicate with fathers. It also covers effective teaching strategies to bring fathers into the breastfeeding relationship.  Newly updated for 2020

Jarold (Tom) Johnston

Country: United States of America
Phone number: 910-964-7679
Email: jjohnston@methodist.edu
Download CV


COVID-19 Illness: Mother-Baby Separation, Viruses, and Breastfeeding

This study highlights the long known, but easily overlooked benefits to breastfeeding in the face of infectious diseases. Initial fears over infection lead the CDC and health care professionals to isolate newborns from their COVID positive mothers, effectively doubling the chance that the newborn would become COVID positive while in isolation.

Objectives: Some hospitals have instituted separation of mothers and their newborn(s) when SARS-CoV-2 is suspected or confirmed in the mother. Limited data are available for SARS-CoV-2 vertical transmission, including studies on breast milk. This article looks at SARS CoV-2 case
studies and data to date as well as prior pertinent research.
Methods: Informal searches of PUBMED, CINAHL and Ovid Emcare were used to identify early reports of vertical transmissions of the novel Coronavirus, case reports, and population based reports of early evolving protocols and their outcomes. As this is a novel virus the authors used
previously identified anti-infectivity and antiviral mechanisms of human milk on other similar viruses to guide analysis. Further this article reviewed the well established literature regarding the risks of undue infant separation which negatively affect nearly every aspect of infant and
maternal health.
Results: Informal searches conducted in the spring and early summer of 2020 identified 14 early reports attempting to analyze the initial and evolving global response to SARS-CoV-2 and the effects of the virus on the maternal-infant dyad.
Conclusion: The feasibility of single-family rooms and support for breastfeeding as an alternative approach that addresses many of the risks favorably and reduces economic cost, both in lifetime disease burden and direct care are discussed. Initial reports seem to indicate that immediate
separation of the mother from her newborn is likely to increase the risk to both mother and infant.

Development and Interrater Reliability of the Lactation Assessment Care Tool (LACT)

This study is a validity and reliability study for a discharge screening tool for newborns with breastfeeding difficulty.

Background: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. Research Aim: To describe the development, content validation, and interrater reliability of the LACT.

Methods: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff’s alpha.
Results: An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument.

Conclusion: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

Incorporating “Father-Friendly” Breastfeeding language in maternity settings

The purpose of this commentary is to provide perinatal providers with the tools they need to incorporate fathers into the breastfeeding relationship. Research shows that engaged fathers increase initiation rates, decrease the rate of breastfeeding complications that lead to premature cessation, and increase the duration and exclusivity of a mother’s breastfeeding efforts. Despite this evidence, studies frequently show that fathers report being ignored or excluded from breastfeeding education. This is likely an oversight on the behalf of perinatal providers rather than a conscious effort. Ultimately, however, perinatal providers need to be prepared to address the concerns of all parents who will provide care to the infant and not the mother alone. This commentary discusses the value of fathers as breastfeeding supporters and offers evidence-based teaching strategies requested by fathers. This commentary also identifies and describes 4 father-friendly breastfeeding promotion resources and highlights the techniques used to draw fathers into the mother’s breastfeeding efforts.

Johnston & LeRoy (2018) Engaging and Supporting Fathers with Breastfeeding Partners. Clinical Lactation 9(1); 18-22

This article explores the need for healthcare professionals to address fathers’ concerns regarding engagement and supportiveness with breastfeeding partners. Fathers often feel left out during the partner’s perinatal care and do not get the same amount of education and support, especially regarding breastfeeding. The desire to have practical information that is specifically related to the paternal figure is a common complaint among fathers. Educational classes involving childcare and breastfeeding information provide positive results regarding an increase in breastfeeding rates. The purpose of this article is to address the need to acquire interventions that engage and assist fathers with supporting their partners. Currently, two known programs exist to attempt to speak directly to fathers seeking practical breastfeeding advice: “Dads and Breastfeeding” and “Cribside Assistance.” However, there is still a lack of research regarding effective interventions that assist fathers and increase breastfeeding duration.


Document Type: Research Article

Publication date: February 1, 2018

“Clinical Lactation” in A Guide to Mastery in Clinical Nursing

This chapter is a brief description of Human Lactation for the nurse generalist.  It includes the major concepts of human lactation (Milk Synthesis, Milk Production, and Milk Transfer). The chapter also offers an explanation and description of the clinical assessment skills required to provide basic breastfeeding supportive care.  This chapter is intended for the generalist nurse or the newly qualified registered nurse.

“Self-Efficacy” in The Encyclopedia of Nursing Research, 4th Ed.

This chapter is a brief description of Albert Bandura’s Self-Efficacy Theory.  It includes examples of the application of Self-Efficacy Theory in Modern Nursing Research

Labor and Delivery in my Pocket: “Fetal Death”

Tom contributed a small section on perinatal loss and bereavement care to the first and second edition of this handy little pocket guide for Labor and Delivery nurses.

New route of Danazol for Endometriosis needs more study

Johnston, JT & Ericson-Owens, D. (2004) “New route of Danazol for Endometriosis needs more study” JNMWH 49(6) p. 546-8

In this article the authors discuss the use of a Danazol loaded IUD tested for the treatment of endometriosis.

On Bed Sharing [Letter]

On Bed Sharing [letter]  JOGNN 37(6), p. 619-21. Nov/Dec

In this letter to the editor the authors discuss a recent study regarding the hazards of bed sharing and attempt to counter arguments that American mothers continue to sleep with their babies despite knowing the risks.  The Authors took issue with the statistics used and the exaggerated risks portrayed in the original published article.