About the Speaker

Acquiring new knowledge about breastfeeding and lactation is an ongoing professional responsibility for all who work with new families. Marsha’s presentations endeavor to provide evidence-based practice guidelines, hands-on suggestions for remediation of breastfeeding problems, and insight into making changes at the institutional level. Professional offerings span a wide range of subjects including clinical, advocacy, systems changes, and breastfeeding as a public health issue. Whether it is a hospital in-service, WIC workshop, regional perinatal program, or large professional association conference, all material is tailored to the needs of the target audience.

Official Bio for Brochure

Marsha is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently on the board of directors of the Massachusetts Lactation Consultant Association and is the Executive Director of the National Alliance for Breastfeeding Advocacy.

Bio for Introduction

Marsha is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently on the board of directors of the Massachusetts Lactation Consultant Association and is the Executive Director of the National Alliance for Breastfeeding Advocacy.




Presentations

Look what they’re doing! Formula marketing assault on exclusive breastfeeding

Time-frame: 60-120 minutes
CERP: yes

Infant formula marketing has become more intense. As formula companies vie for positioning, customers, and leverage over infant feeding decisions, exclusive breastfeeding has come under attack. Formula companies, especially new and smaller ones trying to break into the market have endeavored to change the narrative on how babies are fed. They are trying to capture the breastfeeding market by redefining infant feeding to that of combination feeding, creating a market where none existed before. Exclusive breastfeeding is positioned as a problem, with formula as the solution to encourage combination feeding as the norm. A blitz of ads on social marketing sites vilify exclusive breastfeeding, use paid influencers to persuade mothers to add formula to their infant’s diet, and tell mothers that it does not matter how they feed their baby. New formula companies have partnered with healthcare platforms, breast pump companies, and retailers to promote combination feeding and desensitize parents to the benefits of breastfeeding. This presentation will expose these new marketing tactics and offer interventions to counter a well funded campaign to erase exclusive breastfeeding.

Armoring parents against infant formula marketing tactics: Countering the snow job

Time-frame: 60-120 minutes
CERP: yes

Sophisticated marketing techniques such as artificial intelligence, data mining, history sniffing, machine learning, and predictive analytics are utilized to capture buying history, pregnancy status, secure contact and other personal information, and craft emotional appeals to consumers. Social media and digital marketing reach deep into the marketing psychology used to convince parents to purchase infant formula. Formula companies have hijacked science to convince sleep-deprived parents that their products are solutions to common infant behaviors. This presentation exposes deceptive infant formula marketing tactics, the current push to encourage combo feeding, the psychology of formula marketing, and how to arm parents to recognize and resist the allure of infant formula. Exposure of these tactics may help parents understand how they are being manipulated and deceived by sophisticated marketing and reduce the success of the predatory threat to breastfeeding.

The WHO Code–Who Cares?

Time-frame: 60-120 minutes
CERP: yes

The International Code of Marketing of Breast-milk Substitutes and subsequent resolutions is a set of recommendations for member states of the World Health Organization (WHO) designed to regulate the marketing of breastmilk substitutes, feeding bottles and teats. It is often referred to as the ‘ WHO Code’. It was introduced in 1981 in response to the concerns being raised about the marketing of breastmilk substitutes in developing countries. The WHO Code was adopted as a resolution by the World Health Assembly (WHA), the decision-making body of the WHO, in May 1981. The Code aims to contribute ‘to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution’.
The United States voted against the adoption of the Code and has since made little attempt to adopt any portion of the Code into regulation or law. Infant formula marketing has become ubiquitous and highly sophisticated using techniques such as artificial intelligence, data mining, predictive analytics, machine learning, and history sniffing. Social media influencers and celebrities promote infant formula and even healthcare professionals collaborate with formula companies. Some people, organizations, businesses, and government entities think the Code is outdated, irrelevant, and ignore the implication of not meeting their obligations under the Code. Adherence to the Code reduces the specter of conflicts of interest, serving to advance the priority of breastfeeding and the provision of human milk. The Code places the interests of underfinanced national governments and non-governmental organizations promoting breastfeeding against those of multinational corporations that make hundreds of millions of dollars annually marketing infant formulas.

This presentation will encompass the history and purpose of the Code, its provisions and subsequent resolutions, the obligations of healthcare professionals, organizations, and governments, what Code violations look like, why the Code is still relevant, how to remain Code compliant, and what can be done to advance provisions of the Code. Code compliance is challenging, and this presentation will look at real-life situations, work through common questions and challenges to the Code, and build your knowledge and skills surrounding Code issues to meet professional credential requirements regarding the Code.

Probiotics in the NICU: Helpful or Harmful?

Time-frame: 60
CERP: yes

During the fall of 2023, the FDA issued a series of
warnings about the use of probiotics in preterm infants.
The FDA reported that an infant died after receiving
a commercially available probiotic . It contained the infantis subspecies of the live bacterium
Bifidobacterium longum. The infant died after developing
sepsis from the bacterium, which was a genetic match
to the bacteria contained in this probiotic product.
Probiotic use in preterm infants has been associated
with more than two dozen other reported adverse
events in the United States since 2018.

The FDA reminded healthcare providers that these products have
neither undergone an FDA premarket review evaluation for safety and effectiveness nor have been
evaluated for compliance with the agency’s manufacturing
and testing standards for drugs and biological products,
including testing for extraneous organisms.

Given the ongoing controversy regarding the use of
probiotics for hospitalized preterm infants, the fact that
the FDA has not approved any probiotic product for
use as a drug or biological product in infants, and
the known NEC risk reduction effect of human milk,
lactation personnel may wish to
improve breastfeeding practices in the NICU as an
important intervention in reducing the risk of NEC
and to consider implementing evidence-based breast-
feeding and human milk feeding policies and practices,
such as those that incorporate baby-friendly principles
into the NICU.

Suggestions for improving breastfeeding practices in the NICU will be provided.

Chrononutrition…or can breastmilk tell time?

Time-frame: 60-90
CERP: yes

Chrononutrition is the intersection between nutrition and the body’s circadian rhythms. A selfsustained molecular oscillator, composed of clock genes, is located in all cells of our body. This oscillator drives rhythmic expression of clock-controlled genes, which make up 10–20% of a tissues’ transcriptome (all the gene readouts present in a cell). This results in a nearly 24-hour rhythm, which drives circadian variations in hormone levels, enzyme activity, and cellular activity in most cells of the body. The maturation of circadian rhythms in infants takes several months. Circadian rhythmicity is demonstrated in various breastmilk components. Breastmilk is often fed to infants at a time of day different from the time it was collected. Does this mean we need to change our recommendations for feeding expressed milk? This presentation will explore why infant circadian rhythm development is important, the circadian rhythms of breastmilk components, the potential effects of consuming mismatched breastmilk, and potential interventions based on chrononutritional concepts.

The infant formula shortage: What are we really short on?

Time-frame: 60-90
CERP: yes

The response to the infant formula shortage in the United States focused on increasing access to infant formula. The formula shortage was caused by a convergence of factors including market concentration of formula manufacturers, lax federal policies, supply chain issues, short-sighted legislators and policy makers, and regulations favoring the the continued monopoly in formula manufacturing. Absent from the response and discussion was how to reduce the demand for infant formula. This presentation will review the multiple contributors to the formula crisis, the players involved in precipitating the formula shortage, and interventions to reduce the demand for infant formula. Such interventions include enacting a national paid family leave policy, what is needed to be done by and for stakeholders in the breastfeeding arena, implementing the International Code of Marketing of Breastmilk Substitutes, interventions by state and federal agencies, etc. Discussion will also include examples of how to decrease the pervasive creep of infant formula use.

Lab Values and Lactation

Time-frame: 60-90
CERP: yes

Laboratory values during lactation can be a helpful assessment tool when working with issues such as insufficient milk
production, overproduction, delayed lactogenesis II, acute and chronic health conditions, non-binary lactation, adoptive
nursing, and puzzling infant symptomatology. Labs can be drawn for many hormones or nutrients such as prolactin, thyroid
hormones, estrogen, progesterone, testosterone, iron, vitamin B12, zinc, A1C, and vitamin D. Values can also be studied in
human milk. While there are published normal ranges for the above, ranges during lactation differ and can be inconsistent
between laboratories and depending on which types of tests are used. One value outside the range of normal does not provide
a complete picture of what may be causing a problem. Lab values can also be influenced by nursing patterns, diet, medications,
health status, and metabolic status. This presentation will explore lab values related to lactation, what they could mean, and
potential suggested interventions.

Exclusive pumping: Pros, cons, and considerations

Time-frame: 60-75 minutes
CERP: yes

Approximately 85% of mothers have expressed milk sometime since their infant was born. About 5.6% of these mothers exclusively pump their milk. There are many reasons for this and a number of unanswered questions regarding the practice–do the same health advantages accrue to the exclusively pumping mother compared with a parent that directly breastfeeds (reduction in reproductive cancers, type II diabetes, myocardial infarction, metabolic syndrome)? Are there different health outcomes for the infant? Is pumped milk equivalent to milk directly fed from the breast? Expressed milk can be exposed to nutrient degradation through handling, storing, and even altered depending on which bottle-feeding system is used. Bacterial richness is lower in pumped milk which can alter the infant gut microbiome. Milk lypolysis can occur during storage causing an off odor and rancid flavor. Breastmilk components communicate the time of day to infants through a process called chrononutrition and may not be circadian matched. Milk pumped during the day is different than milk pumped at night. This presentation will explore the many nuances of expressed breastmilk, breast pumps, pumping more effectively, typical problems and possible interventions. Recommendations will be provided for a healthy, successful experience.

Just one bottle—helpful or harmful?

Time-frame: 60 minutes
CERP: yes

Can one bottle of formula (or more) really affect a newborn infant or derail breastfeeding? While it may sound harmless and helpful, bottles of infant formula given to newborn breastfeeding infants have been shown to interfere with the successful establishment of breastfeeding, reduce both the exclusivity and duration of breastfeeding, and permanently alter the infant gut microbiome. One bottle of formula per day for the first week of life is enough to shift the gut microbiome toward proinflammatory taxa, a condition where gut inflammation becomes the precursor to both acute and chronic diseases and conditions such as autoimmune diseases and obesity. Yet, some infants and maternal situations may require medically indicated supplementation, so how can unwanted side effects of infant formula be reduced or prevented? This presentation will explore the side effects of just one bottle, discuss scenarios where a supplement may be needed, and present approaches and alternatives to the high rate of formula supplementation seen in some hospitals and in the early days following birth.

Hypoglycemia, hyperbilirubinemia, excessive weight loss, and dehydration: breastfeeding’s nemesis quartet

Time-frame: 60-90 minutes
CERP: yes

Unfortunately,hypoglycemia, hyperbilirubinemia, excessive weight loss, and dehydration can sometimes be unwelcome visitors to the start of breastfeeding. These entities can be interconnected, anxiety-provoking, and potentially a breastfeeding deal breaker, leading to supplementation or abandonment of breastfeeding. This quartet has its origins in the early hours and days of breastfeeding relative to hospital policies, skilled support, and careful monitoring of at-risk mothers and infants. This presentation will explore the etiology of these conditions, preventive measures, and suggested interventions. A look at policies, crucial observations, and what mothers and clinicians need to know will be discussed.

Can you solve these mysteries? Puzzling case studies that challenge our skills

Time-frame: 60 minutes
CERP: yes

Case studies present realistic, complex, and contextually rich situations, often involve a dilemma, conflict, or problem and are used in problem-based learning. They give students practice identifying the parameters of a problem, recognizing and articulating positions, evaluating courses of action, and considering different points of view. Cases can be used not only to teach scientific concepts and content, but also to develop skills and opportunities for critical thinking. The brain is hard-wired for processing stories and case studies can be engaging, can facilitate learning, and can leave a lasting impression of how to use the process of deduction. This presentation will allow participants to engage in an interactive discourse to solve complex clinical breastfeeding case studies such as insufficient milk in a mother with spina bifida occulta, an infant with multiple sign and symptoms culminating in a vitamin B12 deficiency, a mother with insufficient milk production due to a polymorphism in cellular zinc transport. Participants will use their knowledge of anatomy, physiology, and lactation acting as detectives to discover the etiology of selected breastfeeding problems and develop a plan of care for each scenario.

Mammary dysbiosis: Probiotics, vibration, and turmeric?

Time-frame: 60 minutes
CERP: yes

Mastitis can be an unwelcome and debilitating visitor to breastfeeding mothers. The mammary gland has its own microbiome that can be affected by reduced polymorphonuclear neutrophil recruitment during the first 3 months postpartum as well as the receipt of antibiotics during the last trimester of pregnancy. This can leave the breast vulnerable to pathologic bacterial overgrowth. Mammary dysbiosis is a process whereby the population of potential pathogens increases at the expense of the normal mammary microbiota. Multi-resistance to antibiotics plus tricky evasion techniques engaged in by bacterial agents can result in microbes that are elusive to antibiotic therapy. Therefore new strategies are needed for the treatment of this threat to continued breastfeeding. This presentation will explore new possibilities in treatments for mastitis the inflammation and mastitis the infection. Agents such as probiotics, vibratory techniques to disrupt blocked milk ducts, and even turmeric (turmeric contains the chemical curcumin which is a strong anti-inflammatory) will be discussed.

Insufficient milk: Etiology and interventions (or where has all the milk gone?)

Time-frame: 60 minutes
CERP: yes

Insufficient milk (real or perceived) is a major reason for formula supplementation and the abandonment of breastfeeding. Much of this issue can be attributed to mismanagement of early breastfeeding or a slow start due to multiple factors such as birth interventions, maternal diabetes and/or obesity, breast anomalies, and infants factors that preclude appropriate milk transfer. Interventions depend on the etiology of the cause and range from simply more breastfeeding all the way to milk expression and the use of galactagogues. There are however some situations where none of the traditional interventions work to resolve the problem. Is there something else going on in cases where our usual tricks don’t work? New research has identified two areas of concern–genetic and environmental. This presentation will go beyond the common etiology and interventions and look more deeply into genetic and environmental contributors to low milk supply.

Nipple shields: useful or useless

Time-frame: 60-90 minutes
CERP: yes

Nipple shields have been used for hundreds of years by mothers to capture leaking milk or manage sore nipples. More recently they have been used as a tool to achieve latch and milk transfer in infants having difficulty with these tasks. Controversy surrounds the use of this tool as there are both pros and cons regarding their use and desired and undesired outcomes. The newborn mouth is a sensitive area with specialized cells tasked with oral tactile recognition. Nipple shields can provide a platform for easier latch and milk transfer in situations of low oral vacuum, upper airway alterations, oral anomalies, and a host of other conditions. However, a rigid nipple shield has the potential to be recognized as a decoy or substitute for the soft pliable breast, can mask the olfactory orientation to the breast, and can act as a super stimulus during a critical period of time when breast recognition is taking place. This presentation will explore the concepts of imprinting, super stimulus, critical periods of time, the development of a conscious mouth image, alterations of the suck central pattern generator, as well as the small amount of research on the use of nipple shields and their effect on breastfeeding.

Top 10 new lactation tidbits

Time-frame: 60 minutes
CERP: yes

The field of lactation is constantly changing with new research, skills, equipment, policies, and data constantly being added to our knowledge base. A look at Pub Med at the National Library of Medicine shows the online availability of more than 39,000 articles when the term “breastfeeding” is searched. Keeping up with the volume of new publications can be daunting. This presentation will discuss the top ten newest items in lactation and breastfeeding research as a means of updating clinicians in what’s the newest in the field. Some of it may be surprising!

Nipple confusion: Yes, no, maybe?

Time-frame: 60-75 minutes
CERP: yes

Ambiguity exists regarding the term “nipple confusion.” Various definitions have been put forth to describe an infant’s difficulty with latching or feeding at breast following exposure to artificial nipples. Conflicting recommendations may further cloud the topic, as the World Health Organization recommends that no artificial nipples be given to neonates while the American Academy of Pediatrics recommends the use of pacifiers as a method to prevent sudden infant death. Sucking at the breast requires a different mouth conformation than does sucking on an artificial nipple. Once exposed to an artificial nipple, some neonates experience a preference for the artificial nipple, refusing the breast or demonstrating difficulty in attachment to the maternal breast. This presentation will explore definitions and evidence for and against this phenomenon, discuss whether nipple confusion is a cause or result of breastfeeding difficulties, examine the differences between the properties of the human nipple/areola and the artificial nipple, discuss the concept of imprinting, and strategize interventions that may provide remedies for infants with latching and feeding difficulties following expose to artificial nipples.

Delayed lactogenesis II: the waiting game

Time-frame: 60-90
CERP: yes

​Delayed lactogenesis II can be the source of much anxiety and frustration along with early formula supplementation and eventual early abandonment of breastfeeding. A number of risk factors influence the delay in milk coming in that include cesarean delivery, primiparity, obesity, preterm delivery, retained placenta, polycystic ovarian syndrome, prenatal SSRIs, and diabetes. Assessment and interventions for both clinicians and mothers will be discussed.

Breastfeeding and Employment

Time-frame: 60-90
CERP:

​Returning to employment following childbirth and continuing to breastfeed present significant challenges to new mothers. This presentation explores the legislative and employer environment for breastfeeding employees as well as discusses how to best help mothers prepare for the return to work. Specific breastfeeding plans for the return to work based on the age of the infant will be presented as well as tips for addressing common problems. 

Ouch! Nipple and Breast Pain (can a nipple actually be too short?)

Time-frame: 60-90
CERP: yes

Nipple and/or breast pain can be a breastfeeding deal-breaker. If breastfeeding is not supposed to hurt, then why do so many mothers experience pain while breastfeeding? Is it maternal anatomy, faulty physiology, infant sucking alterations or anamolies? This presentation will look at nipple anatomy, the changes nipples experience during pregnancy, precursors and causes of nipple pain, and the magic number of 7 millimeters. Can 7mm serve as a screening tool for potential breastfeeding problems? If nipple pain is bad, then what about breast pain? An exploration of breast pain looks at the contributors to an unwelcome lactation guest.

Supplementing Breastfeeding with Formula: Help or Hype

Time-frame: 60-90
CERP: yes

The pressure for breastfeeding mothers to supplement with formula has escalated with the recent publication of a paper claiming that formula supplementation in the hospital increases breastfeeding duration and the simultaneous appearance of a new formula specifically labeled for breastfeeding supplementation. This hardly seems a coincidence! This presentation is designed to deconstruct claims that formula increases breastfeeding duration, examine the new formula, and explore the potential hazards and side effects of early formula supplementation.

Cracking the Code: Demystifying the International Code of Marketing of Breastmilk Substitutes

Time-frame: 60-90
CERP: yes

The International Code of Marketing of Breastmilk Substitutes (The Code) has gained increased visibility relative to the ethical practice of health care providers and the health care system. More hospitals are engaged in the Baby Friendly process whose foundation rests on the Code. Continuing education offerings from breastfeeding coalitions and organizations are trying to adhere to the principles of the Code, as are individual lactation consultants and other health care professionals. Manufacturers and distributors of products covered under the Code are constantly changing their marketing of products, making it difficult to know who is Code compliant and who isn’t. How can we keep up with all of this? And by the way, what does the Code really say about some of the scenarios we are faced with today? How do we adhere to both the letter and the principles of the Code? Who can help with the sticky questions? This presentation will take a look at the Code, validate its continued importance (no, it’s not out of date!), and help make it relevant to current clinical practice.

Breast pumps and pumping protocols

Time-frame: 60-90
CERP: yes

Have we gone too far with pumping? Do we really need a breast pump in every postpartum hospital room? Is it a toy or does it really work? What’s with all these pumps? More and more mothers are using breast pumps for a variety of reasons. This presentation looks at the why of pumps, pump history, how pumps work, how to select the best pump for the situation, pumping scenarios, creation of pumping protocols, and how to integrate hand expression into the pumping regimine. We will also explore problems with pumps and pumping, safety issues of pumps, and the use of previouly used pumps.

Stemming the Tide of Supplementation

Time-frame: 60-90
CERP: yes

Supplementation of the breastfed infant has been steadily increasing over the years, reducing the rate of exclusive breastfeeding and increasing the likelihood of premature weaning. This presentation explores the reasons for necessary and unnecessary supplementation, as well as when, why and how to supplement if necessary.

Birth Interventions and Breastfeeding

Time-frame: 60-90
CERP: yes

Most mothers giving birth experience a myriad of interventions. Many of these affect breastfeeding and the infant’s acquisition of early feeding skills. This presentation discusses many interventions from labor medications and IVs to separation and crying and their affect on the breastfeeding dyad. Suggestions to remediate problems associated with birth interventions are presented.

Breastfeeding and Obesity

Time-frame: 60-90
CERP: yes

Overweight and obesity are at epidemic proportions. Both conditions complicate pregnancy, childbirth, and lactation. This presentation looks at the evidence for the protective effects of breastfeeding upon the development of overweight and obesity, especially in infancy and childhood. Also covered is how obesity affects lactation and the possible complications to breastfeeding that overweight and obesity present. Interventions for remediating these problems are offered.

Breastfeeding and Diabetes

Time-frame: 60-90
CERP: yes

Diabetes (Type 1, Type 2, and Gestational) are all increasing among the general population and especially in childbearing women and their children – much of it as a result of the increasing rates of overweight and obesity. This offering discusses each type of diabetes as it relates to breastfeeding or the lack of breastfeeding and looks at the potential complications to breastfeeding that diabetes can present. Recommendations for diabetic breastfeeding mothers are presented.

Improving Maternity Care Practices: Raising Your mPINC Score

Time-frame: 60-120
CERP: yes

In 2007, all US birthing facilities received a survey from the CDC asking questions regarding maternity care feeding practices and policies related to breastfeeding. In 2008, the CDC sent facility-specific scores to responding hospitals assigning them a score based on how close they came to evidence-based best practices. This talk covers how to use your facility’s score as a tool to create a more supportive environemnt for breastfeeding families.

Breastfeeding the Late Preterm Infant

Time-frame: 60-90
CERP: no

This offering reviews the vulnerabilities of the late preterm infant (34-37 weeks) and offers specific guidelines for breastfeeding these babies and protecting the mother’s milk supply.

Marsha Walker RN, IBCLC


Country: USA
Phone number: 781-893-3553
Email: Marshalact@gmail.com
Download CV

Publications

Breastfeeding Management for the Clinician: Using the Evidence, 5th edition

Breastfeeding Management for the Clinician: Using the Evidence is the perfect tool for busy clinicians who need a quick, accurate, and current reference. It provides the essentials of breastfeeding management to support best outcomes for breastfeeding families. Now in an updated and modernized fifth edition, this unique resource features new information on the political and social landscape of breastfeeding, LGBTQI+ families, milk sharing, exclusive pumping, new breastfeeding products, breastfeeding in emergencies, additional feeding care plans, and access to downloadable Patient Care Plan Handouts to help both patients and clinicians navigate common breastfeeding challenges and questions. Breastfeeding Management for the Clinician: Using the Evidence, Fifth Edition includes literature reviews while covering incidence, etiology, risk factors, prevention, prognosis and implications, interventions, expected outcomes, care plans, and clinical algorithms. With a focus on the practical application of evidence-based knowledge and a problem-solving approach, this reference helps busy clinicians integrate the latest research into their everyday clinical practice.