A Paradigm Shift for Lactation Care in the NICU with Joanie Randle

In this episode of Behind the Latch, Margaret Salty interviews Joanie Randle, RN and clinical research nurse at Nationwide Children's Hospital. Joanie introduces her innovative Comprehensive Lactation Care Model—a paradigm shift in how lactation support is delivered to NICU families. Drawing from decades of experience and deep roots in La Leche League, Joanie outlines how a consistent, anticipatory, and relationship-based model can improve outcomes for preterm and medically complex infants.Randle, J. (2024). The case for a paradigm shift in lactation care for NICU families: A comprehensive lactation care model. Journal of Human Lactation, 41(1), 34–38. https://doi.org/10.1177/08903344241299722Joanie’s Journey into Lactation SupportJoanie shares how:Her early days as a La Leche League leader sparked a lifelong passion for lactation support.Her nursing career took her from bedside NICU work to clinical research and maternal-child health.She recognized the disconnection between early feeding guidance and actual practice in NICUs—fueling her vision for a new care model.What Is the Comprehensive Lactation Care Model?Joanie explains:The model starts with prenatal or antepartum lactation education, especially for parents anticipating NICU stays.One consistent lactation provider follows the family from prenatal contact through postpartum and NICU discharge.Lactation professionals are embedded into the clinical team—attending rounds, monitoring milk supply, and ensuring communication flows between staff and family.Aims and Structure of the ModelThey explore:The primary study goal: whether early, structured lactation education increases mother’s milk provision during the NICU stay.The use of customized, repeated visits to build lactation skills and confidence.How lactation providers serve as care coordinators, bridging the gaps between parent, clinical team, and hospital systems.Clinical Culture Shift: IBCLCs at the TableJoanie highlights:IBCLCs are often excluded from clinical decision-making and viewed as either miracle workers or rigid idealists.Full integration means treating mother’s milk as medicine—not a lifestyle choice—and supporting the dyad holistically.The NICU requires a specialized skill set that goes beyond latch and includes an understanding of maternal and infant health conditions.Structural Barriers and Real-Life SolutionsThey discuss:The need to preemptively address insurance and pump access before delivery.How pump routines should be personalized—not standardized—for maternal well-being and long-term success.The importance of repeated education post-delivery, especially for mothers who didn’t receive antepartum support.Moving from Theory to PracticeJoanie and Margaret talk about:The need for administrative buy-in and physician champions to implement the model.Collaboration with maternal-fetal medicine and NICU leadership to flag high-risk dyads early.Plans for training and developing specialized NICU IBCLC education alongside Claire Eden.Guest Info:Joanie Randle is a nurse, clinical researcher, and lifelong lactation advocate. She currently works at Nationwide Children’s Hospital and is developing research around her Comprehensive Lactation Care Model. She and colleague Claire Eden are leading efforts to revolutionize NICU lactation support.📧 Email: [Available upon...

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