Breastfeeding medicine has existed for decades. Now it’s a board-certified subspecialty.

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When Katherine Standish, MD, gave birth to her first child, preterm at 28 weeks, while she was in medical school, she had the unusual advantage of having a mother by her side who was one of the country's leading experts on breastfeeding medicine.

But even with this expertise, Standish struggled. The experience inspired her to change the trajectory of her medical career and follow in her mother's footsteps, to help others in similar situations.

Though the field of breastfeeding medicine has existed for decades - the Academy of Breastfeeding Medicine (ABM) held its first conference in 1995 - it has gathered momentum in recent years.

The first breastfeeding medicine fellowship, Lessons in Lactation Advanced Curriculum (LILAC) - based out of the University of Rochester (UR) School of Medicine and Dentistry, in New York, and offering a two-year, remote curriculum for physicians and advanced practice providers - launched in 2022, graduating its inaugural class of 12 fellows in 2024.

The subspecialty reached another milestone in 2023, with the founding of the North American Board of Breastfeeding and Lactation Medicine (NABBLM) and the creation of a board-certification exam. Since then, more than 200 physicians in the United States and Canda have passed the exam.

"We are starting to reach a tipping point for visibility," says Karen Bodnar, MD, the medical director of Breastfeeding and Lactation Medicine at Inova Health System in Virginia, an associate clinical professor at the University of Virginia School of Medicine, and one of the founders of NABBLM.

"New graduates of medical school and residency are seeking out this training," adds Standish, who was one of the inaugural LILAC fellows and cofounded the Breastfeeding and Lactation Medicine Center at Boston Medical Center. "We have more and more providers who are of child-bearing age, are bearing children during training, are struggling with breastfeeding, and are realizing there's a huge lack of support," not only for trainees but for all new mothers.

The need

In the United States, as of 2022, more than 85% of infants were breastfed at some point. But that percentage goes down to 62% at 6 months old, and only 28% of infants were exclusively breastfed until 6 months old, according to the Centers for Disease Control and Prevention (CDC). The American Academy of Pediatrics (AAP) recommends that babies be fed breast milk exclusively until 6 months old and receive breast milk and complementary foods for at least two years.

The World Health Organization has set a 2030 target for having 60% of all infants be breastfed exclusively until they are 6 months old, citing research that suggests breastfeeding has health benefits for both babies and mothers, including immune protection and a lower risk for diabetes for the baby and a reduced risk of some cancers for the mother.

Some research suggests that a majority of moms experience trouble breastfeeding, which can lead them to turn to formula, even if they intended to breastfeed exclusively. There are many reasons for this, but among them are a lack of parental leave or accommodations in the workplace, misinformation, early introduction of formula in the hospital, and social norms that make breastfeeding more challenging, according to the ABM.

While many issues can be resolved with education and the help of a peer or an international board-certified lactation consultant, some dyads (the term for a breastfeeding parent and infant pair) face complex medical issues that can benefit from the added expertise a breastfeeding medicine specialist can provide.

In 2025, Casey Rosen-Carole, MD, MPH, and other leaders in the field published a scope-of-practice paper to define the role and need for this subspecialty. It highlights the medical complexity of caring for both the mother and child (or children, in the case of multiples) and the bridge the specialty provides between pediatrics and adult medicine. Although breastfeeding medicine specialists often work in concert with other lactation professionals, they are trained and licensed to diagnose conditions, prescribe medications, and perform or refer for surgeries, when necessary.

Breastfeeding medicine specialists can treat a range of conditions, including low supply related to endocrine disease or postpartum hemorrhage; recurrent mastitis (painful inflammation of breast tissue) or abscess; difficulties breastfeeding for babies who started life in the neonatal intensive care unit; and lactation inducement for adoptive or non-gestational parents, Bodnar says.

At the same time, Bodnar adds that she and other breastfeeding medicine specialists sometimes need to help mothers cease breastfeeding.

"It's about diagnosing the problem so we can give people advice that allows them to make the best choice for them," Bodnar says. "I sometimes say to my patients, 'I'm not a "lac-tivist." I'm a physician who takes care of problems with lactation.'"

Rosen-Carole adds that, despite some framing of breastfeeding advocates as the "breast police," breastfeeding and lactation medicine providers strive to make their practices welcoming to all parents, no matter their feeding choices.

"I tend to tell families that breastfeeding is worth a lot, but it is not worth everything. Parents make choices every minute of every day about what is best for their kids, and the hardest part of parenting comes down to making choices between two options that are neither of them perfect," she says. "None of these should be reduced to whether or not a mom was 'successful' with breastfeeding."

Rather, Rosen-Carole says, energy should be directed toward improving public policy and providing more comprehensive training for health care providers, so they can better support moms who want to breastfeed.

"When you learn about the breast, you should learn about more than breast cancer, which is all I learned," she says.

A gap in training

Like Standish, Rosen-Carole was surprised by how challenging she found it to breastfeed her first child after completing her pediatrics residency.

"I thought I was very well trained and knew everything about kids," she says. "Now that I know what I know, the advice I got was terrible. I felt really betrayed by the medical field."

Rosen-Carole returned to work six weeks postpartum and had to stay late to make up for any time she took to pump, taking time away from being home with her newborn. On top of that, her breast pump did not fit or function properly, and her lactation consultant, whom she spoke with on the phone, didn't ask her about these problems so she could get more support.

"I remember sobbing as we gave my child formula, because I felt like such a failure. With my second, when I knew more - but still not enough - and had better support, I had an oversupply. So, I knew I could have done it with my first had anyone bothered to check on me," she says. "I wanted to make sure that no other parent got such bad support from health care, but also that they would not be given such rigid advice that they felt like a failure if they needed to supplement!"

Rosen-Carole went on to study under Ruth Lawrence, MD, who was one of the first woman physicians to intern at Yale University, in the 1950s, and is considered a trailblazer in the field of breastfeeding medicine. Bodnar was turned on to breastfeeding medicine by Lawrence's son, Robert Lawrence, MD, who was a physician at the University of Florida, where she attended medical school and residency.

Ruth Lawrence, who had nine children, was among the first physicians to research lactation and to advocate for recognition of the treatment of breastfeeding problems as a field of medicine. In 1979 she and her son, Robert, cowrote Breastfeeding: A Guide for the Medical Profession, which was long the main resource for medical education on breastfeeding. She died in 2025 at the age of 101.

Rosen-Carole says that Ruth Lawrence and others championed the cause of breastfeeding medicine for decades, advocating and mentoring the next generation of subspecialists, but that the field lacked a formal framework that could help it grow. That's why she helped found the UR medical school's Division of Breastfeeding and Lactation Medicine, the first of its kind, and leads the LILAC fellowship. She's also the president-elect of ABM.

"It took the entitlement of being the third generation of women in medicine to be able to look at this and say, 'We don't need to be the exception. We need to be the rule,'" she says.

Julie Ware, MD, a breastfeeding medicine specialist at Cincinnati Children's Hospital Medical Center and the president of ABM, says that some medical schools offer limited education about breastfeeding, even though most physicians will treat people who are breastfeeding in their practices.

"My children were born in the 1990s, and in my training program it was barely mentioned at all," she says. "Thankfully, more women want to breastfeed, so it's become a necessity for physicians to know how to help them. The advancement of the field was born out of a necessity because we have so many families breastfeeding."

That includes physicians and trainees. In 2000, about 23% of physicians were women. In 2025, women accounted for 55% of medical school matriculants.

Rosen-Carole says she's seen more physicians, trainees, and other advanced practice providers seek out breastfeeding medicine, often because of their own experiences with breastfeeding.

And Bodnar has gradually increased the Inova Breastfeeding and Lactation Medicine clinic's influence on trainees. All pediatric and OB-GYN residents, and some family medicine residents, do a rotation in breastfeeding medicine. More recently, the hospital's breast-surgery fellows have started spending two weeks in the clinic.

"[Almost] every single type of doctor takes care of patients who are lactating," Bodnar says. "The learners are really hungry for the education."

Research and advocacy

In addition to training providers and treating patients, the ABM includes research and advocacy among the pillars of its mission.

In previous decades, research into breastfeeding was mostly focused on identifying its benefits. In recent years, researchers have analyzed the makeup of breast milk, to better understand how it helps provide immune protection and informs gut health for the baby. Some research has also highlighted disparities, such as Black moms receiving less support with breastfeeding from their birthing hospitals, as compared with white moms.

But leaders in the field say there has been a dearth of research into the common and complex medical problems that arise during breastfeeding, and how to better treat them.

"We still don't know the best treatment for mastitis, the best pumping regimen to increase milk supply, or the best supplement of formula to keep the baby well fed while addressing breastfeeding problems," Standish says.

Bodnar adds that many public health initiatives around breastfeeding focus on the patient's intention to breastfeed and less on addressing the barriers to doing so.

Among these is a lack of diagnostic codes (used for insurance billing and research) that appropriately describe the work that breastfeeding medicine specialists do.

"There's a code for being bit by an orca, but there's no code for breast pump trauma or unintended weaning," Bodnar says.

The ABM advocates for hospitals to achieve a Baby-Friendly hospital designation, which means their providers abide by the Ten Steps to Successful Breastfeeding guidelines endorsed by AAP, the CDC, and other medical professional organizations. It has also published position statements supporting at least six months of paid maternity leave and the recognition of breastfeeding as a basic human right.

As the field continues to grow, its leaders say that they hope that more people in and out of the medical field will recognize both the complexity of breastfeeding and the value that supporting healthy breastfeeding can bring to society.

"I would love to get people out of the mindset that this is 'just a mom-baby thing,' which people may or may not do in their homes," Rosen-Carole says. "It is a complex biological process with a huge social component that requires support at every level."