As a lactation professional, your role in supporting and guiding mothers on their breastfeeding journey is invaluable. Ensuring that your advice is grounded in the latest and most reliable scientific evidence is crucial for providing the best possible care. However, the sheer volume of research available can make it challenging to find and evaluate the right information quickly and effectively.

As a researcher and lactation instructor, my passion is to give all lactation professionals the tools to stay up-to-date with lactation research and the skills to search for and apply current evidence to their lactation practice. 

In this blog post, I will provide you with practical strategies for locating high-quality scientific papers and evidence-based resources. From navigating key databases and utilizing advanced search techniques to critically appraising the credibility of studies, I’ll help you enhance your practice with the most current and robust evidence. Join me as I delve into the tools and methods that will empower you to stay at the forefront of lactation science and provide optimal support to the families you serve.

I will give you a practical example of a lactation literature search that you can conduct on your own in an hour with just Google Scholar.

Start with a Question

Let’s say you work at a hospital as an IBCLC in a mother-baby unit. Nipple shields are one of the tools you have at the hospital to help when babies are having trouble latching. A new pediatrician just started at the hospital and she raised her concern with your manager about nipple shield use because she claims it leads to poor milk transfer. You are tasked with providing the most current evidence to your manager and the pediatrician about the impact of nipple shields on milk transfer.

To conduct a search for research, first start with a question:

Do nipple shields impact milk transfer in breastfeeding infants? 

Step 2: List Your Keywords

To search for articles about your topic, you’ll use keywords. Keywords are crucial when searching for research articles because they help ensure a thorough, efficient, and comprehensive search for your topic. Start by breaking down the research question into core concepts. Next, create a list of acceptable keywords for your topic from those core concepts. Think of synonyms, related terms, and variations for each core concept. This will help ensure you capture all relevant articles, regardless of the specific terminology used by different researchers.

For the topic of nipple shields and milk transfer, our core concepts are nipple shield, milk transfer, and infant. Here are keywords for these core concepts:

• infant
• baby
• newborn

Step 3: Conduct Your Search

Next, you’ll begin your search in your favorite database. You can use Google Scholar, PubMed, Science Direct, or your university or hospital library. There are several techniques you can use to conduct a thorough search. In the video below I’ll walk you through a search using Google Scholar, but all of the databases work similarly and the same search tools will work. 

• Search using Boolean Operators
  • Use AND to include all keywords
    • nipple shield AND breastmilk transfer
  • use OR to include either of the keywords
    • infant OR newborn
• Use allintitle: to require all of the keywords to be present in the title
  • allintitle: nipple shield breastmilk transfer
• Use the minus sign – to excluse a keyword from the search
  • baby -preterm
• Use double quotation marks ” “ to search for exact matches
  • “nipple shield”
• Use date to search by year or custom date range
  • since 2014
  • 2020-2024

Step 4: Review and Refine Your Search

Analyze the initial search results to assess their relevance. Refine your keywords and search strategy based on the articles retrieved. If you find too many irrelevant articles, narrow your search by adding more specific terms or using the AND operator. If you find too few articles, broaden your search by adding synonyms or using the OR operator. You can e

Step 5: Review

Once you’ve narrowed down your list of articles based on accessibility, credibility, age, and keywords, the next step is to review the abstracts for relevance. Remember, the abstract gives us a brief overview of why the paper was written, the methods, and the outcomes.

Start with the Background section. This will describe with the aim of the paper. You should be able to tell from here if this paper answers your research question. In this scenario, we are looking at the impact of nipple shield use on milk transfer. Studies that look at milk transfer should be included. Studies that look at other things like breastfeeding duration, maternal attitudes, etc., should be excluded.

Next, look at the Methods section. This section will give a brief description of how the data was collected and who the participants were. In this scenario, we are looking at nipple shield use on the mother-baby unit only. Therefore, I’d eliminate any studies that include preterm babies in the NICU.

Step 6: Disseminate Your Findings

After you’ve completed your search and narrowed down your results to high-quality, accessible articles, you can read and disseminate your findings. For the search you did regarding nipple shields and breastmilk transfer, here are some of the findings:

• The authors found no relationship between nipple shield use and 24-hour milk production. (Coentro et al., 2021, a) 
• Milk production and milk transfer were not impacted by nipple shield use.  (Coentro et al., 2021,b).
• Nipple shields may reduce milk removal. Mechanistic study conducted by evaluating milk removal using a breast pump, not an infant at the breast. May not be directly generalizable to a baby at the breast. (Coentro et al., 2020). 

In conclusion, while some studies suggest that nipple shields can have a positive impact on milk transfer and breastfeeding duration, there are also concerns about their potential negative effects. The decision to use nipple shields should be made cautiously, considering individual circumstances and with appropriate guidance to ensure optimal breastfeeding outcomes.

With the step-by-step instructions that I’ve given you with this relevant lactation example, you should be able to conduct your own search for lactation literature using Google Scholar. The next time you are confronted with the need to find evidence to support or inform your practice, you will be able to efficiently and effectively locate high-quality scientific research in record time. Happy searching!

Bonus Tip: Managing Your References

Effectively managing references is crucial when conducting scientific research. It helps keep your work organized, makes it easier to cite sources accurately, and ensures that you can quickly retrieve and review relevant studies. Here are a few ways to manage your references:

Google Scholar: My Library

• By clicking the star at the bottom of the citation in your search results, you can save the citation to your Google Scholar Library account.
• Within My Library you can create labels to categorize your citations by topic or action. (For example, “nipple shields” or “to read”.)

Create Folders for Research Articles

• Create folders or collections for different topics or sections of your research.
• Use tags or keywords to further categorize references based on specific themes, methodologies, or other relevant criteria.

Bonus Tool: Using AI to Search for Research Articles

Scite is ChatGPT for research. It is a tool that uses AI to analyze and index scientific literature. Its primary aim is to provide deeper insights into how research papers are cited by other articles, offering a more nuanced understanding of the impact and reliability of scientific studies. See below how it works: 

Drawing Conclusions

To learn more about how to critically analyze research papers, such as understanding methods, recruiting, conclusions, limitations, and how to apply the findings to your own work read my post: Mastering Critical Analysis: A Guide for Lactation Professionals to Evaluate Research Papers.

References

Coentro, V. S., Lai, C. T., Rea, A., Turlach, B., Geddes, D. T., & Perrella, S. L. (2021, a). Breast milk production in women who use nipple shields for persistent nipple pain. Journal of Obstetric, Gynecologic & Neonatal Nursing, 51(1), 73–82. https://doi.org/10.1016/j.jogn.2021.09.005

Coentro, Viviane S., Perrella, S. L., Lai, C. T., Rea, A., Murray, K., & Geddes, D. T. (2021,b). Impact of nipple shield use on milk transfer and maternal nipple pain. Breastfeeding Medicine, 16(3), 222–229. https://doi.org/10.1089/bfm.2020.0110

Coentro, Viviane Silva, Perrella, S. L., Lai, C. T., Rea, A., Murray, K., & Geddes, D. T. (2020). Effect of nipple shield use on milk removal: A mechanistic study. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-03191-5