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Mary Miller, Ph.D. is a 2026 graduate of the PhD Program in Leadership and Change at Antioch University.

Mary Miller at her Dissertation Defense.

From L-R: Dr. Jennifer Raymond, Committee Member, Dr. Yulia Tolstikov-Mast, Committee Chair Dr. Lisa Akers, Committee Member.

Dissertation Committee

  • Yulia Tolstikov-Mast, PhD, Committee Chair
  • Jennifer Raymond, PhD, Committee Member
  • Lisa Akers, PhD, Committee Member

Keywords

Carol Bacchi, WPR, problem representation, ankyloglossia, tethered oral tissues, breastfeeding policy, maternal and child health, clinical guidance, epistemic injustice, healthcare governance

Document Type

Dissertation

Publication Date

2026

Abstract

While breastfeeding is recognized as fundamental to global public health, oral restrictions that can affect infant latch, milk transfer, and feeding efficiency warrant further examination within policy frameworks. This dissertation proposes an expanded conceptualization of tethered oral tissues (TOTs) that encompasses not only anatomical frenal restrictions but also fascial tensions, neuromuscular limitations, and other conditions restricting orofacial function that may be congenital or acquired. The purpose of this study was to critically examine how this clinical guidance document shapes understandings and responses to TOTs. Using Carol Bacchi’s “What’s the Problem Represented to Be?” approach, a critical discourse analysis of the Academy of Breastfeeding Medicine’s 2021 Position Statement on Ankyloglossia (LeFort et al., 2021) systematically examined against WPR’s six guiding questions, with coding and thematic synthesis used to identify recurring patterns in problem representation. While the Position Statement focuses specifically on anatomical presentations of ankyloglossia, this study applies a broader functional framing of TOTs to examine how the document reflects and contributes to enduring controversies in diagnosis, care, and perceptions of clinical legitimacy. Six key topics of problem representation were identified: an emphasis on anatomy over function; professional hierarchies that may constrain interdisciplinary collaboration; selective evidence criteria that limit the inclusion of clinical and experiential knowledge; binary outcome framing that may v oversimplify maternal–infant experience; structural barriers to care; and discontinuities in how the problem has been historically constructed. These representations shape how the issue is understood, which responses are legitimized, and whose contributions are valued. While the statement is not binding policy, it functions as a governing force through professional norms, with downstream effects on care delivery and insurance decisions. The analysis suggests that simplified causal explanations risk obscuring the complexity of infant feeding concerns. Recommendations include involving interdisciplinary contributors in guidance development, integrating diverse forms of evidence, and creating feedback systems that account for clinical realities. This dissertation is available in open access at AURA (http://aura.antioch.edu) and the OhioLINK ETD Center (https://etd.ohiolink.edu/).

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Mary Miller

ORCID No.: #0009-0005-4567-4361

Dr. Mary E. Miller is a scholar-practitioner and International Board-Certified Lactation Consultant (IBCLC) with over 20 years of experience in public health and human services. Her academic focus is deeply rooted in her personal journey navigating complex breastfeeding challenges and tethered oral tissues (TOTs) with her own children, which compelled her to transition into the field of lactation.

Her dissertation, Diagnosing the Discourse, utilized a critical policy analysis to examine how a major clinical guidance document problematizes the assessment, diagnosis, and treatment of TOTs. The research, grounded in Carol Bacchi's "What’s the Problem Represented to Be?" framework, revealed how this professional discourse shapes problem understanding, knowledge hierarchies, and systemic access to care. Dr. Miller completed her PhD in Leadership and Change with a concentration in Public Policy at Antioch University, an MA in Health and Wellness (Lactation Studies) from Union Institute & University, and a BA in Communications from the University of Rhode Island.

In addition to her academic role, she owns WNY Orofacial & Infant Feeding Support Center, a specialty private lactation practice, where she treats families and mentors apprentices. Dr. Miller maintains a long-standing focus on social justice and volunteers on the Board of Directors for Rooster Sanctuary, a 501(c)3 animal rescue. She lives in Buffalo, NY with her family.

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