I’m bringing back the “Postpartum Insights” series, and today we’ll be speaking with a local International Board Certified Lactation Consultant (IBCLC) and Nurse Practitioner (NP), Tiffany Haddad of MilkBodySoul. I am so excited to speak with Tiffany as there tend to be so many questions surrounding newborn feeding for my clients and new parents in general. Tiffany has had her private practice right here in Hoboken for four years and recently brought on a new colleague, Jori, who is also an IBCLC and Certified Nurse Midwife (CNM). I am so excited to share some of Tiffany’s vast knowledge with you today as she covers a variety of topics surrounding newborn and infant feeding.

Tiffany has a ton of experience in this space and has also exclusively breastfed her three children! Something unique about her practice is that she offers full-spectrum care for feeding your baby, from the beginning all the way through the weaning process and everything in between and her credentialing as a Nurse Practitioner allows her to work with your provider and prescribe medications related to lactation, if required. In addition to her work experience, Tiffany is also a mama of three, wife, volunteer as both a Girl Scout Leader and a La Leche League Leader, a runner, hiker, camper and skier!

Tiffany, thank you so much for your time! I would love to start off by what an IBCLC is and how it is different from a Lactation Consultant/Counselor.

An IBCLC stands for International Board Certified Lactation consultant. There are many workers in the field of lactation and many confusing acronyms for these people! 

LC/CLC/CBS/CBE are all acronyms used by workers who may have some additional training in lactation. Often times they are people who are on their journey of becoming an IBCLC or are other healthcare providers who wish to expand their knowledge in lactation to help benefit the care they already provide (for example: your pediatrician, chiropractor, or labor and delivery nurse may also have CLC or CBS after their credentials). Most often you can become a certified lactation counselor, certified breastfeeding specialist or certified breastfeeding educator by, first, having a passion to help lactating families! Secondly, by taking an online course (20-120 hours) followed by a short at-home online exam.  

An IBCLC is an internationally recognized process that includes both an online component (90 hours of education), in-person hands on clinical training (300-1000 hours), and a certain amount of collegiate credits in science and research followed by the successful completion of an internationally recognized exam (proctored at an examination site). The rigor of this process helps to provide families with care coming from a person who has a wider lens of knowledge of lactation and the complexities that come with it. 

While general lactation education topics can certainly be addressed by an LC/CLC/CBS/CBE, a particularly tricky case could require higher level knowledge and a more holistic-wide scoped approach provided by an IBCLC.

How can parents tell if their newborn is satiated after a feeding?

A great question, and I would say this is at the heart of most cases I see. We typically live in a society where we are able to “see to believe '' but nursing can be challenging for most as it requires looking at other signs and symptoms that the baby is well fed without being able to quantify the volume. This also requires confidence in ourselves and bodies as women and confidence in our intuition. 

There are many signs that a baby is satisfied from nursing but it might change as baby gets older. Smaller babies tend to roll their hands into fists when hungry and become more loose, limp and sleepy after feeding. In general, babies less than 2 weeks that are well fed will want to wake every 3 hours. They will also have pretty consistent patterns of waking, eating and sleeping without much support needed to get them to sleep. 

Older babies have similar signs, however they may not fall asleep after feeding but should perhaps start with a bit of a crankier attitude (i.e. hangry) and end the feed in a good, happy, and playful mood (or want to sleep).

Other signs to look for in conjunction to the above would be a mom who feels that her breasts are softer after feeding and who doesn’t have any pain during feeding sessions. 

More importantly than the per feed satisfaction I like to look at the bigger picture- is the baby making enough pee and poop? Is weight gain steady? Is mom feeling that feeds are enjoyable and satisfying and that she has enough time between feeds to care for herself?

There seems to be a lot of chatter in this space about tongue and/or lip ties. What are they and when would a family know if they need to get their child evaluated?

This is a very hot topic for sure! In all transparency I go back and forth daily between “are ties over-diagnosed” or “are ties under diagnosed”?

Tongue or lip ties are typically classified in classes from 1-4.  This number attempts to roughly estimate mobility of the tongue based on the frenulum (skin tissue) that connects our lips to our gums and our tongue to the floor of our mouth. Tighter/shorter frenulums will cause less mobility of lips and tongue. Nursing requires a lot of action from the tongue and lips! If a baby can’t adequately move their tongue they will certainly learn to compensate- maybe by using their jaws (ouch!) or by squeezing tightly with their lips to hold onto mom’s nipple. 

Unlike diagnoses such as high blood pressure and high cholesterol that come with hard subjective numbers and parameters for diagnosis, the movement of the tongue is a bit tricker to quantify. Here are a few symptoms that can certainly lean toward a tongue or lip tie affecting breastfeeding:

• Maternal symptoms: pain, cracking of nipples, low supply, frequent plugged ducts or blebs, white or purple nipples after nursing, or nipples squished flat after feeding

• Infant symptoms: clicking noise during feeding, spilling milk during feeding, tight & narrow gape that worsens over time, poor tongue extension (not sticking tongue out of mouth or doing so causes tongue clefting at tip), very slow and frequent feedings, slow weight gain

Of course all of the listed symptoms could be related to other causes from both mom or baby’s end. I think it is incredibly important to rule out all other causes of these symptoms so we can feel confident of the root causes as we develop a plan together. If you do suspect a tie may be affecting your baby or your nursing it's strongly recommended to meet with a feeding therapist or IBCLC before evaluation. It's a lot like meeting with a physical therapist before you jump into getting surgery.

When would someone reach out to you for services or what would you tell a woman if she’s thinking she needs feeding help?

I love to have moms reach out before they deliver baby. We often don’t talk about nursing or see nursing or lactating happening in public so most of us come to this part of motherhood with little to no knowledge on the topic.  Prenatal visits are a great way to develop a plan of care and learn about lactation before parents are overwhelmed and sleep deprived!

Otherwise I think if mom or baby are having any discomforts or just not enjoying the journey it’s a great time to meet to see what we can improve to make this easier and more enjoyable for mom or baby.

If mom is having any pain while still in the hospital from latching, I would say email me right away so we can solve this before pain turns into greater nipple discomfort. The same logic applies for baby, if they’re having issues regaining weight or losing too much weight (>10%) in the early days so we can find the root cause and troubleshoot early. 

My main priority in all consultations is to make mom feel confident and to ensure she is enjoying feeding her baby- which makes each and every visit very unique to each family!

Can a mama work with you if she’s doing combo feeding (breast and bottle or pumping)?

Oh absolutely! Going back to my main priority (moms enjoyment and confidence) combo feeding works great for many, many families to meet this goal. I often help parents to use several tools we have available (pumps, formula, donor milk, bottles, pacifiers, etc.) to ensure everyone in the house is happy, comfortable, and well-fed! 

Lastly, do you have any advice for navigating the newborn/postpartum season?

Yes! Get help! Learn everything you can before baby comes. Ask everyone about their experiences and journeys (then leave some of that info behind and take what works for you). Give yourself grace. Some moments will be magical and many others will be really, really difficult. 

Most importantly and often the most overlooked- families need to develop a plan for how they will take care of MOM! Babies are well cared for by the community, families, and friends- but encouraging mom to ask for help for herself is a constant work in progress.

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If anything from this conversation resonated with you, you can reach Tiffany via her website to schedule a consultation for services. As previously mentioned, Tiffany is experienced in working alongside you and your child’s existing care team and welcomes a collaborative environment to set you and your family up for success. 

Andrea Yates at Caring for You Doula is a postpartum doula based in Hoboken, NJ, serving families across northern NJ- Hudson, Essex, Bergen, and Union Counties. She is passionate about nutrition for new moms, the postpartum period, and helping parents navigate this time with confidence. Contact her today to set up a free consultation on how she can help care for you and your family during this amazing time.