My Interview About PMAD, Breastfeeding, and More for the Perinatal Support Washington Newsletter

See below for the interview I did with Perinatal Support Washington (formerly Postpartum Support International of Washington), for their July 2016 newsletter.

Perinatal Support Washington


Sarah Tyack RN, BSW, IBCLC

Sarah Tyack is a registered nurse and internationally board certified lactation consultant in Seattle and the Eastside. She has over [25] years of experience working with new moms and their babies. We had the opportunity to interview Sarah regarding her experience and expertise.

What are the most common breastfeeding issues that come up in the population with whom you work?

The most common issues are low supply and sore nipples. The reasons for both of these issues can be complicated but it’s often from not getting the proper support in a timely manner.

What percentage of the women with whom you work are also experiencing a perinatal mood and/or anxiety disorder?

A large percentage. I’d say 75% of my clients have some sort of PMAD. I do a lot of emotional work with my clients. My clients are used to situations where B comes after A and C comes after B and if B doesn’t come after A, they know exactly what to do to make that happen. So when they have a baby and B isn’t coming after A, they think there’s a problem that needs to be fixed. So they search the internet to figure out how to fix these “problems.” The internet can be so undermining to new moms. There’s something to support any position you take about anything so therefore you’re always wrong. I really try and get my clients to learn how to read their baby’s needs and get off the internet.

In your experience, is there a connection between perinatal mood and anxiety disorders and breastfeeding? 

Absolutely! In my experience, there’s a strong connection between breastfeeding difficulties and perinatal mood disorders. I work with a lot of professional women who are used to feeling competent and knowing exactly how to achieve a goal. Having a baby and having breastfeeding challenges is very disarming for these women. It may be the first time in her life she doesn’t feel competent. Almost all my clients say, “I feel like a failure. I can’t even feed my baby.”

What are the most common worries or fears of pregnant women regarding feeding? 

Unless someone personally knows someone who has had breastfeeding challenges, I don’t think most pregnant women think about it. They’re very focused on the birth and think they can just figure out how to breastfeed on the internet.

Are there common “myths” or misconceptions about breastfeeding that you hear regularly?  

Moms are often surprised at how difficult it can be. They think it should be easy and instinctual and when it’s not, they feel like a failure. Other myth: Breastfeeding is supposed to hurt. If it hurts, it’s time to see a lactation consultant.

In your opinion, what are the most important things for pregnant women to know about feeding in the first several weeks postpartum?

When I teach prenatal breastfeeding classes, I focus on what to expect in the first 24 hours, the first few days, and the first few weeks. In the first 24 hours, babies only eat an equivalent of a half a teaspoon of colostrum a few times. The next 48 hours, they should be eating every couple of hours. What goes in, comes out. This is why we’re so focused on pees and poops. This is how you know if your baby is getting enough. Until the baby is back up to birth weight, moms should only go one 4 hour stretch in 24 hours without feeding. We expect babies to be back up to birth weight in 2 weeks, though most babies are there sooner. Once the baby is back to birth weight, I tell moms to nurse on demand. They don’t need to look at the clock anymore. They just need to look at their baby.

When would you recommend contacting a lactation consultant and what are the reasons somebody might contact a lactation consultant? 

The majority of calls I get are from moms with sore nipples or a baby’s inadequate weight gain. I love it when moms contact me while they’re pregnant. When I work with someone in the first few days, we’re able to nip problems in the bud. I recommend that every mom have an appointment with a lactation consultant. Since a lot of moms think this should be easy, they’re sometimes embarrassed to call or they wait until they’re so miserable with sore nipples or their baby isn’t gaining weight. Moms are often crying when they call me or are crying at our appointment.

What should a woman be looking for when searching for a lactation consultant/what questions should a woman ask before hiring a lactation consultant?

My clients often find me by looking at my reviews and my website online. Make sure this person has great, genuine and authentic reviews. Ask about the lactation consultant’s experience level, ask how long the appointment is, ask what is typically done in the appointment, ask about follow-up support.

Are there other resources available for women with feeding challenges in the community?

A personal in-home appointment with a good lactation consultant is really the best kind of resource. There are some support groups focusing on breastfeeding and other support groups focusing on emotional issues that can present themselves as a result of feeding challenges.

Any final things to consider relating to feeding and maternal mental health?

I often see moms who were given a very complicated and unsustainable plan. I always ask what her goals are and then we set out to try and achieve HER goals, not mine. Moms often forget they have common sense. Common sense goes a long way! I find myself telling my clients that this is a process and there isn’t always a quick fix. It’s important to be patient and have some self-compassion. I’m always assessing a mom’s mental health and so I don’t use a cookie-cutter plan for every mom.


Sarah has a private practice as a lactation consultant and has an excellent understanding of some of the most common and not-so-common challenges new moms encounter. She’s worked in many specialties as a registered nurse. She also volunteers as a court-appointed special advocate for kids. These varied experiences have helped Sarah look at situations with a holistic approach. For more information about Sarah and her services, please visit her website at