Triple Feeding, Scope of Practice, and Collaborative Care: A Conversation with Dr. Cindy Rubin

Behind the Latch

In this episode of Behind the Latch, Margaret Salty interviews Dr. Cindy Rubin, a pediatrician, IBCLC, and board-certified breastfeeding and lactation medicine physician, about her clinical approach to managing complex lactation cases—including the hotly debated topic of triple feeding. They explore when triple feeding is appropriate, how to support families through it, when to wean, the role of galactagogues, and how IBCLCs and breastfeeding medicine physicians can work together for better outcomes.

Dr. Rubin’s Path to Breastfeeding Medicine

Dr. Rubin shares how her own struggles with breastfeeding as a pediatrician changed her perspective:

• Realized how little she truly knew about lactation
• Became an IBCLC and later certified in breastfeeding and lactation medicine
• Left the traditional system to open a home visit and telehealth practice in the Chicagoland area

Healing the Divide: Physicians and IBCLCs Working Together

Margaret and Dr. Rubin discuss:

• The historic divide between providers and IBCLCs
• How breastfeeding medicine fills a gap—not competes with IBCLCs
• The importance of staying within scope and collaborating for comprehensive care
• Why referring to each other strengthens—not weakens—practice

Triple Feeding: What It Is and When to Use It

Dr. Rubin explains:

• Triple feeding = nursing at the breast, pumping, and supplementing
• It’s a short-term tool—not a long-term solution
• Often used when it’s unclear whether the issue is supply or transfer
• May be used as a “test” to guide next steps

When Triple Feeding May Not Be Necessary

Key points:

• If baby is nursing well but supply is low, pumping may not be needed
• Sometimes nursing + supplementing (double feeding) is sufficient
• Always consider mental health and sustainability for the parent

Pumping Frequency, Sleep, and Mental Health

Dr. Rubin emphasizes:

• Seven pump sessions with one long stretch of sleep is often better than eight with no rest
• No amount of milk is worth compromising the parent’s mental or physical health
• Customize plans based on the parent’s needs, goals, and capacity

SNS Use and Feeding Plan Flexibility

They discuss:

• Why SNS can be helpful—but isn’t right for everyone
• Feeding at the breast once or twice daily while pumping/bottle feeding the rest can reduce burnout
• The importance of patient choice and informed consent

How to Know When to Wean from Triple Feeding

Dr. Rubin recommends:

• Weighted feeds to assess if baby can take full or near-full volume at the breast
• “Boot camp” weekends where the dyad nurses ad lib without pumping or supplementing
• Watching for signs of success: swallowing, relaxed hands, diaper output, and steady weight gain

The Role of Galactagogues

Dr. Rubin explains:

• She uses galactagogues selectively, often after trying triple feeding first
• Goats’ rue may be beneficial in parents with insulin resistance or PCOS
• Always considers side effects and tailors to the individual
• Emphasizes that IBCLCs should refer, not recommend or sell galactagogues

Referral Networks and Working Across Disciplines

Dr. Rubin offers guidance:

• Use the NABBLM website to find breastfeeding medicine physicians in your area
• Understand physician licensure restrictions across state lines
• Attend conferences like the Academy of Breastfeeding Medicine to network
• Offer education (like grand rounds) at local hospitals to build relationships

Advice for Aspiring IBCLCs and Physicians

Dr. Rubin shares:

• For aspiring IBCLCs: learn to be deeply curious and a great listener
• For physicians: consider certification through the North American Board of Breastfeeding and Lactation Medicine if you're interested in filling the medical gap

Guest Info:

Dr. Cindy Rubin, MD, IBCLC, is a pediatrician and board-certified breastfeeding and lactation medicine physician. She is the founder of In Touch Pediatrics and Lactation, providing home and telehealth services in Illinois.

🌐 intouchpediatrics.com

📱 Instagram: @drcindyrubin

📹 YouTube: @cindyrubinmd

🔗 LinkedIn: Cindy Rubin, MD

Resources Mentioned in This Episode:

📌 North American Board of Breastfeeding and Lactation Medicine (NABBLM)

📌 Academy of Breastfeeding Medicine (ABM)

📌 Dr. Anne Eglash – Breastfeeding medicine pioneer

📌 Research on galactagogues and insulin resistance

📌 Goats’ rue for low milk supply with insulin resistance/PCOS

Connect with Me:

Have questions or suggestions for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Cindy Rubin

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #TripleFeeding #BreastfeedingMedicine #LactationSupport #IBCLC #Galactagogues #BreastfeedingPhysician #LowMilkSupply #LactationCare #LactationConsultant

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