Episode 43 - Breastfeeding Success with Dr Robyn Thompson
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
Mel:
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Right. Welcome everybody to this episode of the Great Birth Rebellion. And so I've lined up a super special guest who I've kind of had on my mind for a while and it's finally time. Robin Thompson has joined me, well, Dr. Robin Thompson has joined me here on the podcast today because she's a breastfeeding guru, among other things. Her PhD is in breastfeeding.
Mel:
[0:45] And so she's here to talk all things breastfeeding. We want to talk about increasing breastfeeding success and chat through strategies on how to just ensure that women actually achieve their breastfeeding goals. So I have a little bit of a disclaimer for this episode because I know that breastfeeding can be a super sensitive topic because a lot of women want to breastfeed and for some reason couldn't.
Mel:
[1:13] And sometimes it brings up feelings of defensiveness and guilt and sadness.
Mel:
[1:18] And so this episode is for women who are keen for tips on improving their breastfeeding success and we acknowledge that there are some circumstances under which women are unable to breastfeed or choose to feed their babies in other ways. We understand that breastfeeding can create a lot of joy for women but also
Mel:
[1:37] a lot of angst and disappointment if things didn't go as planned. So we just want to acknowledge that this is a sensitive and emotional topic but we are going to still hit it hard because this information is super important and just like we're trying to change the language and current situation around pregnancy and birth the same thing needs to happen for breastfeeding so we're going to do it and just like we hit everything hard in this podcast we're going to hit this information hard so if this brings up something for you make those emotions but also welcoming this information because it could change your journey for next time so well let's let's kick it off so a lot of people might not know you I've been following your work for some time and actually as a baby midwife I actually have a photo with you at my very first home birth conference which was in Echuca about oh my god I know I know about would be at least 14 or 15 years ago making it longer so yes I have a photo with you I don't know how we ended up in the same photo but it's just you and I and we were
Robyn:
[2:44] Probably up to no good.
Mel:
[2:45] Probably for sure I mean yes So talk me through your midwifery career because that's one of the things in your basket is that you're a midwife.
Robyn:
[2:57] Yeah, I think first I start with I've been 61 years in the Australian health system and that includes my wonderful nursing career. Then I had my own babies and I stayed at home until the oldest one was nine, nine and a half. I can't quite remember the detail now. And then I decided that I'd go back to work because I needed some stimulation. And then I decided, just out of the blue, maybe I'll do midwifery and that's how it started. So midwifing, 50 years now, enjoying every single moment of my career.
Mel:
[3:29] Amazing. And you were a home birth midwife.
Robyn:
[3:32] Sure I was for 25 years.
Mel:
[3:34] 25 years. Amazing. I'm up to year 15 as a private midwife. I'm nearly there. Nearly there. Ten more years of slugging it out. Yeah.
Mel:
[3:44] And so then, I mean, you moved on to do a PhD because that's what's landed you where you are now.
Robyn:
[3:50] Well, yes. That was by pure chance, though. I didn't plan to do a PhD and I never, ever imagined myself as an academic, ever. But just I was relieving for Maternal and Child Health Service in Melbourne and a large one. And they then asked me would I focus on the breastfeeding. and I agreed on the proviso that would let me visit women at home rather than women coming out with their babies. And I had kept a database for my own private practice for years and so I started another database and they became analysed by experts, and that took me on a journey to speak at conferences and then I started being coerced, which I don't like the word but you know what I mean, persuaded, persuaded is a better word, to come and do something with my work. And so I ended up at Charles Darwin University doing a master's for two years and I was called up to the head office office, Scared out of my brain and I was told after one year that my master's was being converted to a PhD.
Mel:
[5:06] You were told that rather than trying to do a PhD, you were absolutely pushed.
Robyn:
[5:13] I had no control over my whole progress of career, like progress of labour. I controlled my – and I had beautiful people who were looking after me and I think that's the key to everything. If you have someone who cares, who nurtures, who's actually interested in what you're doing, who's correcting you and you can accept the corrections that go on along the way, the learning process, the education was brilliant, absolutely brilliant.
Mel:
[5:45] Amazing. It sounds like your PhD journey was similar to mine. I also got dragged into an office at one point.
Robyn:
[5:53] You got.
Mel:
[5:53] You got told, you should be doing a PhD. go and see this person take some things and then before I knew it I had a topic and I was doing all of the PhD-ing and I thought gosh I didn't even know what a PhD was.
Robyn:
[6:06] No I do believe it started a bit earlier than that though because when I was three months through as a midwife the director of nursing came along the corridor and that then frightened me too I get frightened by those things you know yeah authority and she came to tell me that in two weeks, I would be in charge of the labor war. And I said, no, I can't do that. I still go goosy when I talk about it. And she said, yes, you can. And you're going to. And I said, but what about all these people? They've had much more experience than me. No, you're going to be there. So.
Mel:
[6:42] You've been in charge. You've been a home birth midwife. You've been forced into a PhD. And here you are, no sign of slowing down. No. I'm not going to ask you how old you are. I'm happy for you to offer that information. Age is not an issue for me, but.
Robyn:
[6:57] I'm 79. I'm 80 in February. Oh, baby. And I keep going till I drop dead.
Mel:
[7:04] Yes, I'm going to drop dead keeping on going too. That's my plan. So if anybody's wondering, gosh, how, you know, I'm 25 and I've just started my midwifery career.
Robyn:
[7:15] You're a baby.
Mel:
[7:16] You know, you've got a lot ahead of you. you could be accidentally pulled into a PhD at any time. So that's an incredible, I love that story. I love it. So your PhD was in breastfeeding. Can you tell me, you know, what was your topic yet?
Robyn:
[7:32] The reason I became interested in it was because, first of all, in my private practice, women were being referred to me with breastfeeding complications. And then when I went to relieve for the maternal and child health service, it was obvious that women were coming out of the hospital with complications that I had not seen with women who were home birthing and I wanted to know why.
Robyn:
[7:53] And that's what led the way because I asked that question. So it's always important to ask questions.
Robyn:
[8:01] And it took me on a journey that is a whole new learning journey, absolutely whole new learning journey that my professors, after I was awarded my PhD.
Robyn:
[8:12] Had reviewed, done a review of all of the literature at the time and told me that I was the only one that looked at breastfeeding in the way that I had. So I went very deep into the anatomy, the function, the surrounding cranioservical spine, the small brain. I did all of the things that I could almost, you know, watching, watching, watching what was happening with baby's behaviors and how things were being done. And then just change it gently with the mother. Never touch her baby ever. She might touch her hand occasionally when I was younger, but not now. Never would I touch her. And she did it just gently herself. So I have photographs in my thesis of women, one woman in particular, who was feeding six weeks on the most horrific damaged nipple. And she fed first time. And she said, oh, my God, I'm not pain free. It's sensitive. I am pain free, sorry. It is sensitive, but that baby fed both breasts and from then on she took off. She just took weeks to heal the scar. And of course, it takes time because the baby's saliva moistens it each time and stretches the cells when it draws. But she breastfed and then she breastfed her next baby.
Mel:
[9:33] What was your topic when you were looking at your PhD? What was your question? What did you want to find out?
Robyn:
[9:39] It's a retrospective cross-sectional study of an in-home breastfeeding program. So the question was, why were so many women coming home from hospital with significant breastfeeding complications? And I had the photography, thanks to those beautiful women, agreeing to that photograph. I was able to share what I was seeing because that then gives a really much better picture. If you're trying to explain it verbally, it's much better to have the picture to show. So that's how I asked that question. And the most significant, statistically significant issue was nipple tip trauma. And that's why women were stopping breastfeeding because it was so painful. And then I looked at the other factors were most of them were using breast expressors and the breast expressors were damaging the base of the nipple, the areola. And sometimes the modern ones now are damaging the nipple when it's being drawn into a tunnel.
Mel:
[10:46] Right.
Robyn:
[10:47] And there's not enough room and there's no way that a breast expressor can simulate what the baby does because the baby doesn't do like the ones that do the cows, right? So it doesn't do that mechanical maneuver. It actually draws the nipple right back to the soft palate or cleft and then it stimulates first. And then when it swallows, when the milk flow comes, it swallows. That the baby's making a unique teat, maternal teat, inside the mouth to the shape of the mouth.
Mel:
[11:21] Yes. And so what did you discover? Because this is one of my questions I wanted to ask. We know that women are experiencing a lot of complications with breastfeeding, particularly in hospitals. And as you said, as a private midwife myself and as you were working in private practice, I very rarely need to navigate breastfeeding complications. I've never sort of been inspired to get more qualified or do a lactation consulting course or anything like that, because when birth works, generally speaking,
Mel:
[11:51] breastfeeding also works. But what's the current situation in this world and in this birthing, you know, in this maternity care system? What's currently happening for breastfeeding women? What are you witnessing?
Robyn:
[12:05] Well, one of the most common things that the women say, which I have detailed recordings of, you know, now I'm a real dire collector of data, including videos of women telling their stories. One is the conflicting, confusing information and the concern that they're not having their baby at birth if they're healthy, well babies, that the babies are being taken for routine procedures. There's a whole range of things that are happening that are interrupting or separating mother and baby. And then what we do then is the survival skills of the newborn are alert most times and ready to go if the babies are not opioid affected. If they're opioid affected, then it takes extra time for the opioids to be, you know, for the binding process and the liver to break it down and send it out through the systems, the evacuation systems. So they're the things that stand out the most. The most common problem is still nipple trauma and most commonly nipple tip trauma.
Mel:
[13:12] Right.
Robyn:
[13:13] We do see a lot of, and we did back then too, is breast engorgement because people don't understand the normal milk production, how it works, how it progresses. And there's an expectation that babies will put on weight, not lose weight, but they mostly all lose weight from birth for a period of time. And then they gradually gain it back as the milk volume peaks. And that's all normal, very normal for milk production. And there's a real fear around that at the moment. So the women feel really nervous that their babies are going to have non-human milk in that time. If they're preparing to breastfeed, you know, if they're preparing to breastfeed and then the other one is mastitis which follows on from blocked ducts as you know um, So, they were the three most common in my research of the complications, yeah.
Mel:
[14:07] And so, what you're saying is that when babies are affected by some kind of whatever medication the women have had during their labour, so often pain-relieving medication through labour, that's affecting the baby's capacity at birth for feeding?
Robyn:
[14:25] What it does is, obviously, it affects the baby's coordination to be able to breastfeed. And, you know, pregnancy, labour, birth and breastfeeding, unnatural transitions. They're not separated things. So it does affect the baby. And we see a lot, my team that are working with me, see a lot of the sleepy baby syndrome. And then we have to work with those mothers in a different way.
Mel:
[14:51] So can we talk through the physiology of milk coming in? Like you were just saying, women's expectations and maternity care providers' expectations of when to expect weight gain in a baby and how does the milk come in? If we could talk to women about the physiology of that.
Robyn:
[15:10] So it's all hormonally activated, right? We have the most amazing bodies, us females, and so do the guys too, but different to ours. And our pituitary
Robyn:
[15:20] gland is phenomenal in the way it works. So the colostrum's laid down in preparation while the baby's in utero for birth. And then when the baby is born, the baby's showing when it's ready, not in a hurry always, but sometimes it can be.
Robyn:
[15:37] It's desire to start seeking, searching, smelling, tasting, touching. Fine motor, gross motor skills are awakening. So that's survival. so they're coming down ready to come to the breast or they're moving in coming towards the breast whatever it wherever however they are in that moment of time and preferably immediately with their mother never touched by anybody else to start with and certainly not taken away from her unless there's an absolute reason to do so you know that's they're the things that are very important I think and then the baby makes its way to the breast and stimulates the breast for the first feed and starts to draw down thick, rich colostrum. And the microbiome content and the preparation for the gut is happening gradually with that movement of the colostrum. And then there's generally, and I'm not saying this is for everybody, please don't think this, but generally the picture is, in my experience, the baby goes off to sleep. The baby and mother have done a lot of hard work, right? They've done that together. They've worked together. And now the baby's.
Robyn:
[16:48] The gastrointestinal system feels comfortable and satisfied because we know the baby's been drinking in utero because they get the hiccups. And when they're drinking, they're laying down interstitial fluid, which they draw on for the next three days, three to four days, but three days on general when there's no major complications involved. So they'll then start when they wake up. And when the first baby went more than six hours, I was really scared with my home birthing. But then I found out, just be patient. The mother knows best and follow her. And I learned how they sleep till they're ready. Then they wake up. Then they feed frequently both breasts. So they're stimulating release of prolactin and oxytocin. Oxytocin's high anyway once the placenta's born. But they're stimulating that rhythmical cycle starts of stimulating the hormone. And then they continue on doing frequent feeding until the mother starts to feel, oh, gosh, you know, these are starting to fill.
Robyn:
[17:51] And so I generally change over to both breaths per feed at that stage with the rest and digest so that it reduces the risk of breast engorgement and mastitis by doing that. Some mothers produce more than others. Some mothers produce more in one breast than others. And with the genetic history, that's quite normal. When you look at the family history and the genetics, it's nothing that's abnormal. It's just the way they're designed. And each person on the earth is unique. Every one of us, there's no two the same. So I look at all those things. And then we move on to that one breast, rest and digest. the other breast, rest and digest, and in the rest and digest, the baby extends. So that extends the digestive system, the middle, head, I say hip to shoulder.
Robyn:
[18:47] If you sit a baby down, try and burp it, it's really uncomfortable because it's tight. So by stretching out, so the fermentation of the milk, which is often referred to as air, it's not air, it's gas. And the gas is rising the same as it does with us when we eat and drink and finally we have a burp, it's the gas rising. And then once that's happened, it moves on through the digestive system into the intestine, broken down further and further. and then the baby's then ready to have a sleep before it wakes for the next feed. So that's milk production over the first three to four days. Then there's a worry because there's high volume and then the next step there's always a worry because there's low volume but that's the regulation of the high volume now and the baby regulates that by the cycle around the clock that the baby feeds. And I do recommend feeding both breasts each feed when you can but not overfeeding on one breast and then, you know, staying there for a long time. Once the baby's changed the draw swallows breathe rhythm because if we alternate breasts, we're stimulating left and right brain. So the babies, you know, you can see them. They're actually coming, oh, you know, and they're looking and their activity changes earlier, I believe.
Mel:
[20:09] There you go. I didn't know that because, I mean, personally, when I was feeding, I found it easy to do one boob, one feed. But, I mean, there's so, yeah, I find that there's so much variety about how to get a milk into a baby. And, yeah, I haven't at all looked into the science of both boobs versus one boob, so I'm grateful for your knowledge on that.
Robyn:
[20:29] Well, one breast means that if you're only one breast per feed, that means eventually your milk volume will reduce because you're not stimulating in the way the pituitary gland does. Now, some people might need to do that. And I have had one mother, a beautiful mother, who's written a book. Four babies, she breastfed until she was two on one breast because the other breast did never, ever develop. So she only developed one breast. I've had another one who breastfed on one breast because she had the other breast was a nipple at the top of her breast and one at the bottom, but not one central. And so she breastfed one breast, no problems at all. So again, you know, every body is unique. Every story is unique. Every observation that I'm working with when I'm working with beautiful women is their uniqueness, not what everybody else – we're taught in a way that it's all mathematical and this is what you do and this is how you do it and when you do it. Not for me.
Mel:
[21:28] Yes. I love it. Yes. And I often talk to my clients about how, you know, when they worry, oh, my gosh, is the baby hungry? And, you know, they have that really ravenous second, third, or fourth day where they're kind of like running out of stores now, milk needs to come in. And, you know, the baby comes out and I go, just remember, the babies come with a packed lunch. They all think they love that. They're like, what do you mean? I'm like, it's your baby knew, knows that there's going to be a delay in the milk completely coming in. You've got colostrum now. That's all it needs now. But it came with a pack of lunch for the next three days. So it packed on fat and it packed on fluid so that to get itself through these next weeks.
Robyn:
[22:09] Well, it actually put it, interstitial fluid was laid down right throughout the baby's body. If the baby was hiccuping, you know the baby's drinking and they're putting down and laying down into the cells. And those cells release that fluid over time to keep the renal function going. Meconium will pass, big stool will pass, they'll drop weight. The fluid they're drawing on comes to them, it comes out, you know, that's all breaking down to keep their renal function going and they drop more weight. And that's all normal. And then once that third day is reached or, you know, some people do it in two days, but on the average about that. There's no mathematics to it in a way, but it does explain that on the average. Then they start the replenishment, replacing the fluids and the nourishment and all the nurturing and all that goes with it, but also the immune properties that go with it. Everything that's there for that little baby is made by the mother and the baby together.
Mel:
[23:15] Can you talk to us about volume? because I know when, you know, and this doesn't happen too often in my practice, but if a baby is admitted to special care nursery or is introduced to, you know, feed quotas, I've just noticed that they feed little tiny babies so much, so much milk in the first day when they might be getting, and they would definitely be getting a lot less if they were breastfeeding from their mother. I don't understand, and you might have some knowledge or you might also be completely confused by it, but why are the quotas so high for breast milk in the early days?
Robyn:
[23:56] I think that's a fear, and it's been a long-time education. If you watch the baby's cues, you always pick up when their stomach has reached capacity because the nerve from the stomach tells the brain, I've had enough. And so this is watching the breastfed baby, but also with the little babies in the NICU too, they're on a program, right? The staff are coming and going and they have to feed these babies. And if they don't, you know, all these things happen. But urinary output, fecal output are primary indicators of what the baby's doing. If the baby's grunting and groaning, and which the little babies in the nurseries often do because they're over full, come back to thinking about the baby's stomach is only about the size of its closed fist. That's the analogy that I use and that's based on Leonardo da Vinci's relativity. But that's a good one because I use that as mine now and I tested it on myself. I'd never ever done anything like that before, just had to eat everything on my plate as a kid. Now we're different altogether. I only eat to satisfaction and drink to satisfaction. But again, the babies know when they're satisfied. They've reached capacity. And if we learn their cues from the get-go, then they're telling you. And if we learn the sensations of what they're doing inside their mouth.
Robyn:
[25:22] We don't, but the mother does. She can tell us when we're listening to her, if we're listening to her, what the sensations are. We know the baby has reached capacity. and then they can have a rest and digest and change to the other side and that's how they fit in the two but they have little babies have to feed around the clock they have to feed around the clock to meet their requirements in those rapidly growing weeks and months till they they don't feed about three to four months they're starting to change their clock around and you can see them actually starting to sleep longer at night feed more during the day and that's a normal progression of milk production, a normal progression of baby growing and developing, and a normal progression of the individual unique satisfaction that we all have when we've been eating and drinking. And if we learned that, we wouldn't have any problem with knowing when we're actually reached capacity. It's like having the second breast. We're not overindulging.
Mel:
[26:23] And what are your opinions on feeding intervals, like feeding on schedule versus feeding on demand? Because this is, you know, another argument that people, you know, oh, you can't feed your baby on demand or you have to feed every three hours or whatever. Yeah, I know.
Robyn:
[26:40] That's the confusing and all the conflicting advice that comes for them. And the mother always, without doubt, knows best. We listen to her. She will tell us every single time. When I do a Q&A, if I read the last sentence, there it is. She knows. But she's seeking reassurance because there's so much conflicting information. And again, I don't have rules. I prefer not to have rules because if I do that, I only make it worse for the conflicting, confusing information that goes on. So by being with the individual unique mother and her situation and her baby provides me with how I can help her, you know. I'm not taking over either. I'm listening to her. She tells me what she needs to do. So if a mother has had a life of mathematics and programmed, then she may need to go with that. That's how we observe and how she feels about it as she goes with it. So it's really no one answer for everybody.
Mel:
[27:44] So a lot more just kind of letting go of the rules, Pay attention to your baby and also the general predisposition of what particular women do in their lives.
Robyn:
[27:56] Yes, that's right. Family life is so important. So it's understanding the genetics, the family history. It's understanding the individual mother, her circumstances, and her baby and not telling her what to do but working around it in a way that I make suggestions. And then try the suggestion if they want to. And if it doesn't work, then they can try something else.
Mel:
[28:22] Amazing. Great advice because we're in an age where women like a good book and to follow some steps and then have success. But if we let go of the rules, then we feel a lot more empowered to just kind of follow our intuition.
Robyn:
[28:39] In fairness to the professionals too, they've been programmed as well. So, you know, that programming. Now, for example, the babies in the NICU, a colleague of mine, two colleagues have done amazing things. One put all CPAP babies on their mother's. And amazing the baby's interactions with the mothers. She did that in a major, major nursery. And then moving on, another one did the wash the hands, feed the babies through the tube some of the milk that was. Then wash the hands, feed the next baby one breast. Then come back, wash the hands, feed the baby, first baby, the second breast, and those babies settled beautifully. So it just takes a little bit of thinking. And it doesn't mean to say everybody has to do it. It's just suggestions that I make to think about how our bodies work and how, you know, you imagine if we're all feeling so uncomfortable in the gut that we're burping and we're farting and we're doing all those things over the top of what would be natural, normal burping and farting, then the gastric pain we cause for some of those babies is phenomenal.
Mel:
[29:56] Yeah.
Robyn:
[29:57] Yeah.
Mel:
[29:58] Well, can we maybe look at three to five, I don't know how many tips you've got, really practical tips.
Robyn:
[30:07] Mathematical?
Mel:
[30:08] Mathematical. I want calculations, numbers.
Robyn:
[30:13] I think you're talking to the wrong person here. No.
Mel:
[30:16] I can't even make this craft information, Robin. If you could give a woman, say, three top tips. If she says, I want a successful breastfeed, what can I do?
Robyn:
[30:27] Yes.
Mel:
[30:27] To contribute to that success. Yes. What would be your advice?
Robyn:
[30:31] Okay. So I would suggest, right, I would suggest that you think about prenatal preparation. So you're thinking in pregnancy, oh, you know, I wonder, oh, no, I won't worry about it. And then you think, oh, I wonder, you know, I really want to breastfeed, but I don't have time to do that now. What I would think about a gentle way to do some prenatal preparation, gentle and calm and sharing information with people who have knowledge and skills and, you know, experience knowledge and skills is very important. And then progressing from there, understanding the first breastfeed, how important that breast feed is unhurried. So I have three golden hours, and it doesn't mean the baby's going to feed immediately. It doesn't mean the baby's going to feed for three hours. But it's a time frame that the mother can hold her baby and have her baby before someone's trying to do something. But then I suggest that you don't let them take your baby for unnecessary procedures. You know, that's...
Robyn:
[31:33] Well, more than three hours if you're going to hang on to your baby because they don't need routine procedures. They are not urgent or emergency procedures. So the mother decides that and she always understands in my practice the law of consent. So I always provide for her an understanding of the law of consent. And I think prenatal preparation is one way, but taking your partner or advocate with you to those so that you've got someone with you all the time that's hearing the same that you're hearing and is there to protect and nurture you if you need it. If you don't need it, that's different. It depends on the circumstances. Everything is unique, different all the time. Wow. Yeah. And so that'd be one preparation. How many mathematics did you want?
Mel:
[32:23] Oh, look, what have you got, Robin?
Robyn:
[32:27] The second would be making sure your advocate and your or your chosen person is with you, if you're you do need help and that you're concerned about the help you're having you ask people to stop and you ask for a senior expert to look after you i want women to be strong their advocate to be strong and i don't want people just saying oh because it's policy we have to take your baby. Policy is not law, right? So you do not have to have your baby taken based on policy. You do not have to have your baby taken under threat. If you don't do this, your baby will die. That's not the way it goes. You sit down, you talk. I am responsible to sit down and talk with you about the benefits, the risks, the alternatives, your right to say no, and your right to seek another opinion and I think if we apply that more women will be stronger about what they know about themselves their self-knowledge and their maternal instinct as well if more people understood that then we wouldn't have all this fear that's generated amongst women and then you know the control of what's happening in the system and those people are being controlled as well by the system it's creating major problems yes.
Mel:
[33:48] And what would your um
Robyn:
[33:51] That's two oh.
Mel:
[33:53] That's two yeah have you got what so we've got the three golden hours yes prenatal preparation
Robyn:
[33:59] For understanding the milk production in the first 72 hours to 96 hours if they've had surgery it might go a bit longer depending on their previous history genetics family history and then how the baby how you provide your milk for her milk for her baby and then for what would be the fifth, oh, yeah, yeah, I would say for women who have come out of major abdominal surgery for cesarean section, should not be discharged from hospital on day two. I just think that's really out of order. But again, that's my professional experience and it's my professional belief on how we push women in, through and out of the system. So someone who's had a mother who wants to go home on day two with baby that's fine but someone who's really not really well enough and and then the readmissions after that too i have histories of all that have occurred not all of many that have occurred readmissions because they've been sent home early for various reasons yeah.
Mel:
[35:04] And and i think too women need to realize the difference between breastfeeding if you've had the full hormonal process of a normal vaginal birth versus the hormonal process of a cesarean section without labour, you know, that does change, like you said, how long it might take.
Robyn:
[35:22] Yes, it might take for the, but that's because also the baby's not feeding often from, it doesn't do the, it doesn't do the first feed like you would if you hadn't had the, you know, that experience and it doesn't do the first 72 hours. So in that way, so then the hormonal production is slower for that time. It's happening because oxytocin's quite high anyway once the placenta's born, but it's really happening in its own way, but not with the stimulation of the baby. The baby is the one that stimulates all of that to start to take place.
Mel:
[35:59] So do you think that breastfeeding has become too regimented and rules-based and structured? I mean, I guess this is where I'm coming from. I think that the hospital gives women all these rules and requirements to meet. For like, if you don't meet this, then your baby hasn't properly been in bed, or if it doesn't last for this long, or if you're doing it more than four hours apart, all these rules, and then women get all confused and think, am I doing it right? Have we over-prescribed the rules for breastfeeding?
Robyn:
[36:31] Have we done the full circle? We're back to where we were when we started, right? We were talking about that. Yes, absolutely. there are no rules and regulations to a genetic biophysiological, anatomical neurologically, psychologically and emotionally different mother and baby all the time. There are no rules and regulations. There are good, professional observations good professional listening skills but not taking over her decision making the mother's decision making no.
Mel:
[37:03] And yeah and um i i'm curious as well to and i feel like i already know the answer because we've already talked about throwing out the rules and using maternal instinct and listening to women and women listening to their babies but you know there's kind of i feel like there's a few different techniques for helping women to get their baby's latched at home I encourage women to just do sort of infant led weaning like watch your baby see what it's doing offer access to the nipple and it'll probably just latch on and feed whereas I've seen there's that really kind of almost forceful strategy of holding the breast holding the baby bringing the two together a lot of kind of aggressive unifying of the baby and breast by you better
Robyn:
[37:45] Read my thesis.
Mel:
[37:46] Okay I actually have got your thesis then anyone who wants to read it it's actually really easily accessible.
Robyn:
[37:52] I think you better read my thesis. Look, I don't want to upset all my colleagues and everybody because it is a learned process, right? I did it all years ago and pulled out.
Robyn:
[38:04] It's not right for me. What's right for me is the baby belongs to the mother, has not belonged to us to take or handle unnecessarily. Her breast is not for us to handle. And it's never to be handled without consent, legal consent. And it would be much better to understand when that process of feeding the baby by holding the cranioservical spine, by holding the mother's breast, by directing the nipple up to the nose, it would be much better to understand all the anatomy and all the function that goes with that. And that's how my PhD came about. We are creatures for survival and we have instinctive knowledge from the moment we're born. And I see these little babies every day, so instinctive, so knowledgeable, and they know what to do to survive. And we need to learn about that. We need to learn about those principles rather than we take over principles. It's not where we touch a mother necessarily. We don't need to do that. But if she's well prepared in pregnancy, she'll have a good idea. And if it's her first baby, it'll be her first experience ever. If it's her second or third baby, it's quite different. Sometimes they've been through the trauma and now they're not going to accept it this time.
Mel:
[39:26] Yep. And you, so from your PhD then, you then developed this program from what you've observed and what you've learned at Thomson Method.
Robyn:
[39:37] Yes. And I didn't label that. Oh. My colleagues did.
Mel:
[39:42] Right. But you've hit on something and they thought, oh, we need to share this. You've found some information that needs to be shared and it happened to be packaged under the Thompson method. Yeah. And so what does that method advocate for?
Robyn:
[40:00] It's the mother's baby. Please don't touch her. Please don't handle her unless it's absolutely necessary. Watch their skills together. Learn from them. Babies are not ever meant to be forced to the breast. You don't see other mammals being shoved to the breast. You don't see that forceful technique happening. It's time to take a step back. It's time for more midwives in In particular, some of my medical colleagues who came to home births with me just to see were amazingly overwhelmed by the way what women did. And they were just then starting to reteach in the system. I never had problems ever entering the systems. I never had to have insurance. I never had to have all the rules and regulations that go with this.
Robyn:
[40:47] But I think more midwives need to join experienced midwives in the practice of home birth. And I do would like to say it should be for all midwives that are learning to be able to spend time with experienced people who are providing home birth services and increase the availability of women's choice to go where they want, when they want, with whom they want.
Robyn:
[41:13] There's no rules about, you know, all of this sort of thing. That's their choice. And if we go to their home and we look after them, we are visitors and we are very, very privileged to be there. Very privileged to be there. We have at our fingertips all the help that we need. We carry all the things that we need. I don't think anybody thinks we really carry anything with us. We can do the things that are necessary in the interim if we need help or we can do it, you know, before we transfer or whatever it is. There's a whole range of things. I only had a 2% transfer rate, never by ambulance, never by ambulance. So again, it's observing, listening, staying with but not in her space, you know, learning from her. They're things that I never, ever experienced in the system.
Mel:
[42:04] Yeah, and I have to agree with you. I think if women had access to their own midwife in the setting that they chose, the breastfeeding rates would be significant.
Robyn:
[42:15] Absolutely different.
Mel:
[42:17] I think it's, yeah, a lot of breastfeeding issues are a product or a fragmented system that's in a hurry for everything, that's governed by fear, that's run by schedules, that counts in meals instead of, you know, quality time, you know. Like three golden hours is just a magical unicorn idea in a system where you're wheeled from the birth unit to the postnatal and you meet a different person and, you know, it's just like you wonder how anybody does successfully feed in such a fragmented circle.
Robyn:
[42:48] And then the student midwife, she's under pressure all the time from those that don't want her to do it that way, you know, and that has to stop. We have to nurture each other. Now, if we can't care about each other wherever we work, If we can't provide the understanding that we care for each other and work with each other, then how can we do that with women? So I do believe the education process needs a review and I do believe student midwives need to be nurtured more, much more than what they're telling me, a lot of them. And I think, you know, that we're generating fear for them as well. You know, we don't need to be, we need to be nurturing mothers. So how can we nurture mothers if we're not nurturing each other? And if we're in a position where we're feeling overwhelmed in the system because we can't provide, well, we can, but the fear is we're not allowed to, is to back people off and say, my duty of care is here now. Please, if you've got a problem, take it to management. My duty of care is here now. And I think if we started a process going where we feel stronger amongst each other.
Robyn:
[44:03] You know, that we're nurturing, we're looking after each other. If someone can ring someone and say, help me, or whatever it is you need, we can move towards where we were. We're actually returning, right? The cycle is changing. And the cycle's taken, what, nearly 50 years in my experience to come to here, so it's going to take a little while to get back. But if we become energetic enough together, I'm sure that we can. And, you know, it's happening in the UK. Midwives are marching. They're fed up with what's happening. I don't believe that we've been treated with the right respect for a long time.
Mel:
[44:44] Yeah, absolutely. Amazing, Robin. Thank you so much for being here. I'm just so grateful that we've been able to benefit from your wisdom and all the work that you accidentally did in your PhD.
Robyn:
[44:59] Actually, to be honest, I've never planned my life. It just goes, I'm on a journey, you know, and I go on that journey all the time. And sometimes I'm a bit worried about what the journey might be.
Mel:
[45:11] It's a little bit like breastfeeding though, really.
Robyn:
[45:14] Yeah, it is.
Mel:
[45:15] Watching, seeing what happens, welcoming things, you know, adjusting based on the circumstances. I mean, you've got to read these circumstances and just.
Robyn:
[45:24] It's such a privilege to be with a woman. So if we can have it as a privilege and we can use our skills and our observations of hearing and looking and seeing, we will make a huge difference. I'm not saying we don't do that, but we don't have the time to, that helps us penetrate the information that we're receiving.
Mel:
[45:45] Yeah. Amazing. Well, thanks, Robin. I don't have any other questions. Did you even not want to ask me? I mean, I don't know.
Robyn:
[45:53] I would just suggest, as I do, you keep going because women need you, midwives need you, and you need to be able to develop and help with the next generation that's coming. You know, we're progressing through generation through generation. And I was so lucky through my generation that I want to make sure that I do that for, and I would love to see you continue that too.
Mel:
[46:21] I absolutely will. That was this episode of The Great Birth Rebellion. And as always, if you want more information on this episode, you can go to www.melaniethemidwife.com and join the mailing list for this podcast. That'll give you access to all the resources that we use to formulate each podcast episode. I'll put Robin's PhD in there and everyone can have a good read of that as I. And also, if you're interested in going even deeper, the recordings for this podcast and other resources on this particular topic on breastfeeding will be in the Great Birth Rebellion Information Hub, which has opened recently. So thanks again and i will see you in the next episode of the great birth rebellion hey that's all right thanks robin
Robyn:
[47:10] Okay mel well done well done you're you're you're there on the job it's beautiful coming up i feel inspired because i can look back and see it all now on reflection you see much more right you understand much more because on on the progress you're making the journey and you're learning as you go but when you reflect back oh my gosh yeah it's phenomenal, amazing yeah oh.
Mel:
[47:39] Good I'm so glad to see where you are in your journey I feel like that'll be me looking back in my life going do you remember when I did home birth and do you remember when I did that podcast thing and do you remember when yeah
Robyn:
[47:50] That's right and I can actually go right back now and understand my mum gave birth to me in Leichhardt in New South Wales in a birthing home, Frank Bridge. And, yeah, and my goodness, what an effort, eight-pound baby, Frank Bridge. And I had my legs coming down over three days, three days it took for them to come down. And she told me for the rest of my life, you do things, ask about face all the time.
Mel:
[48:19] That's why you're here on the Great Birth Rebellion.
Robyn:
[48:23] And I said, yeah, Mum, I know. Anyway, it's all good fun. As long as along the line, you get cranky every now and then, and that's normal, and you respond and you react and you come up and down and you go in and out like the waves. But most of the time, there's some good fun to life.
Mel:
[48:39] I can't wait to see you at the Home Birth Conference. It'll be nice.
Robyn:
[48:42] That'll be lovely. Thanks, Mel. You're a gem. You're an absolute gem.
Mel:
[48:46] Oh, thanks, love.
Robyn:
[48:47] See you. Bye.
Mel:
[48:48] See you. Bye. okay to get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes
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