Episode 135 - Breastfeeding with Lucy
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[00:00:00] Mel: Welcome to the Great Birth Rebellion Podcast. I'm your host, 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.
[00:00:24] Mel: Welcome everybody to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today I welcome guest Lucy Weber, an experienced lactation consultant and midwife and published author of the book Breastfeeding and the Fourth Trimester. And today we're talking about breastfeeding and I'll be asking Lucy some questions that address the most common breastfeeding myths and some listener questions.
[00:00:50] Mel: Lucy lives in North Somerset in the UK with her husband, three children, their cats and a beagle. Welcome Lucy! Good morning. Well, it's morning for me. It's evening for you. Right. This is the thing when, you know, you don't live in Australia like I do. We are doing podcasts at the beginning of the day and the end of the day for both of us.
[00:01:10] Mel: Lucy, we're going to jump straight in because I know this is probably going to be a jam packed episode and I'm going to kick off with my first question. And that is actually more about your qualification. So what is a lactation consultant? Because they call them IBCLCs. And there was a question from a listener saying, how do you become one of those?
[00:01:29] Lucy: Oh my goodness. Yeah. It's not easy. Lots and lots of people sort of reach out and say, Oh, you know, I want to do this and that's great because we, we need more people, but it is not, it's not as simple as sort of a weekend course or anything like that. It's, it usually takes people, I think it's about five years to get to this point.
[00:01:45] Lucy: So. There's a few different Five years! Yeah, around about five years. And I think some people have likened it, it's a roundabout sort of master's degree level sort of qualification it's likened to. There are three different routes you can go down to get there. The, regardless of which route you take, you have to have covered 14 different qualifications in health sciences.
[00:02:09] Lucy: So a lot of people come from a health professional background, so like me, I'm a midwife, so I've kind of, that was already covered in my midwifery. You have to do a thousand hours. of supervised practice, I guess. So supporting and being, you know, having people watching you, supporting 95 hours of lactation specific education.
[00:02:28] Lucy: And then when you've got all of that, you can then apply to sit your exam and the exam pass rate, you have to get a very, very high rate. It's a pass or fail thing. And I think the year I did it, I think you needed to get, I think it was something like 80%. So it's quite a, you know, high thing. So it, it's, it's a, it can be an expensive thing to get there and it takes a lot of time.
[00:02:50] Lucy: And the people that have managed to get there are, are, we're very aware of how privileged we are to get to this point, actually. And not, it's not open to everybody. But it does mean that if you were working with somebody who has the skills, This credential is a protected qualification. You can call yourself a lactation consultant, but you can't call yourself an international board certified lactation consultant because that is a protected qualification.
[00:03:12] Lucy: If you're working with somebody who's got that, it does mean that globally they should be working to the same standards that they are the highest recognized qualification in lactation,
[00:03:20] Mel: and that's what the I-B-C-L-C. title is. So if someone tells you they're an IBCLC lactation consultant, that means they've been through that process.
[00:03:30] Mel: And I can understand why people are so protective over it, because breastfeeding is very, very important. And there can be some wayward information that leads women off the breastfeeding path. So in, in, in brief, in five minutes, can you explain what a woman What people could look for when they're feeding their babies, what can they look for as signs that things are going really well and A OK, and they don't need to employ the help of a lactation consultant, and what might be the triggers might indicate to them that they need extra
[00:04:06] Lucy: help.
[00:04:07] Lucy: So, the first thing I always say is You don't need to have a reason to want to work with an IBCLC, a huge percentage of our workload is reassurance and normalizing. So you could be having no problems at all, no worries at all. If you want to speak to someone and work with someone for a bit of cheerleading or a bit of backup, That's absolutely fine.
[00:04:29] Lucy: We do a lot of that because the early weeks, especially, are intense, even when things are going very, very well. They're a rollercoaster, your hormones are everywhere, you're sleep deprived, and especially if it's your first baby, it is like a shock to the system actually, and so many people don't realize quite overwhelming it is.
[00:04:48] Lucy: So even when things are going well, it's, it's absolutely fine to want to work with somebody. But things that make us feel sort of quite happy and get smiley as lactation consultants are if people say that it's comfortable. If they're comfortable, there's no pain, we're like, Good. This is really good. Pain has become very normalized.
[00:05:08] Lucy: Like, really, in a lot of countries across the world, that pain is a normal thing, that you need creams and potions and lotions and gadgets and cooling things and heating things and, you know, all this sort of stuff. Pain is very common. It's common, but it's not normal, and the two are really different. So I'm not saying that people won't have pain.
[00:05:28] Lucy: There absolutely can be pain. But it's a sign to us that something might not be right, actually. And it might be something to do with latching. Usually it is something to do with latching. Might be something to do with the baby, maybe tongue tie. It might be something to do with, you know, blood flow to the nipple.
[00:05:42] Lucy: You know, there can be all sorts of different reasons. But if somebody's got pain that is beyond the first few seconds of latching, and is, you know, persistent pain and especially if they've got cracks and bleeding and things and that is absolutely alarm bells. We can, we can sort that. That's not something to just go, Oh, well, pain is normal.
[00:05:59] Lucy: We'll just carry on then. That's fine. It's to be expected. That's definitely a sign of, of something needs a little bit of adjustment and can be sorted almost overwhelmingly can be sorted. So pain for us, we like it when people are comfortable. We like it when When people talk to us about what's coming out in nappies, we get very excited about nappy contents.
[00:06:19] Lucy: We love a good photo of a poo. They're like, oh, do you mind if I show you a photo of what's in the baby's nappy? I'm like, yeah, absolutely show me because it's really, really helpful. So, we know in those early days that the poo changes colour. You know, that meconium comes through, it's like that. Thick black tarry stuff and then over the first few days it changes colour and it gets to this lovely yellowy kind of mustardy stuff, maybe seedy, and we want that poo to stick around.
[00:06:45] Lucy: And poo is a really good sign that what's coming in is going out and it's going through and it's working really well. So we do want there to be a nice lot of poo. And wee as well. You know, the wees as those early days progress and the milk volumes increase, more and more wee happens and it becomes more and more dilute and bigger, heavier nappies.
[00:07:06] Lucy: So if somebody is saying to us, they're getting lots of full nappies, you know, when you say, What's coming out the other end? And they go, Oh, loads. You start going, okay, good. This is, this is happy days for us. So comfortable, lots in their nappies. When they say that they feel relaxed and comfortable in themselves as well, you know, if they are feeding and they're hunched and they're twisted and they've got shoulder pain and back pain and arms are aching and they, you know, wrists are hurting.
[00:07:32] Lucy: So it's not just comfortable in the breasts, it's comfortable in whole body and it's a sustainable position. We like it when they tell us the baby's feeding frequently there's a difference between frequently and constantly. So frequently is very normal. Night feeds suck for a lot of people, they really do, but they're so normal and they're expected especially in the early weeks.
[00:07:54] Lucy: If a baby, especially in the early weeks, isn't feeding frequently at night, we start going, okay, I wonder what's going on there. So good sign if baby's feeding, yep.
[00:08:02] Mel: Yeah, and definitely as we go through this episode, there was a big topic coming through on the questions of how often should I wake the baby, all this.
[00:08:11] Mel: So I reckon we are going to have a huge chat about feed frequency as we get on.
[00:08:17] Lucy: Yeah. Yeah. So frequent feeding is is good. After the initial, we talk about milk coming in, you know, and, and bigger volumes of milk arriving in those sort of early days after the colostrum is there. We like ideally for your breasts actually after that initial potential kind of engorgement happening or fullness.
[00:08:36] Lucy: For breasts to soften down relatively quickly and feel pretty normal and comfortable. You know, they should, they may feel fuller or heavier, but they shouldn't be feeling like you've got two rocks stuck on the front of you. You know, if you're feeling like your boobs are really hard and full, which, May feel reassuring, like, oh gosh, I've got lots of milk here, this is good.
[00:08:56] Lucy: But actually from a lactation perspective, we want them to be softening down and feel really, really comfortable. And obviously we want the baby to be growing, you know. Weight gain is part of the picture, but it is an important part. We have, you know, weight checks here in the UK that happen every few days at first, and then they space out if things are going well.
[00:09:13] Lucy: But actually, you know, when we went into lockdown with COVID, there weren't any weight checks. And it threw a lot of people because we've become very dependent on weights and, oh, how do I know without the weight? Well, you know, because they're growing out of their clothes and they're growing out of their nappies.
[00:09:29] Lucy: And they're looking visibly bigger, you know, they're bigger in that basket. You've been putting them in or on the play mat. They're filling out a bit. And in pictures, you know, you look back at your pictures from, Oh, look at them a couple of weeks ago and they look different, you know, so we don't really need scales to, to know, but I get why Why people, you know, I kind of care about them and we do want the weight to be them to be gaining weight on the scales as well.
[00:09:52] Lucy: So comfortable and growing well and filling nappies are all really, really good signs.
[00:09:58] Mel: And I suppose, you know, if your baby's fed well, because they usually are a lot more settled and content. You know, I've seen hungry babies in my work as a midwife and they are cranky and I loved what you said about not needing to actually have a.
[00:10:15] Mel: problem that you feel like you're having in order to bring a lactation consultant into your care. And it highlights too, actually, and I hope it's better in the UK, but here in Australia, postnatal care is a really neglected part of women's maternity care. And for me, I'm a private midwife. I see my clients all the way through to six weeks and I'm on call to them.
[00:10:37] Mel: And so, , if they having breastfeeding issues, I just do more appointments, but that's a very unique and privileged situation for a woman to be in. Mostly they're being discharged from hospital without any ongoing care, except for maybe a GP appointment at one week, but they're not really very good at helping women with breastfeeding.
[00:10:57] Mel: And then the community nurses might come out, but maybe once in that six week period. So there's actually not a lot of postnatal support. But I imagine lactation consultants end up. Becoming these default practitioners who also support women, as you said, just to say, actually, this is looking really good.
[00:11:16] Mel: You can feel confident to keep going. That's usually what women need.
[00:11:21] Lucy: Yeah. We, we have a strange sort of system here. So we've got our NHS, obviously. And so they're supported through, yeah, midwives in those early couple of weeks, they're often they're discharged from the midwives about day 10, then they'll see a health visitor.
[00:11:34] Lucy: Health visitors funding is. over the years since I've, you know, I qualified as a midwife, what, 25 years ago, nearly. And in that time, you can imagine, I've seen a huge amount of change and the drop off, you know, they used to see them every few days for weeks, and now they sort of see them once a week, and then a few weeks later, and it's really, really dropped off.
[00:11:51] Lucy: So, the, just the practical, someone being there to help you has, has dropped off massively. The amount of training and support, it can be, and I don't want to come across as dissing NHS or the support that is there. But it's, it's not adequate actually. And our breastfeeding rates in the UK are the lowest in the world.
[00:12:10] Lucy: And, and it's apparent why when I, I speak to people and they're, you know, the things that they're being told or the support that being given. So there is, we do potentially have infant feeding teams in the hospitals or in the NHS trust that they can get referred into, but they often don't know that that's available.
[00:12:28] Lucy: They have the option of working privately with a lactation consultant like myself. But what percentage of people can afford to do that? You know, that's we're talking like a minority and that's it's not fair and it's not the way it should be at all. And so I do, yeah, I, I do see a lot of people, yeah, for just normalizing, but often it can be right through to, you know, very poorly babies, babies with cancer or if mum's got cancer or it's really had a stroke or something or, Lovely lady, I can still remember her who broke her neck and needed support with how do I position this baby while I can't move because my neck is broken, you know, so all sorts of different things that we support with right through from the basics.
[00:13:06] Lucy: So it's, it's lovely work. It's wonderful. It's wonderful.
[00:13:09] Mel: Yeah. Incredible. Well, so we'll kick off with the myths or I guess the kind of the big topics that often come up for feeding. So you touched on it already. is painful breastfeeding. And can I say this? There's a scale of pain and discomfort with feeding.
[00:13:27] Mel: There's the toe curling, kind of want to push your baby off your breast, cannot bear the idea of bringing your baby Heart
[00:13:33] Lucy: sinking, dreading. Yeah.
[00:13:35] Mel: Oh my gosh, this baby's going to be back on my nipple and it's, and it's so uncomfortable. And all the way down the spectrum to kind of like, am I feeling pain or is that just what it feels like?
[00:13:46] Mel: Where? The baby comes off and you can't see any damage, but the woman still feels some discomfort, but can feed through it. So there's this huge spectrum of pain. Can you talk about what level of discomfort is normal? Is, is there any level of discomfort that's normal? And What should really be addressed? Like, is there a type of pain that will just settle over time?
[00:14:11] Lucy: Yes and no, I think is the answer to that. So some people are very hormonally sensitive. So before every period, early pregnancy, their nipples are just, you know, nothing can touch them. They're just somebody whose nipples are incredibly tender and very sensitive hormonally. So you can imagine that in those early weeks, There's still going to be that kind of, Oh, this is a lot more sensitive.
[00:14:29] Lucy: And for them, it might take that bit more adjusting. But I think the difference being is that it should always be manageable. It should never need painkillers. There should never be cracks and bleeding. Your nipple should always be looking a normal shape for you. So longer, absolutely. But if it's coming out flattened, pinched, ridged, blistered, a different colour you know, any abnormal appearance, it's That's kind of a sign that actually this pain is not normal pain for you.
[00:15:01] Lucy: If your nipple's looking normal shape and actually it was a bit tender, but actually it was okay, it was a bit tender, I don't know, maybe keep an eye on that, I could maybe go, okay, well let's look at the whole rest of the picture and see what's going on. If somebody's got some discomfort and the baby is actually feeding really, really frequently, it's, you know, the baby's not pooing much, the weight isn't great, that's a sign to me that actually maybe something's going on with the latch.
[00:15:24] Lucy: Whereas actually if there's a bit of discomfort, but they're growing well. She's okay. Everything's okay. Breasts are soft and comfortable. Then you might go, you know, okay, well maybe this is the norm for you, but I think the key is to not assume it's the norm and just go, okay, pain's normal. It's right. So you've got pain.
[00:15:40] Lucy: Let's figure out if this is normal pain for you. Or if this is not and most of the time it's not but yeah there can be and I think it's because Latching is not easy. It is not easy. It is not natural and instinctive Mother earth. Oh just wonderful. And when we're pregnant we go. Well, I'm going to breastfeed So I just put the baby on the boob and we often don't do as much prep as we do for birth.
[00:16:06] Lucy: So when we come to latching this floppy baby, who's got this massive head in comparison to their body that's Flopping all over the place, and you're trying to get 'em in a position where actually their head is back and their head wants to go forward, and you've got your boob and your boobs a different size and shape than it's ever been before, and you're trying to put the two together and you ca can it, it's just all a bit of a nightmare.
[00:16:24] Lucy: Not every latch is gonna be textbook. Most of them aren't going to be textbook because you are learning this. It's new skill. So I think the vast majority of pain comes from the fact that you're going, Oh, okay, baby's on. I think I'm just going to stick with that one for now kind of thing, you know? Yeah, 99 percent of the time pain is not going to be normal.
[00:16:44] Lucy: There's a tiny, tiny little bit where, where there will be, but I think if anyone's ever having any pain, don't just make the assumption it's fine, but better to get the help and double check.
[00:16:53] Mel: Mm hmm. And you know, that early learning phase of feeding, because I was a midwife. even before I had my babies.
[00:17:01] Mel: Yeah, same. And still, I remember thinking to myself, six weeks into my first feeding journey, if I didn't know that this was going to work out okay in the next like six weeks, I thought I'm going to give myself good. Yeah. I think I would, I very much understood why women would just. Toss it in and think it's too hard.
[00:17:26] Mel: And even now I tell my clients, don't make any decisions about stopping breastfeeding until you've tried it for 12 weeks, you know, it's kind of my benchmark, I'm like, don't think you're going to get it at the end of the week. You might. Don't think you're going to get it at the end of two. You probably will, but give it 12 weeks, you know, at least before you make any big decisions because it is a learnt thing.
[00:17:50] Mel: You learn what fit, what a good latch feels like. Your baby learns which latch is most effective for them. You know, there's, it's so varied, and each individual
[00:18:01] Lucy: journey is varied. You know, like, you have your first baby, and you nail it, and then the second baby you think, well, I know about breastfeeding because I've already fed a baby, and the next one comes along and you're like, oh, this is totally different, and you have to relearn all over again.
[00:18:14] Mel: Well, the babies are totally different. My first, Mm hmm. Wanted to feed every 45 minutes and he was, he was premmy. So I was like, stay around as long as you want. And then my next came out and only wanted four hourly feeds. And if I offered her more than that, she would fight it. So each child is different.
[00:18:32] Mel: And so, yeah, I think we have to approach breastfeeding a little bit like every different, every labor. And birth is different with every baby, as is every pregnancy. And I think another real issue with feeding is that often the feeding journey is the offshoot of the birth journey. And if the birth has been interrupted and the, You know, the woman or the baby's unwell or there's been an interruption in the physiology and the baby's not as alert as you would want them to be for this, these ideal first feeds, it can really set a difficult pattern.
[00:19:08] Mel: So yeah, for my clients who give birth at home, often I say to them, do you know what, let's just put the baby near the boob. Let's see what it does. Nine times out of ten, the baby is alert and the birth hasn't been interrupted and it latches and they go, oh, okay, cool. But that's a unique and different situation to a woman, for example, who's needed to have their baby born by forceps.
[00:19:31] Mel: Laura's had medication through the labor where the baby's not as responsive. So I think part of it can be is that you're already starting on the back foot sometimes with these high interventive birth practices. But then also there's a lack of support afterwards. So, you know, we're definitely in this really tricky realm.
[00:19:49] Mel: So then painful feeding, you know, if you can't see a reason for it, it's a good time to be engaging with a lactation consultant. And I think a lot of pain is, is really easy to remedy
[00:20:01] Lucy: most of the time, would you say? Yeah. Sometimes I'll like, I'll go on a home visit within the first five minutes, we've gone bosh, bosh, ah, and then we spend an hour and a half chatting and they're just going from side to side.
[00:20:11] Lucy: Oh, this is, this is much better. It can be the tiniest little adjustment. It's usually moving the baby around towards their feet, making sure there's nothing on the back of their head. They can tip their head back beautifully and then things are just sort of sorted. Often it isn't that easy, you know, and there are, there can be really complex issues.
[00:20:25] Lucy: Sometimes there's, there's you know, ties, you know, tongue ties and various things. Sometimes there's something going on with blood flow to the nipple or, or blocked ducts and mastitis and things like that. And so it can be much more complex, but often it's really easily sorted. And the detective work around figuring out what's going on.
[00:20:41] Lucy: which of these things it is and how to remedy them is why it is difficult, I think, for families is because they kind of are hit with this barrage of information from their health professionals who may be well meaning, but perhaps not have the most up to date information. Then they're hit with all this information online, which can range from Absolutely fantastic, brilliant information that is bang on right through to some complete nonsense about, well, it's because you didn't use a cheese grater on your nipples when you were pregnant and toughen them up and things like that.
[00:21:13] Lucy: You're just like, wow, how is this out there? You know, so they're trying to find this information. They don't know which is the reliable resource to kind of go to necessarily. So they're just, it just absolutely completely screws your brain up and you're like, well, yeah, I'm just going to stop doing this then because it's too hard mentally and physically.
[00:21:31] Mel: Yes. And I think being an external person doing the detective work is a lot easier than being the mother. Definitely. To try and be deciphering that in the days following birth is just impossible. And so it's nice to have somebody external to say, actually, I think this is an easy fix or hey, we're in for the long haul on this one, but, but I can help you.
[00:21:51] Lucy: Yeah.
[00:21:52] Mel: So we've done a bit of pain. Can you, you know, you, you kind of alluded to flipping back and forth to the, to different breasts. So this is a question I have, cause I personally was a one boob, one feed mama it worked for us, but there's this information about you should feed them on one side, then take them off and then pop them on the other side and, and flip, you know, engage both breasts Every feet and my, my inner midwife and, and mama wants to say, look, if it works, does it really matter?
[00:22:27] Mel: But do you think there's a better way? Either one boob, one feet or flipping from one to the other, each feet or some kind of other alternative.
[00:22:36] Lucy: So the long run answer to this is, you do what works for that individual diet, you know, that, that mum and baby, if, if they're a one boob, if they're both boobs, my first was a one boob, my second was both boobs, my third was completely random, you know, depended on the day and the time and the whatever.
[00:22:55] Lucy: So it's different with each feeding journey as well. What's important to know is that the Early weeks, actually, we want to assume it's both breasts, because babies thrive on flow of milk. So when you put them to the breast, new babies, especially if there has been some difficulty with birth, or they're sleepy, or they've had a difficult time, or 36, 37 weekers are really difficult with this as well, because they often come out maybe a kind of, you know, an okay weight.
[00:23:25] Lucy: And they're, you know, acting like they're a term baby, but they're really just a lot more sleepier, not quite as active at the breast. So especially for those babies. But, but even if they're, you know, 41, 42 weeks, 43 weeks, whatever they, they, if we need to be making sure that we're doing our part to encourage them to be actively feeding and really at first.
[00:23:45] Lucy: Partly for the baby, but also partly for breast stimulation. We wanna be working on both breasts and then assuming it's both until we figure out it's only a one a er. Mm-hmm . Which for some babies it will be others. It'll be both. The majority, it will be offer one. Let them take one and then offer the second.
[00:24:04] Lucy: Sometimes they'll want it, sometimes they won't. Follow their need, but the early weeks because of that getting milk supply up and running and because babies can be a bit sleepy and kind of conk out and need encouraging with that flow, if you've got a baby who is not gaining weight as expected, or is not filling nappies as expected, then we definitely want to be getting them taking both.
[00:24:24] Lucy: You know, we absolutely do. And even multiple times over, because they are driven by this flow, when you stick them back onto the breast, you get that lovely hormonal surge, which makes your body go, Oh, you want more milk? The muscle cells squeeze, the milk comes out. the milk jets down towards the nipple, and because the flow is there, the baby goes, oh, great, there's milk there, I will drink it.
[00:24:43] Lucy: I will swallow it, and they keep going. Once that flow slows down, the baby goes, oh, it's slowed down, and they go sleepy and they move on to this fluttery sort of sucking. And flutter sucking is a lovely, valid bit of feeding. It's a really nice bit, snoozing, it's fine, and it's not a problem for the vast majority of babies but when you've got a baby with weight problems or with you know not filling their nappies or not taking enough milk for some reason We want to try and cut that down and actually keep them actively feeding.
[00:25:10] Lucy: So switching back to the other side, more flow. Oh, lovely, gulp, gulp, gulp. Switch them back, gulp, gulp, gulp. Switch them back, gulp, gulp, gulp. And that will just get that bit more milk in, boost that supply up. And then once that's all sorted itself, then you can slow back down to offering one or maybe two.
[00:25:24] Mel: Yeah. And I, you know, you're right in a sense that it depends on the situation, because also if you've got a woman who is, is battling something like true low milk supply, you wouldn't want to be doing one breast feed because then the other breast is not being stimulated at all that feeding cycle. So, when you're establishing feeding, each breast is independent.
[00:25:44] Mel: So, if you feed more off one breast than the other, One breast is going to make more milk than the other, ultimately. So getting that initial six week establishment is what you're talking about with
[00:25:54] Lucy: that two breasts. Making sure you're getting that even stimulation, yeah, absolutely. Though most people do make more in one side than another, so it's completely normal.
[00:26:02] Lucy: Most people make more in their right for some reason. doesn't seem to be linked with right handedness either. Yeah, I was a right hander. There certainly is for a lot of people, it's because it's more comfortable on one side and they just feed more on that side and they make more, but there does seem to be something else underlying as well.
[00:26:15] Lucy: They're more people make, you know, most people make more on one side than another and that's normal. I think it's if. They're feeling very, very like actually one is just the absolute go to and the other one's just, there's just, we're not doing well on this one at all. That's when things need evening out that little bit more.
[00:26:30] Mel: Yeah. And, and the next question is length of latch, because there are some people who are like, if it's a five minute feed, it doesn't count or, you know, they shouldn't be feeding for any longer than this period of time. Is there a normal? suckling time that seems to be optimum for babies? Do we need to be timing feeds?
[00:26:51] Lucy: So you could have, so apps are all the thing, right? The apps are the thing and everybody's writing down the time of the feed. Now I could have somebody who presents me with their app and shows me that they are doing Lovely long, you know, might be doing half an hour every couple of hours and on the app on paper It's looking great.
[00:27:08] Lucy: You're like plenty of time at the breast But if that baby is not latched deeply and is just sleepily sucking They might be getting barely any milk compared to a baby who goes onto the breast and feeds for three minutes with a beautiful deep Latch go go go go go go go go conk lovely so time Can only tell you so much.
[00:27:27] Lucy: It's not going to tell you everything. You also want to be making sure that your breast is feeling that bit fuller before a feed, and drained after a feed, or softer after a feed. It's never empty, never ever empty, but it will feel softer, or a bit lighter. We want to be watching for the swallowing during the feed.
[00:27:45] Lucy: Is the baby actively feeding? Are they gulping nicely and frequently during that feed? Because that's really kind of key. Some babies will take very short feeds always, some babies will take very long feeds. If they're consistently doing very short feeds, we'd be going right, what's happening with the rest of the picture?
[00:28:04] Lucy: Are they pooing and peeing? Are they gaining weight? Do you feel comfortable? In which case, crack on, lovely. Equally, if they're not pooing, if you're uncomfortable, if your nipple's hanging off, if you, then the short feeds might be a sign of a problem. Ditto long feeds. If you're consistently feeding very long feeds, really frequently, and, you know, you're exhausted because you just don't get any break from it at all, the baby's not doing great, they're really sleepy, lethargic, they're a bit jaundiced, or something like that's kind of going on, then, That length of feed is not right for that baby.
[00:28:37] Lucy: It's because they're not able to feed as effectively as they need to for some reason. So if all is well, comfortable, growing, pooing and peeing, then the length really doesn't matter too much at all because some feeds are about milk. Some feeds are about, I miss you. I heard loud noise and it scared me.
[00:28:55] Lucy: I've got a sore tummy. I need to do a poo. They go to the breast to help themselves poop. You know, there's so many reasons that they go to the breast for. It's their default setting. It's absolutely, you know, they're, I need to be at the breast. It's their new umbilical cord. It's where they just want to be and they want to hang out all the time.
[00:29:12] Lucy: It's helping to smooth all those bones out in the skull. You know, there's so much going on with feeding that it isn't always about the milk that's going in. Obviously, it's a big, big part of it. But, you know, short feeds here or there are fine. I would say the vast majority of babies will do little ones here, longer ones there.
[00:29:28] Lucy: If you're at the extremes, either end. Or if you've got any worries, then check it over.
[00:29:33] Mel: Yes. But as a single element, and what I'm hearing from you actually is that, that whenever we're assessing or whenever you're assessing a breastfeeding journey for a mom and a baby, it's not about picking out one or two individual symptoms or situations.
[00:29:49] Mel: It's putting the whole picture together. And as you said, if the baby's gaining weight and is settling after a feed and is weeing and pooing and everything is fine and no one's in pain, we're going We don't have a problem, whatever the picture is, but if there is a problem, then you start thinking, well, how long are the feeds?
[00:30:05] Mel: And is there any pain? And yes, exactly. Well, can we talk about poo then? Because the amount of different colors, textures, volume, frequency of poos, You know, things you see on the internet about baby poos and the chat rooms that say, Hey, my baby's poo is green and frothy. What does that mean? And then there's 50 different answers.
[00:30:30] Mel: Yep. So let's start with poo frequency because, you know, When I was training as a midwife, they said breastfed babies could go normally up to 10 or 12 days without doing a poo and that's normal.
[00:30:45] Lucy: Absolutely is something that is still, it is around and about today. People kind of saying this, that breastfed babies, you know, don't need to poo very often because there's, you know, breast milk so good that there's no waste.
[00:30:55] Lucy: And I love that fact. thought that breast milk is so good because it is, it's amazing, you know but actually what about the baby that's thriving and growing well and pooing 10 times a day? Does that mean there's a problem for that baby? What we know when we look at the bigger picture of big groups of babies is that the ones that are pooing less frequently tend more likely to be the ones that are having difficulties with something.
[00:31:16] Lucy: Often that's their milk intake or a feeding problem, vast majority of the time. Sometimes it's something else going on, like, Allergies or there's a tongue tie or that, you know, something kind of happening. Maybe they all had antibiotics and that's throwing things out or they're on some medication. So what we don't want, it's always these rigid rules, isn't it?
[00:31:34] Lucy: Is the, is the problem. So we can't say it's fine to not. Poo or you must be pooing this amount of time. It's about that whole picture again. So if you've got a baby that is not pooing frequently, if it's in those early weeks, then that would be definitely a red flag. Something needs to be checked out quite quickly.
[00:31:52] Lucy: A baby definitely should be pooing in those early weeks. If they're not, then you absolutely need somebody really well experienced and qualified to go, Okay, let's figure out what's going on for you here. And making sure that baby's getting enough milk, most importantly, and adjusting the latch and the position and various things.
[00:32:07] Lucy: Once you get to the four to six weeks, more like six weeks kind of plus, that stalling pattern can change. It can change and it may be normal sometimes for some babies to do less poo.
[00:32:22] Mel: But
[00:32:22] Lucy: the key is not just going, Oh, your baby's not pooing. Fine, that's normal. The key is going, right, that might be normal for you, but let's figure out if it is, and let's go through all these other things first, and if we get to the bottom of this big long list of things, and all those tick off, and they're beautiful, and there's no problem, then tick that's normal for you.
[00:32:40] Lucy: We don't put it at the top and just go, that's normal not to poo. We go, right, it may be normal, but we need to check through all these other things first and see what's going on for you. That's where the difficulty lies is that this myth is out there that it's just fine to not poo and actually often isn't.
[00:32:55] Lucy: I've worked with a lot of people whose babies have had really, you know, difficult faltering growth. You know, then they're just not growing very well, you know, not gaining weight as they should be. And they've been told their baby is not pooing because it's normal for babies to not poo because that's what they've heard.
[00:33:14] Lucy: That's what they've been told. They're being reassured. And actually for us. If a baby is not pooing and they're not gaining weight, it's very, very obvious what's happening is that actually they're not getting enough milk through and when you increase their milk intake through whatever route you need to they start pooing again.
[00:33:30] Lucy: And actually you think, well, if that person had been told So, actually, this might be the sign of a problem. They would have got the help they need and things would have been very, very different for them. So, that's why I think as lactation consultants we get very passionate about poo frequency is because it can be really a very obvious sign.
[00:33:48] Mel: Yeah, I have to agree with you. The times where I've had clients that have been having feeding difficulties are the ones where they, they are doing less frequent poos. I don't think I've ever seen a well healthy baby who's feeding great. Not poo at least every second day. Yeah, yeah. And you know, they're volumous.
[00:34:06] Mel: They're just Yes, yeah, that's it. It's, it's out the nappy, it's up the back, it's everywhere and Yeah, they're all soggy and it's just copious and it's like, okay, whatever's going in. I mean I, and I'm not sure, I haven't looked into the actual litres, but is it true that women can make, or a baby can drink like over a litre of milk a day?
[00:34:28] Lucy: Yeah. Yeah. From a, from a month to six months, the amount of breast milk they take on average per day doesn't change, which is a very cool fact that a lot of people don't know. They feel like they are, well, always having to make more milk, make more milk, because as the baby gets bigger, surely the baby needs more milk.
[00:34:44] Lucy: And we're used to seeing babies having formula taking bigger and bigger and bigger bottles of milk as they get older. But actually, once you've got to a month, until that six month mark, the volume really doesn't doesn't change. It's the composition of the milk that changes, which is just very clever and very cool.
[00:34:59] Lucy: And it, you know, it always just fascinates me. So yeah, so that the average that they're making is about 750 mils. per 24 hours, but it can be, you know, there's obviously outliers to that. So it can be around about, yeah, a litre for some people. Absolutely. Yeah. So it's got to go
[00:35:16] Mel: somewhere. I mean, they're not going to be all of it.
[00:35:20] Mel: Yes. So infrequent poos, basically, are a tally on the, hey, maybe there's something going on chart. Yes. You add that to the whole picture. Yes. So then let's talk about feeding schedules and timing of feeds. I was on the, I'll feed my baby whenever it seems hungry train. So if my baby woke and was and appeared like it needs the breast, or actually if my baby woke, I just put my boobs out anyway.
[00:35:48] Mel: I don't know. That was my parenting strategy. Just boobs for everything. But there's, I see mixed advice given to women about actually your baby should be on a feeding schedule and you should time when they're going to get a feed and how long their feed is and you should stop their feed at a certain number of minutes and don't feed them in between.
[00:36:06] Mel: Like they shouldn't be snacking. They should only be having these big, huge meal type feeds. So what is your position on feeding schedules and timing of feeds.
[00:36:19] Lucy: Yep. So I guess if we think about this from, from the three perspectives, the perspective of the baby, the perspective of breastfeeding and the perspective as us, the ones that are feeding them from a baby and a breastfeeding perspective, We want them to be feeding responsibly, on demand, when they want to, when they need to.
[00:36:39] Lucy: And it can be from our side as well. Like if we're like, Oh, I could do with a feed or actually I've got to go out in 20 minutes. I could do with whacking the baby on, then, then great. So from a baby side, from the breastfeeding side, it needs to be this just completely random. 10 minutes later, 3 hours later, 4 minutes later, 20 minutes later, an hour later, all over the shop.
[00:36:57] Lucy: You know, it's completely normal for it to be like that because it isn't just about milk. It's a parenting tool. It's used for everything, absolutely. And it's important that babies are able to just go to the breast when they, when they need to. But as a society, as our culture dictates, babies need to be put into routines because that's how we like it and actually it almost feels a lot of the time like babies we don't trust that babies know what they need and that we need to be doing things for them And that actually because sleep and routines are so important to us That we need to be getting on this and doing this because it won't happen unless we do it And actually, it does happen naturally for a lot of people.
[00:37:39] Lucy: After those early months, a pattern emerges and they can tweak the pattern a little bit if they need to. But for a lot of people, the entire time they're breastfeeding, it is just completely all over the place. And that's completely physiologically, biologically normal. It's the norm where this comes from is the sort of sleep training industry, which is hugely lucrative massively financially lucrative and very predatory and very little subtle undermining messages everywhere about, you know, you must not be doing things well if your baby isn't sleeping well by X old, then it's because you're doing something wrong.
[00:38:17] Lucy: It's because you're letting the baby snack and not take full feeds or it's because you're feeding them too frequently and they know that they can manipulate you into it. It's terrifying because this is not research based in any way. This is just completely what our research tells us. Is that when babies are responded to as they need, and I'm not suggesting it's easy by the way, it's intense and it's hard and it can be really flippin miserable at times to give yourself over like that to another little person.
[00:38:46] Lucy: But from the baby's perspective, the research shows us that when we can do that, They thrive physically, emotionally, mentally, and not just short term. We're talking long term. We have studies that show us that babies are, they have better school readiness. So when they come to going to school, the babies actually have had this form of responsive parenting.
[00:39:09] Lucy: And it isn't even just about breastfeeding, it's about bottle feeding too, formula feeding. Responding to that baby's needs, giving them sleep support, giving them feeds when they request feeds, giving them comfort when they need comfort. These children then actually are better able to adapt to these situations, better mental health as an adolescent.
[00:39:27] Lucy: Teenagers, bless them, are really struggling right now, you know? Teen I have two teenagers and, and it's a really hard time. Social media, phones, Covid. Puberty, the whole thing is a mess. You know, these generations are not doing well mental health wise. We're in a really sticky point and so actually to know that while you're breastfeeding this baby and you're up 3 a.
[00:39:49] Lucy: m And you're seeing adverts on your phone going you could sleep train your baby. You could be sleeping You could do it and you're thinking why am I doing this again? Why am I doing this? It's digging deep and remembering that you're doing this because actually this is important life. long. And that feels like a lot of pressure.
[00:40:04] Lucy: But I think if we're not honest about it, and we don't let people know, then what they're actually hearing is, you're doing it wrong, you're doing it wrong, you're doing it wrong, you should be doing this, your baby should be sleeping, you're not feeding them correctly. I think it's important that we go, you're doing it right.
[00:40:17] Lucy: And yes, it's hard. And I'm really sorry, it's hard. And how can we help you with it. But believe me, you're doing a good thing. You're doing a really, really good thing. So A big part of this need for routine and blah blah blah is all coming from money making industry, unfortunately.
[00:40:34] Mel: Yes, we did very responsive parenting with our children with that idea of, I would love for them to in their Deepest being know that if they call out for their mum and dad, that mum and dad are coming and they can trust on us being there.
[00:40:51] Mel: My son's 11 and on the cusp of, you know, this teenage journey, and I just think, Oh my gosh, I hope all those years of investing in his, the very core attachment to him and us through feeding and through our sleep. Strategies and the responsive parenting strategies that actually we've laid down some really positive frameworks of when he's older and thinks, Oh, I need my mom and dad.
[00:41:18] Mel: His mind goes, well, they're always here. You know, we can, we can trust that they're always here. Yeah. So. In terms of feed scheduling, then if we are just feeding in response to our own and our baby's needs, we can't really go wrong in terms of, you know, you can't overfeed or too many feed a baby.
[00:41:40] Lucy: Yeah, yeah.
[00:41:41] Mel: There is a
[00:41:42] Lucy: tiny, tiny percentage of babies that can be overfed, but not from a growth and weight perspective. So some babies just rocket up those centile charts and they're growing and growing and growing. Yeah. Kind of like, you know, often they'll hear you're overfeeding that baby and no, not at all.
[00:41:55] Lucy: That's not, there's no evidence to suggest that that is a health issue or anything like that. The only time overfeeding could be an issue is if you've got quite a lot of milk on board. If you're on that sort of spectrum of milk making where you're somebody who makes a lot of milk and your baby is feeding and Taking a ton of milk, they can get quite bloaty.
[00:42:11] Lucy: Quite gassy. The tummies get uncomfortable 'cause they're processing so much milk all the time. That's a tiny percentage of babies. And usually those people are aware because they're like, do you know what? I've just, I've just milk for days and this baby's just, I feel like they've just taken too much and I need to give them a cuddle rather than kind of feed them.
[00:42:28] Lucy: Most people like 99.9% of people. can whack that baby on as often as they want for every single reason and it is never, ever, ever a problem. I really, truly believe that if all babies were parented in a responsive way that, that helped to form this deep attachment that so many of life's babies have.
[00:42:47] Lucy: problems would be gone. I really do. If I could change one thing, it would be to give people the confidence to truly respond to their own babies. And I have got two teenagers and an eight year old and I parented them very differently in their early days to I did with my eight year old because I felt like I should be doing the things that I was told I should be doing.
[00:43:09] Lucy: Sleeping in their own bed, sleep training, not feeding, you know, responsibly. I should be making them independent. They shouldn't be having bad Tantrums. Tantrums are bad and we should be putting them on naughty steps and leaving them to deal with it. That terrifies me now that I parented in that way. I can't change it.
[00:43:25] Lucy: So i'm not going to feel guilt or regret about it because it is what it is. But ultimately I now know that actually a toddler having a tantrum actually is somebody who's got really big emotions and doesn't know how to cope with them. And if I were having a really big spell of emotion and I reached out for support from my trusted person I'd really hope that they would help me
[00:43:46] Mel: and not go.
[00:43:47] Lucy: No, you can go and sit quietly on your own. I don't want to see you having big emotions. So,
[00:43:52] Mel: you know,
[00:43:53] Lucy: it's just a very different way of thinking and parenting, isn't it?
[00:43:56] Mel: But I think that philosophy goes hand in hand with the idea of giving a baby a responsive feeding strategy and a responsive sleep strategy.
[00:44:06] Mel: Absolutely, it all starts from
[00:44:07] Lucy: there. Yeah,
[00:44:08] Mel: you're then aware as a parent and your child is aware that my parent responds when I need something and yeah. And I feel like their needs move from being more physical as little babies, I mean, they are also emotional, but then as they grow, their needs become so much more emotional.
[00:44:24] Mel: And then in the teenage years, it's like all emotion. Even for my seven year old, it's like, oh, wow, it's all about the teens. And you know, so much so that My kids still look at me and go, I'm so angry. Or you know, the other week my 11-year-old said he was crying and he said, please help me. And that was him saying, I am feeling something so massive.
[00:44:51] Mel: I didn't know what to do. Even I was
[00:44:53] Lucy: steered myself.
[00:44:54] Mel: Yeah. You with, you know, my person who is always helped to be all he knew how to say is help me. And I was like, okay, this kid needs me and he knows I'm here. So, you know, I feel like this is such. It's, there's a philosophy behind this way of feeding and caring for babies.
[00:45:08] Mel: And so
[00:45:09] Lucy: many people say that breastfeeding becomes part of who they are as a person. It's not just, for a lot of people, it is just a way of getting milk into a baby and that's absolutely fine. It's no right or wrong. But so many people, especially when they feed into toddlerhood or beyond and, and, you know, longer term.
[00:45:26] Lucy: Often go, well, it's, it's part of who I am. It's part of how I mother. It's, it's just, it's a bit of me. It's not just, you know, and that's, it's wonderful. It's magical. We can't imagine that with a tiny little baby, you know, we can't, I can't imagine that, but actually it just happens and develops so naturally.
[00:45:42] Lucy: And that's not, it's not to say that we have to be a complete martyr to this child and just do everything they want all the time. There is a, an appropriate point at which you start putting boundaries in place and going, hey, actually, but It's, you know, that's, that's not an okay thing to do or to say or to, way to behave or, or, you know, I don't, I don't want you to twiddle my other nipple while you're feeding or whatever it is that's kind of going on.
[00:46:02] Lucy: Oh, the twiddling. You remember the twiddling? The twiddling! You know, things that we don't like and we don't have to have happen. So it's not like you just have to give yourself completely over to your children. But certainly in those early weeks, it is a lot more give. You're just giving, giving, giving.
[00:46:18] Lucy: And that is intense. It does level back out in that as they get that bit older, But it's older than society expects. It's not a few weeks or a few months in. It's a lot beyond that. That's when the sleep support isn't needed as much. That's when you can start to have discussions with them about, actually, I don't like it when you do that.
[00:46:36] Lucy: We're not, we're not going to do that. You know, you, you can discipline children and put boundaries in place. It's about understanding that they're not being naughty. They have needs that need meeting all the time. Starts with tiny babies.
[00:46:49] Mel: Yes, absolutely. And I feel feeding and sleep goes hand in hand. And even when, you know, when I was feeding my little ones, people would say, Oh no, you shouldn't let them go to sleep at the breast.
[00:47:02] Mel: Don't let them go to sleep at the breast. I was like, what? That's the only way I get them to sleep. That's like my parenting strategy. How would I do it if they didn't go to sleep at the breast? What's your take on babies going to sleep
[00:47:15] Lucy: at the booth? Oh, it's completely normal and it's just an incredible tool and, and why are we making life difficult for ourselves?
[00:47:22] Lucy: Stop trying to stop this thing that they want to do and everything in us is going, this will work and it's going to be the quickest, easiest way. Absolutely can't do it. I think it all comes from a place of, of, of needing to be more independent and needing to have more control. We're very much these days in control of our lives and in control of what we're doing and when we're doing it.
[00:47:44] Lucy: It's very hard to not be in control of this little tiny person and to be, Not able to maybe go out and meet your friend because you're tied to this. And actually I would have loved to have gone out and seen everybody and blah blah blah. Such a short season. You know, it's such a short time in the grand scheme of things.
[00:48:00] Lucy: It's horrible while you're there. It's really hard. But you can hate it and still do it. You know, or you can love it and do it. Or you can have mixed feelings. The conflicting feelings around feeding and feeding to sleep are massive. You know, I love this. I hate this. All at once, are they? But feeding to sleep is such a normal thing, biologically normal, everybody does it, there's sleep hormones sloppin around everywhere.
[00:48:25] Lucy: Don't make life difficult for yourself. If you're happy doing it, do it. Kids feed to sleep right the way until they stop breastfeeding, potentially. And they will stop. Feeding to sleep, I always say, 100 percent all the time. of babies stop feeding to sleep. Because they do. They will stop doing it. It's not something you need to change, unless you want to, you know, when they're that bit older.
[00:48:47] Lucy: They will stop doing it if they're in accord.
[00:48:49] Mel: Well, I mean, we used the, you know, the very final feeds that we ever dropped were the ones that were attached to the nighttime sleeps because of how much easier it was. And yeah. I was doing my PhD when I had my first baby, so I loved that anywhere that I was, if I was in an office or in a conference or whatever I was doing, I knew I could get the baby to sleep because my boobs were there.
[00:49:11] Mel: I was there with my baby and I didn't need all these little sleep cues like the right blanket and the right bed and the right space and the right music to create this sleep environment. I'm just like, put the baby on the boob, baby's asleep, now I can do my presentation. You know, it was all. It felt easier not to be in a routine, to feed to sleep, to do contact naps, to have them in our beds, it just, I could just take them wherever I wanted, I could go on holidays, like, you know, so, yeah, I don't know, I don't, I don't even understand how putting your baby in a routine makes it easier because you still have to change your own routine
[00:49:49] Lucy: to fit them.
[00:49:50] Lucy: I think it's because other people can then, I think that's what that is about. It's not all on us. And when you are breastfeeding, you are very much the default parent. Everything comes to you. Everything falls on you. Often the mental load is on you as well. And that mental load and that, You're always the one that has to do the everything.
[00:50:14] Lucy: It's not always a nice place to be, and it's not what our society expects us to be doing. It expects us to be having it all, and going out and doing, and working, and back in our jeans, and doing la la la la, and actually a lot of the time that's not possible. When you have a baby and you're breastfeeding, a lot of the time you are pinned to the sofa or snuggled in the bed and, and that's not what's expected of us.
[00:50:33] Lucy: And so we feel like we're fighting against this. And when you feel like you're constantly fighting, it really gets to you mentally. So you go, you know, actually, I'm just gonna, I'm just gonna stop. And actually, if someone else can help, then I can go and do all the things. And then I'm doing what everybody expects of me to be doing, or what I want to be doing.
[00:50:49] Lucy: We're not giving ourselves permission. And the expectation isn't there. There, that actually we need to just give in to this for not just a few weeks, but a few years, actually, of whether you're breastfeeding or not, to be just there more than you're not. And it does get easier with time, but I think it's about the expectations, really.
[00:51:10] Mel: Yeah, and actually we had Dr. Pam Douglas who does the possums program here in Australia on the podcast a while ago and she was saying a lot of the success of Feeling okay to parent in the way that feels right for you is coming from a place of having support So where there's a lack of support You will parent in a way that's kind of more about survival, because you feel like you're the only one who's doing it and no one's looking after you.
[00:51:40] Mel: So, I wonder if these parents who feel like they need to be rigid with feeding and rigid with sleeping and, Expecting their baby to be more independent is what needs are not met in you as a parent that mean you need to create such strong boundaries around how you're going to parent your baby and that self care.
[00:51:59] Mel: And also misunderstanding
[00:52:00] Lucy: of baby behaviors and when they have that capacity to be independent, actually, you know, they don't, they can't really sleep on their own without sleep support. They can't. roll over or grab things or start picking up and eating food until they're ready to do it. But because we have the option to potentially force them into sleeping on their own or, or spacing out feeds, we kind of feel like we probably should be doing that.
[00:52:26] Lucy: Actually, when you think about all the other things that just naturally happen, you can't force them to start walking. They will walk when they're ready. It's the same with everything. You know, it all just happens if you let it happen, but it's giving yourself permission to go with that is the big one.
[00:52:39] Mel: Yes, absolutely. Now, can we flip to, to nipple shape, it's a big questions that I've had and you know, that I've seen in my practice too, is women saying, I have actually no nipple, in a sense, they look inverted or they're completely flat. How am I going to breastfeed? What, what do you say to questions about, you know, how can I breastfeed if I have flat or inverted nipples?
[00:53:06] Lucy: Yeah. Yeah. Yeah. It's, it's. Possible for the vast majority of people, it takes just that little bit more time and patience and practice. So, what triggers a baby's, so sucking is a reflex. So if something hits the back of the roof of the baby's mouth, they'll suck it. Whether it's a finger, or a nipple, or a bottle teat, or a dummy, or whatever it is, if it hits in there, they'll go mmm, mmm, mmm, in those early weeks.
[00:53:32] Lucy: Because, for somebody whose nipple isn't quite as protruding as you might see on all the videos and all the, you know, pictures, which is not helpful for these people, you know When you've got a flatter or a shorter or an inverted nipple, it's not necessarily going to get to that spot to trigger off the sucking reflex.
[00:53:47] Lucy: So the key is working with someone or figuring out how to put your baby to your own individual breast in a way that is going to mean that the breast tissue hits the back of the roof of the mouth to get that baby sucking. Sometimes the nipple will then be drawn out more, sometimes it will, you know, it will actually start to avert, but Often it won't, it will stay inverted, but the reason people struggle with flat nipples is if the baby just can't quite grasp on deeply enough to start sucking.
[00:54:14] Lucy: So they'll go on, suck, suck, come off, go on, suck, suck, come off, and it's because they're not able to get in and grasp. But with the right shaping and positioning, they usually can get that fit. The key is knowing that it takes time and practice. The baby doesn't come out with any preconceived notion of what they're expecting.
[00:54:29] Lucy: They just know I need to find this and, and go on and, and try and do this and we can kind of help them a little bit in that sort of situation. So if you know you've got, you're worried about your own individual anatomy, then it's, it's working with someone who can help you for your individual. This is your baby.
[00:54:44] Lucy: This is your breast. How did the two fit together in a way that it's going to work for you?
[00:54:50] Mel: And you don't need a pointy out nipple to be able to feed your baby. It's just going to be a different, , approach to feeding. And often, as you said, with some nipple shaping, my experience has been that's often the only thing that needs to happen in order to get enough breast tissue into the baby's mouth.
[00:55:05] Mel: And the other part that goes with that is some women talk about having very large breasts and finding it very difficult because their breasts are so large. How, what kind of strategies do you offer to women with larger breasts on? to get a good latch.
[00:55:20] Lucy: Yeah. And again, it's all about working with your own individual anatomy.
[00:55:23] Lucy: Often people are encouraged to lift their breast up, you know, lift the breast right up and put the baby on and then they're stuck. And actually one of the real joys of breastfeeding is being able to have a free hand. So if you're lifting your boob up, putting the baby on, and then you're stuck, you're like, and especially if you've got a toddler or another child, how do you then read a book?
[00:55:41] Lucy: How do you do whatever? So, yeah. I always try and make sure where possible that we can get in a position where actually they're able to have a hand free, even if it's only a little bit free and then they kind of come back. We don't want to be moving the breast to a place where it doesn't naturally sit.
[00:55:56] Lucy: So if the breast is sitting low because it's heavy and it's large, we want to make sure the baby is where the breast is naturally sitting. Sometimes tucking the breast in the corner of your arm and kind of So that you've got that little bit of extra support can work kind of nicely but it's all about the, the two fitting together for your own, your own Some people talk about putting a dressing gown cord underneath and tying it round your neck to lift the breast and I'm like One, it's, it's lifting the breast which isn't gonna be comfortable but also can you imagine the pressure on your neck with that?
[00:56:25] Lucy: I mean if that's right for somebody and it's working for them, absolutely It's not a problem, but I don't, it isn't, it isn't always about trying to make the breast what it's not. It's about trying to do with your own breast what it does and where it wants to be and making the baby fit around that.
[00:56:44] Mel: I mean, there has to be a sustainable strategy.
[00:56:46] Mel: There can't be all these tools that tie you to the house either. You want to be able to feed wherever you are and. Yeah, that idea of just letting your breasts fall wherever they go and then feeding your baby wherever your nipple is instead of trying to make your boobs all perky and up here. And just let them hang where they are.
[00:57:06] Lucy: We'll use a feeding pillow. I use feeding pillows myself. The thing with the pillows is that if you've put a pillow on and then you put the baby on top of the pillow and the baby's up here and your boob is down here, the two are not gonna fit and then you're gonna end up having to lift the baby and then actually, is that pillow really working for you?
[00:57:23] Lucy: I don't think it is. And also, if you lie the baby on the pillow, they can be away from your body, and they can't tip their head back very well. So, if you're going to use a pillow, ideally, get the baby in to you, nice and tight, you know, where everything naturally goes, put the baby on, then tuck some pillows in.
[00:57:40] Lucy: And the pillows really is about supporting your upper body. More than it is supporting the baby. It's about taking the weight through your arm so that you're they're not going Come get an achy, you know It might be just one little pillow under your elbow or it might be that you can use this You know arm of the sofa or something
[00:57:56] Mel: Yeah,
[00:57:57] Lucy: try not to use a pillow for every single feed You know when you're trying to latch them latch first then pillow if you need it,
[00:58:04] Mel: and I think it's more about Position, getting the baby in a position where you don't have to hold the whole baby up for the whole feed either.
[00:58:11] Mel: Exactly. You use your own lap. Yeah. Unless you're like me with these little coconut boobies where, you know, my babies did need multiple pillows to get up here. But that was more just about me not having to hold them all the way up here all the time. And I realize we're getting on in time, so I want to, I want to talk about this, I don't know, do you have special K in the UK?
[00:58:30] Mel: There was a cereal. Oh, with the, with the, yes, with the wide
[00:58:33] Lucy: gapes,
[00:58:34] Mel: which
[00:58:34] Lucy: would be like the K. Yeah,
[00:58:36] Mel: you know, they used to talk about how the baby's lips should be all wide open, like a little special K shape, and be resting over the nipple, and draped over the nipple, and if they were tucked in, that was a sign that the baby wasn't latched well.
[00:58:50] Mel: Oh. And to this day, I see people trying to flick the lips out of a baby and flip the lips. Can you speak into that? Cause I've heard two sides of the story. Some very trusted lactation consultants that I know is still big on the lip thing. Got to be right position. And others are like, look, it's just drapeage.
[00:59:07] Mel: It's, it's nothing. Don't worry about it. So what's your take?
[00:59:12] Lucy: As always, if it's working for that person, doesn't matter what it looks like, it's comfortable, baby's growing, no problems, lovely, doesn't, doesn't really matter. If they're having any problems or if they're new and they're trying to get things sorted, when you open your mouth wide, and we know they do need to be open wide to come on nice and deeply, when you open your mouth wide, you can roll your bottom lip down.
[00:59:34] Lucy: It just it works it happens like if you go to bite a root like an apple or something and you go to take a Really big bite, but actually your top lip is pretty neutral. It's not rolled up It's not flanged up if your top lip is rolled up. You're actually not very wide so if somebody It shows me the baby at the breast.
[00:59:53] Lucy: The baby goes on and the top lip is rolled up. I'm probably thinking they maybe are not quite in perhaps the optimal position or they might not be quite as wide as they could be. So how does that feel for them when it's like that? Ultimately, is the nipple coming out in normal shape? Is the baby able to drink well?
[01:00:10] Lucy: Can we tweak, you know, adjustments around a little bit and see what happens? I'm more of a If the top lip's neutral, that's probably going to be a more comfortable, optimal latch. I certainly wouldn't be trying to roll lips out or anything like that because the lip just sits. The lip, that top lip doesn't really actively do much during the feed.
[01:00:27] Lucy: It just is, is balancing on the breast mainly. If, if the lip is having to grip to the breast and they're using the lip, That's when they get these blisters on the lip, blisters to me are, uh, okay, they're having to grip with their lips and that means that something actually deep within the mouth, the latch isn't quite where it needs to be because they're having to kind of grip with these lips.
[01:00:47] Lucy: So the top lip should just be sitting pretty neutral rather than this kind of flange like Pringle lips or anything or yeah, special K or whatever. Yeah. So bottom lip out and down, but top lip neutral.
[01:00:59] Mel: Got it. So again, if it's comfortable, your baby's getting enough. milk and the poos are all normal and everyone's fine and the lip position is less relevant than if you were working with somebody to help with the feet.
[01:01:12] Mel: Oh, I've got so many other questions. I'm trying to pick the ones that maybe are most kind of globally relevant to me. Clicking noises sound like noisy feeders. so again, I've come across clients who you're looking at everything, baby's gaining, mom's comfortable, everything else is fine, but they are noisy feeders.
[01:01:31] Mel: But you know, a lot of people say if there's clicking or noise, then that means it's a bad latch.
[01:01:36] Lucy: Yep. So clicking, clicking again, if all is normal, clicking may be normal for them. Clicking is a sign that the tongue is used, losing a little bit of suction. So that sort of the tongue works in a wave motion like this from the front to the back.
[01:01:50] Lucy: And if it's kind of just a little bit uncoordinated or it's losing a bit of suction, it makes this kind of noise. Sometimes it's just an occasional one fine, but if it's persistently kind of like this, then it's kind of, Oh, okay, what's going on with that, that tongue kind of orally something isn't, isn't quite flowing as it should.
[01:02:05] Lucy: Often it's because it just needs to reposition the latch, get a deeper mouthful, adjust the position where the head is, etc. Sometimes it's that just the milk is coming so fast that they're trying to coordinate suck, swallow, breathe, suck, swallow, breathe, and they're just like losing it a little bit.
[01:02:20] Lucy: Positioning usually helps with that, sometimes it's just as things settle it gets a bit easier. Sometimes though it is a sign that that tongue is restricted in its movements. It's due to perhaps tongue tie or something and that would be working with somebody who really specialises and understands oral function and tongue tie, not just someone who looks and goes, looks fine to me.
[01:02:40] Lucy: It's not about how it looks. It's about how it feels and how it is functioning. So if there is persistent clicking, worth getting a proper oral check to see that there's no tie going on. But again, yeah, if it's comfy and all okay. Lesson.
[01:02:54] Mel: Great. Well, and you already, you've given me the next, the last question that I'm going to ask you because that was another one I was tossing up between the letdown.
[01:03:03] Mel: So a lot of women talk about, Oh, I've got a really strong letdown and the baby gets all choked up and pulls off. And then actually one of my friends has Story where her, she had a really strong letdown and her baby used to pull off and it happened in a restaurant. She was at dinner with a whole bunch of friends and she sprayed the table with breast milk.
[01:03:23] Mel: Right. So so the letdown for anybody who's new to feeding is basically once the baby latches, there's some early suckling that goes on and then the mother's body just kind of relaxes the nipple opening and out shoots. all this milk into the baby's mouth and it's called a letdown. Some women can feel it all tingly and they can feel it flow out.
[01:03:45] Mel: And as you said, there's sometimes this spluttering and and then it settles and there can be multiple through the feeds. But for some women have a really forceful one and their baby seems to be choking and gagging. Is there a strategy, you know, a lot of people say, well, just take the baby off, let the letdown happen, or, you know, let the letdown settle and then put the baby back on.
[01:04:06] Mel: What are the. Strategies for this. Does anything show? So first,
[01:04:11] Lucy: first port of call, if somebody says to me their baby's coming off, coughing and spluttering a lot with the fast flow, my first thought would always be, let's look at how the baby is positioned at the breast. If you've got a baby who is in a sort of neutral position like that or chin down, it means the nipples are probably going in quite centrally into their mouth and when that milk sprays, it's hitting straight in the back of their throat.
[01:04:32] Lucy: You can imagine that they're going to pull off and protect themselves, it's going to make them cough and splutter. Yeah. If you can get the baby going to the breast with their chin up and coming on so that the nipple is pointing up and that sort of, call it like an asymmetric latch, so the nipple's pointing this way, the milk hits the roof of the mouth, then down the back of the throat, so it's doing this lovely kind of, like this.
[01:04:51] Lucy: They can cope with that usually a lot, lot, lot easier, and they can just, it's, and you can imagine yourself, like, like, when I'm drinking, like this, you tip your head back, because you can cope with the flow of drinking a lot easier. If you try and drink with your chin down, like this. It just doesn't work.
[01:05:06] Lucy: It's uncomfortable, and it just doesn't fit. You need to be chucking your head back like this if you're really gonna have a big fast drink. So, we want to reposition the baby is always the first thing, making sure they're on deeply, asymmetrically, chin right up. If that actually looks great, then it is things like, knowing that most likely it will be, It will calm down.
[01:05:26] Lucy: For most people, it's an early week problem where your body is just a bit overabundant with milk and a bit overexcitable. If it's a sort of longer term thing, yeah, you can, when they come off coughing and spluttering, just, just hold a towel or something over your boob, let that calm down. Once the spray's calm, then put them back on again.
[01:05:42] Lucy: The first let down, that milk ejection reflex, the first one at the beginning of the feed is usually the strongest one. The subsequent ones throughout the feed are usually less strong. Strong. So tend to be less of a kind of problem if again, you've got a baby really struggling with that fast flow. It's working with someone to see if you've got too much milk on board.
[01:05:59] Lucy: 'cause sometimes the two are linked. But also thinking about oral function and ties and things as well because sometimes they can't coordinate that suck, swallow, breathe because of something going on in their chops.
[01:06:10] Mel: Yes. Oh, so much information in one single episode. I do literally have. twice the number of questions that we've done.
[01:06:19] Mel: So there's no way we're going to get to it. But your book is Breastfeeding in the Fourth Trimester, which I'm almost certain would cover a lot of the questions that are already on here. Are there any other resources that you love, that are your go to, or that you recommend to women who are feeding?
[01:06:36] Lucy: Yeah, so, Emma Pickett's podcast, it's called Makes Milk, is phenomenal, I love her, I adore her.
[01:06:44] Lucy: She covers everything, really, you know, anything and everything that you could possibly want to know in there. There's a lot about toddler feeding, older children feeding, there's all sorts in there, so that's well worth looking at. And I tend to go to the Lesley Association of Breastfeeding Mothers and the Breastfeeding Network here in the UK are our go to.
[01:07:03] Lucy: Lines. And we're very lucky in the UK that we have the National Breastfeeding Helpline as well, which is a phone line and a live chat thing and is currently 24 7.
[01:07:11] Mel: And if you're an Australian listener, we've got the Australian Breastfeeding Association, which has breastfeeding counsellors, so similar support.
[01:07:19] Mel: What system? And they also have groups and things like that, that people can go to. So there's lots of places, absolutely
[01:07:26] Lucy: getting to the groups with the research shows us that if you go to a group, you're much more likely to meet your breastfeeding goals. So getting out to those groups and it's terrifying walking through the doors for the first time.
[01:07:35] Lucy: And you're like, what if I'm the only one that's having problems or in a big milky crying mess? That's what those people that are in those groups, running those groups, they were the people walking through the doors for the first time in the big, milky, crying, sweaty mess. And that's why they're there to pick you up, get you a hot drink, give you some cake and go, let's sort you out.
[01:07:53] Lucy: So, you know, just absolutely do it. Be really brave and you will definitely want to go back because it makes a huge difference.
[01:08:00] Mel: Absolutely. And I feel like if, you know, there will probably be two groups of women who are coming to this episode. The group who are kind of like, okay, I'm about to have my baby and I need to be prepared for breastfeeding.
[01:08:11] Mel: Yeah. To that group, what, what, what would you say to those women who are here thinking, I am going to breastfeed my baby? How should they set their expectations on that?
[01:08:20] Lucy: Know that it's going to be a beautiful chaos. It's going to be probably quite intense, and more intense than you realise, and the key is relaxing into it, leaning into it, lowering your expectations right down of what you can manage to do, and getting the help.
[01:08:36] Lucy: Reaching out and getting the support is the key, and knowing where you're, you know, if you do nothing else to help, to prepare during pregnancy, find out who your local support are or who you want to work with. Even if you work with somebody over Zoom, for example, figure out who you like their, their style or their whatever, who is local that can come and do a visit for you that specializes in this.
[01:08:55] Lucy: And that will make a huge, huge difference for you. Hopefully you won't even need it, but then you know where it is if you need it. If in doubt, get it.
[01:09:02] Mel: Yeah. And I think everyone should set up this, like, breastfeeding throne. This, the throne saved my life. It had a table next to it, a very comfy chair, enough pillows within arm's reach.
[01:09:15] Mel: There was always water there, a phone charger, you know, snacks on the table.
[01:09:20] Lucy: And all the snacks.
[01:09:22] Mel: All the snacks. So, you know, you actually are You kind of want to go there and you're like, Oh, the baby needs a feed. I'm going to go to this amazing comfort spot. I'm going to have a good snack. Yeah, that has everything that I need.
[01:09:33] Mel: And to women who are coming to this episode thinking I really need help, that's why I'm listening to every podcast on breastfeeding. Can I suggest That you probably won't find the help that you need by just listening to everybody's advice. I think the faster way to succeeding in your breastfeeding journey is to get individualized care from a professional who is going to assess your particular situation.
[01:09:58] Mel: Because I know there are women out there Googling and asking friends and trying to read it. Doing a 3am
[01:10:03] Lucy: Google of doom, I know.
[01:10:05] Mel: Yes. And I just think it's not going to help you. You need, you'll save a lot of time and energy and sleeplessness and uncertainty by just investing financially in somebody who can assess your individual situation.
[01:10:20] Lucy: Yeah. Lots of people say it's the best baby money I spent.
[01:10:24] Mel: Oh yeah. And actually, I think will save you money in the long run, because if you have a successful feeding journey, that is the cheapest way to feed your baby. If nothing else
[01:10:36] Lucy: make you
[01:10:36] Mel: breast
[01:10:37] Lucy: milk. The midnight shopping when you're like, maybe I could buy myself a new coat or whatever.
[01:10:42] Lucy: Yeah. You have to be careful on the midnight shopping whilst you're feeding. But aside from that, yeah.
[01:10:46] Mel: Get a box set of something that you could watch to keep you distracted from online shopping. Amazing. Lucy, thank you so much for being on the podcast. In the show notes below, I'm going to make sure we link your book, website, socials, your full name, so that if anybody's thinking, I love this Lucy girl, where do I find out more?
[01:11:05] Mel: Just go to the show notes. You can click on all the things. That's this week's episode of the Great Birth Rebellion podcast. Thank
[01:11:12] you.
[01:11:14] Mel: To get free access to all the research that's used to create each podcast episode, you can join the mailing list at melaniethemidwife. com.
