Birth Centres with Guest, Midwife Issy Bourton

Birth Centres with Guest, Midwife Issy Bourton

S4 E4

This episode is essential listening if you’re trying to decide whether to labour in a birth centre or midwife-led unit.

I’m exploring everything birth centres, with my friend, midwife, Issy Bourton. 

Issy and I look at what a birth centre/midwife-led unit is, how your experience there can differ from a hospital birth, what you can expect to happen during your labour, how to request a birth centre labour if you are not low risk, and transferring to a labour ward.

For more information about speaking to your consultant midwife about out of guidelines care plans see Series 1 Episode 12 Birthing Outside of Guidelines with Guest, Midwife Rebecca Savage

You can follow Issy on Instagram @issythemidwife

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TRANSCRIPT

(AI GENERATED)

I'm your host and founder of BirthEd, Megan Rossiter.

If you're looking for the evidence, the nuance, the detail that's missing from your antinatal appointments, then I've got your back.

The BirthEd Podcast is here to help you sort the facts from the advertising, the instinct from the influences, and the information you're looking for from the white noise of the internet.

I hope you've got a cup of tea in hand and a notepad at the ready.

Let's dive in.

Hi everybody, welcome back to The BirthEd Podcast.

I am delighted to be joined today by Lucy Ruddle.

Lucy is an International Board Certified, would help if I could say that correctly.

This trips me up every single time I try and say it.

Lucy is an International Board Certified Lactation Consultant, which is something you'll never hear people say because they will say IBCLC.

She's a breastfeeding counselor, a holistic sleep coach and author of now four books, Relactation, Breastfeeding Myths, and Mixed Up Combination Feeding by Choice or Necessity.

And her new book about breastfeeding grief is due out this summer and is available for pre-order now.

So Lucy, thank you so much for joining me.

Thank you for the slight correction of IBCLC, which to be honest, I can never even remember how to say IBCLC, but you know what you are.

I trip over it myself and most people just say breastfeeding expert, group wizard, someone once called me.

And I think we should go with boob wizard.

Lucy is a boob wizard and an author of now four books.

So in today's episode, we've got an episode on breastfeeding that if you haven't listened to already as well, worth a listen.

And because of Lucy's brilliant book called Mixed Up, we're going to be chatting today a little bit about mixed feeding and bottle feeding.

And it's a conversation that doesn't frequently happen.

And I imagine that's probably why you wrote a book about it.

So what was it that led you to writing Mixed Up?

Yeah, that's such a good question.

And it was a book that I felt that I had to write.

When I wrote my first book, I wanted to write it with Mixed Up.

I just felt like this needs to be written.

When you're an lactation consultant, we spend a lot of our time working with parents who are already using some formula and they often don't want to be using that formula and they have so much guilt around it.

And then there's also this very strong narrative from society that you must exclusively breastfeed.

And actually the other side of that is almost like you must choose to exclusively breastfeed or exclusively formula feed.

And then there's this gap in the middle where many, many parents find themselves, but there's no real information out there.

They have to kind of piece it all together.

And I kind of was on a point where I was like, this is crazy that people can't go and find a book about how to make this work because it isn't actually that hard to combination feed.

You just need the information to let you do it.

So yeah, I kind of was like, right, someone's got to write the book.

Oh, I suppose I'll write the book because I have ADHD.

So I'm like, oh, I'll just do it.

I'll just write this book.

And it ended up taking me like a year to write.

And what's interesting about it is it's actually quite controversial because people who are very pro breastfeeding don't like it because it encourages formula feeding.

And equally people who want to kind of just formula feed feel that it pushes breastfeeding.

And so I'm kind of in a bit of a middle ground where no one seems very happy with the book.

But it does have the people that do read it because they want to combination feed and that's what they want to do or they need to do report that it's very, very helpful.

So that's nice to know that it does have, you know, it is reaching its audience.

It does have more audience.

You sort of touched on that.

Maybe the reason why this conversation isn't something that happens very frequently.

We get a lot of information about how to breastfeed, how to prepare for breastfeeding.

And then the sort of like, well, if it doesn't work, then you formula feed, or people feeling very, very strongly that they don't want to breastfeed and they only want to formula feed.

And, you know, this is definitely reflected in the work, the idea around birth as well, but very, very polarizing opinions about it.

Do you think that's why this isn't a conversation that happens?

Yes, I think it's a very hard conversation to have.

And when I was writing the book, there were many, many times where I was, as I was trying to word stuff and I was thinking, this is a really hard conversation to be having, because I need to tell people why breast milk is important for babies, what it does for babies, that, you know, why we want people to breastfeed.

But I also don't want those people to feel guilty or ashamed if they don't want to exclusively breastfeed, or quite realistically, if they can't, because we live in a society where, even though, physiologically speaking, we should all be able to breastfeed fairly easily, the society we live in doesn't allow that to happen, but parents don't quite get that.

So they feel guilty about not breastfeeding and the whole, no matter what you do, you're going to annoy somebody.

Somebody's going to be upset or offended or hurt.

And when you're trying to write a book that's in that middle ground, it's incredibly challenging to do.

Yeah, I totally get that.

And I find that that sort of where I feel like I sit as well in terms of like birth preparation is that you can get such, such, such strong and often quite valid opinions from both sides that there is a whole host of people that do sit somewhere in the middle.

And if they're lacking that support and that information, then they can just be totally, totally lost.

So as you've already mentioned, there are like any number of reasons why somebody might find themselves in a situation where they are mixed feeding.

And mixed feeding can look like anything from one bottle occasionally to, you know, one breastfeed occasionally.

Where do you start?

There is so much stuff, so much advertising and so little reliable kind of information out there about formula feeding and combination feeding.

So where should somebody start in terms of what do they need and how do they choose it?

Yeah.

I think what we can do actually is we can push all of that aside.

Take the science away, take the marketing away and just ask the parent, what do you want?

If you didn't know anything at all about any of this stuff, what is your instinct telling you that you want to do?

And what's interesting is most of them in pregnancy will say, oh, I don't mind.

I want to combi feed.

And we can set them up for that and say, okay, well, let's try and get the first feed after birth at the breast because that's gonna prime all the milk receptors and then see how that feed goes.

And if it goes well, then you might wanna do the next feed.

And if it doesn't go well, you might wanna give a formula top of that feed.

And then what happens is the baby is born and usually with that surge of hormones, breastfeeding suddenly feels very, very important to parents and they may at that point decide that they want to spend more time breastfeeding and less time formula feeding.

And if you've given them the good information in the beginning, which is, you know, that first breastfeed is really important, we kind of set them up to be able to do that.

And then problems come in.

And that's when often for people, the combination of feeding kind of has to come into play.

And then depending on whether those problems are things like baby isn't gaining enough milk, or simply that the parent or the mom is just exhausted and needs a break, that will then influence how combination feeding works.

So for a baby that's not gaining very much weight, we are going to have to really work on getting more milk into that baby.

That might mean that we give more formula.

For the parent who just wants a good night's sleep, it might be that dad or partner or friend gives a small bottle at 10 p.m.

and parent gets a good three or four hour sleep.

It really can be very, very varied depending on the situation you're in.

Yeah, and it can be so different from, but my personal experience of having two babies is very different from baby to baby.

So we similarly did, and I was that exhausted mom without loads of support around.

And we did the sort of like, my husband worked in the evening, so he got home from work at like 11 o'clock.

And so it made really good sense for us to do a bottle.

He was about four months, we started giving a bottle at that kind of 10 p.m.

feed.

Second baby, I was like, oh, we'll probably do the same.

Probably give like an express bottle at that time.

No, no, he was not having any of it.

He was not interested in taking a bottle.

And so the question that people are always asking me anti-natally, so when they're thinking, oh, I might be that person that wants to give a bottle or to be able to go apart from the baby at some point.

And wanting a bottle or several bottles to form part of their feeding journey.

And I know that there's no particularly perfect answer to this, but when, when, and what kind of bottle?

Ah, yes.

Oh, and I wish there was like a magic, correct answer.

I gave a talk about this recently.

So I was asked to give a talk on bottle refusal for some American lactation consultants, because of course in America, they go back to work so early, they kind of have to bottle feed, even if there's pumped milk in those bottles.

And the science suggests that the earlier you give a bottle, the more likely it is that the baby will take the bottle.

But if you do it too early, that then increases the risk of them saying, the baby kind of going, no, I don't want to breastfeed, thank you very much.

So my kind of generic answer for UK mums is if you can wait until about week four to week six before you introduce a bottle, that's going to give your milk supply a good time to establish, it's going to get your baby kind of lots of time to get used to breastfeeding, and then you can try with the bottle.

However, if you are somebody who knows that you want your baby to take a bottle, you know that's going to be a thing that's going to have to happen, and sooner rather than later, you're going back to work or you know you want to combination feed, you might actually want to start introducing that bottle after about two weeks.

So again, you've had a little bit of time to kind of get breastfeeding going well, but you've still got that more, that window for baby to accept the bottle.

Assuming that breastfeeding is going well, because if you're having problems with breastfeeding, that's a whole different conversation.

Like, that gets very, very complicated.

Yeah, and in that case, a bottle might be introduced earlier or would you try and use other?

Yes, so we would normally want to try and reduce kind of different things going in the mouth so that it's just a boob that's going in the mouth.

But of course, if a baby isn't gaining weight and they're not able to remove the milk from the breast, we're gonna have to introduce other things.

So depending on their age, it might be that we do that through a cup or it is with a bottle.

And then everyone gets very confused about that because they're like, well, I was told not to introduce a bottle because it can confuse the baby and reduce milk supply.

But I'm now being told to give a bottle because my baby's not gaining weight.

And it's like, I know that's really confusing and really difficult, but we have to get the weight on the baby and then the baby can focus on breastfeeding.

But there are ways that we give bottles and we use pace feeding methods and try and make sure we're not overfeeding and all that kind of stuff.

Yeah, and I think I've supported families who've had babies in NICU or time away from the baby and it has suddenly become a completely different feeding journey than they ever imagined.

So it's really important information to have, whether you plan to exclusively breastfeed, whether you think you're going to combination feed or whether you just don't know at this stage.

So you might be listening to this during pregnancy and people might be thinking, I want to do that and I want to feel prepared for it.

Or people might be listening to it and they're in the throes of it.

In terms of what they're going to actually need, they're gonna need bottles, which are gonna need to have teats on them.

They're gonna need some sort of sterilizer to sterilize these bottles.

And they're gonna need something to put in the bottles.

So that could be express breast milk or it could be formula milk, it could be donor express breast milk.

I think that's the exhaustive list of the things that you could put in this bottle.

But when you kind of get to this point, oh my God, it is so hard.

And there are a million different opinions from moms, from professionals, from hospital staff, about what kind of teat you should be using, what kind of formula you should be buying.

So do you have any either information or any tips on kind of how do you navigate that?

How do you separate the kind of the advertising from the facts?

So if we start with the formula, because that's the simplest.

So basically in the United Kingdom, all formula has to meet certain criteria in order to be made and authorized and allowed to exist.

So they all have the same baseline ingredients.

And if an ingredient has been proven to be beneficial, like genuinely beneficial for babies, all the formulas have to include that ingredient.

So anything you see where this company over here are saying that our formula is best because it's got tummy soothing bubbles in it, whatever nonsense they're coming up with today, if that was true, all of the formulas would have to include it in the UK.

So it's just marketing.

So when we kind of understand that, and we also understand that there are actually most of these formulas are made by the same company.

So Cow and Gate and AptoMil are both made by Danone in the same factory.

It's just that the milk is put into different containers depending on who they're selling that milk to.

So AptoMil is aimed at affluent parents who probably wanted to breastfeed.

And you can see that in their adverts.

They talk about when you're ready to move on for breastfeeding.

They have breastfeeding images in their adverts on the television.

Cow and Gate is aimed at younger families and perhaps people who don't want to breastfeed.

So those images, they don't mention breastfeeding in the slightest in those adverts, but they're the same milk.

And it's just that AptoMil is what, four pounds more expensive?

When we understand all of that, that then makes it much easier to choose a formula because my advice is what formula can you get in your local shop at two o'clock in the morning and what can you afford?

And that's probably gonna make it very, very easy to make a decision because that's probably gonna be one of the done-own options.

It's probably gonna be the red one, not the blue one.

And that's not me recommending that brand.

I was just using that as an example, that we don't need to spend loads of money on this stuff.

You might wanna go and get a supermarket-owned version as long as you can access that if you run out in the middle of the night.

That's kind of the criteria we're looking for.

Yeah, and I think that's just so, for people that haven't heard that before, is going to be mind-blowing because that's not the messaging that people are receiving at all.

And we are laid on, particularly as mothers, but as parents in general, to do the best.

Do the best for our babies.

We've been told that breast milk is the best.

So if we can't do that, we have to do the next best.

And the next best is going to cost us 17 pounds per box.

We were filming actually something for our online course the other day.

And I went to purchase some formula to use within the filming.

My mind was blown.

Like even since my, so my eldest is now seven and a half.

So in the last seven and a half years, I was like, oh, I can't believe how much it has gone up by in, yeah.

And yeah.

And when it is ultimately completely unnecessary.

So the other decision I suppose that people might be making is whether they use expressed milk for their bottle feeding needs or whether they use formula milk.

Are there any themes that you see in kind of families that are making that decision, kind of pros and cons of what tends to work for people?

It's an interesting one.

So I find for the families that are kind of working on getting baby back to exclusively breastfeeding.

So there's been some issues in their breast, their combination of feeding kind of because they've been pushed into it rather than because they want to.

They will usually be pumping and giving as much milk as they can as pumped milk.

And the families that are going into this much more like breastfeeding is just too much, it's too difficult.

I haven't got the time.

My mental health is going to go down hill if I exclusively breastfeed.

They tend to be much happier around using formula in those top-ups instead.

And then we have a whole other group of wonderful parents.

And I don't know how best to describe them without accidentally sounding offensive, but the word that first comes to mind is like crunchy or hippie.

And I don't mean that in a mean way.

Yeah, yeah.

And my brain is working right now.

And they will be the group of parents that will be very happy to top up if needed.

And if they don't have access to their own milk, be very, very happy to ask their friends to informally milk-share.

And informal milk-sharing is a fantastic option that isn't often talked about.

It's a bit taboo because people feel a bit itchy about using other people's milk sometimes.

Which is interesting when you take a little bit of a step back and you think that we're all drinking cow's milk quite happily, that's okay.

And we don't even know which cow.

Yeah, exactly.

We don't know which cow we're getting enough from.

Exactly, that's a really good point.

And I understand it because there are theoretical risks to peer-to-peer milk sharing.

You have to trust that somebody isn't watering it down or that they haven't got an infection.

But then the argument to kind of counteract all of that is, why would somebody be producing milk for their own baby if they have an infection or something, which they're taking medication, which means they shouldn't be giving that milk to their baby.

In reality, it's very unlikely that these people are gonna cause any harm, they're gonna be doing anything unnecessary or malicious to the milk.

But the potential, if that does happen, for that to be harmful to the baby is quite big.

So I think that's why people kind of feel a bit odd about it.

But it is a really valid option.

And I think Eats on Feet is a really good website to go and have a little look at.

They have like their four pillars of milk sharing and all sorts of things you can look at to kind of decide if it's the right decision for you.

And just, I suppose, on that, that is something that you do see in a kind of more formal way for babies in NICA, isn't it?

You might be told if your baby's born early, that if they're able to receive breast milk, then that improves outcomes for the babies.

And if it's unable to be your breast milk, then there are milk banks and stuff, but that does tend to be reserved for kind of poorly babies, doesn't it?

Yes, so that milk is pasteurized.

It goes through all sorts of rigorous testing and even the donors have to have blood tests and stuff done before they can donate the milk to the hospital.

And I would also like to put in a little caveat here that anything I'm talking about with regards to can't be feeding, I'm assuming a full-term healthy baby, as soon as we have a preemie, it becomes much, much more important that that baby gets exclusively human milk for as long as possible because of the risk of there's some really awful things that these preemies can get if they don't get human milk.

And that's why the donor milk is offered in the hospital settings because these babies really need it for their guts and for their good health outcomes.

Yeah, amazing.

So while we're just chatting about formula, I suppose a time where people might reach for formula is they're going back to work, baby's in nursery, they're now not able to keep up with kind of pumping demands on top of everything that life is bringing.

They're kind of over maybe six months now, or maybe between six months and a year.

Can you talk to us about something that exists in the UK that is called Follow On Milk?

Oh, I'm sure you want to get me started on Follow On Milk.

Okay, so Follow On Milk was invented purely to get around the advertising guidelines or rules that the formula companies have to abide by in the UK.

They're not allowed under UK law to advertise their milk to parents of babies under the age of six months because they're not allowed to advertise breast milk substitute.

Once the baby gets to six months old, those guidelines drop off because we're introducing solids to the baby.

So it's not that important, but it is important.

But as far as the UK law is concerned, it's not.

I mean, what you'll see when you go down the supermarket aisle is you will see that the stage one and the stage two and even the Glimmons stage three milk and the Glomfett milk, they all look almost identical.

And they've done that because they can put their stage two milk on the television, on a big billboard, and they can advertise it to you without telling you about their stage one milk.

But what they're really doing is they're advertising their stage one milk by actually telling you about their stage two milk.

Because no one who is happily breastfeeding at five and a half months is thinking, oh, should I switch to formula in a minute?

What they're doing is they're selling a friendly face so that when you struggle to breastfeed, you can remember that advert of the ballerinas or the children laughing in the high chair and the colors associated with it.

And you go to that company to get your formula from.

There is no need for follow-on milk.

You can continue to use first stage milk, stage one milk, right the way to a baby who is 12 months old.

The only difference really in follow-on milk is it has a little bit more iron in it, but your baby should be getting that little bit of extra iron from solid foods because you introduced it as six months.

There are some rumors, and I wouldn't know because I've never tasted it.

Maybe I should do this experiment.

But apparently some people say that the follow-on milk is also slightly sweeter, so that it is more palatable for the babies.

And then the toddler growing up milk, which comes after that.

Again, apparently, I've heard is also slightly sweeter, again.

So your baby is more likely to want to drink the toddler milk compared to like regular cow's milk or oat milk or whatever you're using.

Amazing.

And I think that's just people don't realize that.

And they don't realize that stage one formula is not advertised on TV.

And when I say it to people, I've seen it.

I've seen it on the TV.

They were definitely a baby.

And you're like, you know, probably six months and a day old.

And they're a little one.

And that, I think, is one of the hardest things when navigating either exclusively formula feeding or mixed feeding is like, and actually just all of parenting in general, right?

Like, what should they sleep in?

What should they wear?

What should we feed them?

Like, is navigating like what actually is like instinctive, intuitive?

What do they actually kind of need from an evolutionary biological perspective?

And what is sort of like very, sometimes quite sneaky advertising from companies that have billions of pounds basically.

And when we can start to kind of unpick that, it puts you back in control of parenting your baby and not some rich white men in an office.

They make billions in profits.

They make so much money in profits.

And again, I think people sometimes get me a little bit mixed up here.

They think I'm kind of saying, oh, I hate formula.

No, formula is amazing.

Like so many of my clients have to use formula and choose to use formula.

I used formula.

What I hate is the sneaky marketing that makes us think that we need it.

I mean, even I'm thinking about the adverts that say, you know, can be used from six months alongside breast milk or can be used from six months alongside solid food.

That implies that you need to stop breastfeeding for six months and switch to the formula.

And my husband actually thought that was true.

When we had our first son, he was like, so you'll stop at six months and switch to formula, right?

Because that's what the adverts say.

And I was like, no, you can breastfeed for as long as you want.

Like, recommendations is two years, you know.

It's so, so sneaky.

And that alongside how big their profits are.

And if they just kind of maybe pulled back on the advertising and spent some of that money on improving their product, maybe we could get to a position where formula is, you know, really close to breast milk.

Wouldn't that be amazing?

So that people who are struggling to pay for it could afford to pay for it.

But instead, that money is going on advertising the formula, and then it pushes the price up for the consumer at the end of the day.

And this is where we have a product which should have been a medicine, should have been used in a medical clinical way to help babies.

And I know, again, people get a little bit twitchy when I say that it should be used as a medical intervention.

I don't mean, again, I don't mean it in a mean way.

I just mean that all babies can drink his milk.

So it shouldn't be something that we have to pay lots and lots of money for and we shouldn't be kind of battling marketing and commercialization of it.

We should just be able to go and get it.

And it should be affordable because our babies need it.

If you can't breastfeed, what else are you supposed to do?

You know?

Yeah, absolutely.

And that and that message, that subliminal message and that advertising even gets into health care.

I remember seeing my GP and I had an issue with my breast when I was breastfeeding, found basically a lump on the breast.

And they were like, well, come back when you come back six months when you finish breastfeeding and we'll check it.

And I was like, and you know, I was me at this was only a few years ago.

So I was sort of fine to be like, well, no, no.

But you know, that that messaging can you can take that upon yourself straight away and be like, oh, oh, right.

OK, I was finishing at six months and then I've got to come back.

And, you know, they do sneak, they sponsor conferences and all and all, yeah, in like midwifery magazines and they're in all sneaky, sneaky, sneaky places.

I remember choosing a pram for my first baby almost eight years ago.

And honestly, it required as much research as giving birth.

Is it going to fit in my boot?

Will it convert to a double one day?

Will it last in past 18 months old?

Can I attach a car seat?

Will it roll in mud?

Can I put it down with one hand?

And eventually I found the answer to all my questions.

For me, it was the iCandy Peach, which by the way, fits into the back of a Fiat 500 car, which sounds unbelievable for a push chair that sturdy, but seriously it does.

We knew then that we hope to have more than one baby.

So choosing something that was going to stand the test of time and not end up in landfill in a year was really important.

iCandy push chairs come with a five year warranty.

And believe me, we've put it through its paces.

It's been up mountains in Wales.

It's been on and off the escalators and the tubes of London Underground.

It's been in and out of my car boot every day on the school run.

It's flown all over Europe.

And yet still, seven years on, aside from being completely filthy, it's going strong.

If you're looking for a push chair or travel system that's really gonna see you through the early years with this baby and maybe any future babies, nieces, nephews, best friends, children that might join your family, for me, iCandy has been an investment worth making.

Follow the link in the show notes to find the perfect pram or travel system for you.

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So formula we've checked.

So you may want to purchase formula and now you know which sort of things you're potentially looking for.

The next thing that you're gonna want to purchase is bottles, if you are bottle feeding.

And again, we go back, straight back to marketing and everybody will tell you that this one is the shape of a breast and this one is the shape of something else.

This one's super soft, this one's super slow.

What, what?

Now what?

Ah, it's so hard.

That's my very articulate question for you.

That is what's going on in people's minds.

And also my ass, which is, ugh.

So, and this is where it's a bit more complicated than the formula question because there are different shapes of tea.

And what it boils down to really is you have three different shapes of tea.

So you have your long and narrow ones, you have your shorter, wider ones that look a bit more like a boob with a nipple at the end of it.

And then you have what they call orthodontic ones, which are slanted at the edge of the tea.

Whatever these companies are telling you, those are the three things, one of the, they could be telling you one of those three bottles.

And the problem is we have very little scientific data that hasn't been carried out by the companies themselves.

So it's really hard for us to know if there is a better or best option.

And at the moment, we don't know.

So the conclusion that I came to in my book was that you probably don't want an orthodontic-shaped teeth because if your nipple came out slanted at one end after a feed, you've got a problem.

So let's not encourage that sucking action.

So we can probably discard the orthodontic ones.

So that leaves you with the long and thin or the short and fat ones.

And I think genuinely it comes down to what your baby will accept.

Some babies, and actually I could use my own children as an example here, my eldest.

So I formula fed him while I relactated.

I stopped breastfeeding him and then went back to it a few weeks later.

He was bottle fed in the middle.

He didn't care what bottle he had.

He was quite happy as long as it had milk in it.

Didn't bother him.

My youngest would only take the Phillips Avent, which is the very long, narrow teat.

And they were more expensive than the other brands we've been using.

I was like, are you kidding me?

But he actually wouldn't breastfeed.

He had to take a bottle.

And looking back, he had a very high palate.

And I wondered the longer, thinner teat was what needed to get past that high palate to stimulate the soft palate and get him to suck.

And that's kind of a really long, waffly answer.

And that explains my answer.

It depends on the anatomy of the baby's mouth and what they will take.

With all of that in mind, again, let's not go and spend 30 pounds on a bottle because some company are claiming that it's the closest to a boob.

It's not.

Go to Poundland, start off with the cheapest bottle you can find with a slow flowing teat and get that because you want a slow flowing teat so the baby can control the flow of the milk.

You don't want a fast-flowing one.

It's going to overwhelm them.

And if that doesn't work, try a slightly different brand, maybe a different teat, again, nice and cheap.

And if those don't work, then let's move up to the more expensive ones.

But let's start with short and fat, long and thin, cheap, slip-line seat, that's all you need.

And my eldest was exactly the same, and he actually took exactly the South South Second advert for that bottle, but he actually took, but that was the only one we tried similarly, because that's what our friends, yeah.

This was eight years ago for me, and basically you chose Tommy Tippie or Phillips at the Avent back then.

I think Minby were just coming onto the market, but those were our options.

Yeah, I don't remember there being many options.

And then my second came along, now three years ago, and we tried every single bottle.

I did then manage to sell all the ones that we hadn't used.

I was like, anyone with an entire selection, if you want to try them all, here you go.

A selection of boxes and bottles.

He was not happy even.

And similarly, he wouldn't take a dummy, which again, we'd used to my eldest, and he had been quite a helpful tool for us as a family.

And no, we tried every dummy, every bottle, and he was like, no, I will be breastfeeding until I'm three.

So part of it is going to be the baby is going to make the decision on these things.

As much as we like to try and plan and control as parents, you know, we can't always.

And then I suppose in there comes the final thing that you'd want to be buying would be a steriliser and ultimately doesn't really matter.

No, it depends on what suits you.

When I was pumping, I actually found some sterilizing fluid and a very big, I mean, you could buy special buckets for it, but I just found a massive Tupperware tub that would fit enough water in it and put a lid on it.

Because sterilizing fluid lasts for 24 hours.

So I'd simply wash the bottles, bang them straight in a sterilizing fluid and then just take them out when I needed them or the pump parts when I needed them.

So that is not the prettiest option, but it was the cheapest option.

And it meant that I didn't have to keep turning the microwave on, turning the microwave off, all that sort of stuff, or using lots of electricity.

You just pour the fluid into cold water and it's good for 24 hours.

That was the most economic option, I think, for our family at the time.

Then you've got your microwave sterilizers, and then you've also got the big plug-in ones as well.

And genuinely, they all do the same job.

They heat the bottles up to sterilize them.

As soon as you take the lid off, they're no longer sterile.

So it's a little bit of an interesting one.

And actually in other countries, particularly in America, they don't sterilize, isn't it?

I think they just don't do it, which is interesting.

I do think it's important to, particularly with formula, to make sure things are incredibly clean.

And if you can keep them sterile, do.

But again, as with all this stuff, the right size sterilizer at the cheapest price is probably going to be the best way forward.

Yeah, we just got, I think it was like a five pound microwave one.

And then we stored it in the microwave so we didn't have to look at it.

That's it, yeah.

Which was quite helpful.

Yeah, absolutely.

So then comes the kind of making up of the bottle.

So let's assume you're using formula in the bottle.

What is important to know when it comes to making it?

Your very first bottle of formula, if you were using, you could use liquid formula or you could use powdered formula.

Yeah, and I often say if you are someone who's a little bit anxious, although it costs more money, the liquid formula is sterile when it comes out of its packet.

You can't mess it up.

You can't kind of forget how many scoops you put in and all that sort of stuff.

So if you are somebody that that might be tricky for, if that's what the liquid stuff is for, though it costs a lot more money.

You need to make sure that everything is as clean as possible.

And you also need to make sure you're using water at the right temperature.

So we've got these perfect prep machines, haven't we?

And they're a little bit controversial because they deliver this hot shot of water.

But we think by the time you add the hot water hits the powder, it's not going to be at the right temperature anymore because there's not enough of it to hold its heat.

And the reason we say that formula should be made up at 70 degrees centigrade is because that's a little bit of a compromise.

It's hot enough to kill most bacteria, but not so hot that it won't kill most of the good stuff.

So you're kind of saying we want to keep most of the good stuff and get rid of most of the bad stuff.

Because if we made it at 100 degrees centigrade, it would just kill off all the good stuff in it as well, all the kind of nutrients in it.

So we kind of keep it in the middle ground.

Because formula is made in a factory by humans, there is risk of contamination with it.

And that's why we need to use the hot water in it.

It's to kill off the bacteria in the formula.

People sometimes think it's to kill off the bacteria in the bottle.

No, because we sterilize the bottle.

We know we've given that a really good clean.

Yeah, or they think it's to kill off the bacteria in the water.

That's the other one, yes, the bacteria in the water.

No, it's not that.

It's because of the potential for the bacteria in the formula.

And again, this is where we get to a really difficult conversation because it sounds like I'm shaming people for using formula, saying, oh, you're putting your child at risk by using formula because it could have bacteria in it.

It's bacteria in solid food.

We risk food poisoning every time we cook food for our family.

I made a race to Mother's Day on Sunday thinking, am I going to poison?

Is this meat cooked properly?

It's just that when we have such little babies, their immune system and their tummies are not ready to fight off those potential nasties yet.

So we have to be extra careful with them.

And we have had some really nasty cases over the years of contaminated formula causing huge, huge issues.

I think the last one might have been in China.

So we do have to be really careful with it.

So make sure the water is at the right temperature.

I encourage people not to use the Perfect Prep Machine.

It's a lot of money.

We don't know if the water's hot enough.

They get a lot of mold and bacteria in them.

You can just boil your kettle and you can even get kettles that you can boil to 70 degrees centigrade.

And because they're not just delivering a little bit of a hot shot, you make the whole bottle at 70 degrees.

It's more like that water's gonna hold its heat when you use that.

And then I guess the reason why somebody might reach for the Perfect Prep Type Machine is that then when the bottle is ready, it's ready to feed the baby.

And when you've got a bottle that is 70 degrees, you're not gonna be putting that in your baby's mouth just as you know.

They can't quite handle a cup of tea just yet.

What is it?

Do they wait?

Do they cool it down?

Yeah, so you could run it under a cold tap or stick it in a cold jug of water.

That will normally cool it down quite quickly.

And I think this is also where I like the liquid formula because you don't have to do that.

You could feed it from the fridge, at fridge temperature, you can warm it up quite quickly.

It's much easier to deal with and quicker to deal with.

So often I say to parents, for the middle of the night feeds, when you just want to get back to bed as quickly as possible, that's a really good time to use the liquid formula because you haven't got a fath around waiting for a bottle to cool down.

We used to say that you can make up all of your bottles, put them in the fridge and then take them out and reheat them as needed.

That's no longer recommended.

Although interestingly, if you were to go and take your child to nursery, it would be suggested that you make up the bottles in advance, cool them down, put them in the fridge, then nursery reheat them.

But the guidance is that if you are at home, the general kind of purpose is you should be making bottles as you need it because, of course, if you're cooling something down and then warming it back up again, you've got the risk of bacteria getting in.

Yeah, yeah.

Oh, so it often makes it...

And this is the thing that I always find.

People will often say, you know, breastfeeding is really difficult, so I'm just going to bottle it.

And you go, oh, hang on, there are, you know, it's not necessarily always a kind of completely easy option.

Unfortunately, when it comes to feeding babies, there just isn't an easy way to do it.

And I don't, you know, we don't have time to go into tons of detail on the kind of ins and outs of pumping.

But just on that conversation that we're having, sometimes we go, you know, this is certainly my experience.

It's like, you know, I need to make my life easier for myself, so I'm just going to pump and give a bottle.

And then what you end up doing is breastfeeding, pumping and bottle feeding.

So rather than just doing one, you're going to do all three.

Just to make life harder for yourself, because it's a punishment, aren't we?

Yeah, and so it's, again, like it's, I guess it's a case of kind of just going easy on yourself and doing what feels right for your family and what works for you as an individual.

And within that kind of conversation leads us on to, I suppose, the emotional journey that is attached to feeding our babies.

So it can be that somebody has always intended to use formula or add a bottle into or just exclusively bottle feed.

And sometimes they can be faced with lots of judgment for that decision and they can be made to feel quite guilty.

Sometimes people didn't want to do it at all and it has formed part of their journey.

Do you have any like advice or anything for anybody that is this is, it's a difficult feeding journey for them?

And actually this is the fourth book, which we think is going to be called Breastfeeding, Grief, Recovery and Understanding, but we're not sure yet.

We're still wrestling with the title.

That's why I've written this because my previous books have been around relactating, rebuilding a milk supply and also through combination feeding, both of which are very emotive topics because you're coming to relactation normally because you feel so blimmin awful about stopping breastfeeding that you want to start again.

And most people who are combination feeding are doing so because they feel some level of guilt about formula feeding.

So it felt like a natural kind of next step to then write a book about and here's what to do with your feelings.

We know that not reaching your breastfeed or not reaching your infant feeding goal, whatever that happens to be, significantly increases the risk of postnatal depression.

And we also know that when you are dealing with postnatal depression, you may feel disconnected from your baby.

You may not be the parent that you want to be and then that feeds into that guilt and then you feel even worse.

And I think, I mean, it's a very difficult, complex topic.

But when I was researching from the next book, what I kind of, the conclusion I came to was that actually, and this is also backed up with years of doing debriefs for parents, I don't think it's ever the parents' fault if breastfeeding doesn't work.

I think we can put it always back to the society that we live in.

Let's say you're somebody who, you know, you have your baby and you have a really birth that you wanted, it was fine.

You had that first feed at the breast, skin to skin.

It was all fine.

And then on day five, your baby's lost 10% of the birth weight.

You might be told at that point, okay, pump and top up.

If you then get to week three or week four or week five, and you're still having issues, people are just gonna say to you, some people just can't breastfeed.

Just go and get some formula.

You've tried your best.

But there are tests that we can do to see why you're not making enough milk.

There will be a cause for that.

And we don't investigate the cause.

Instead, we say to the parent, you can't make enough milk for your baby.

And that's when the guilt and the grief and the shame starts to really come in because you're being told that you were the problem.

Maybe your thyroid's not working properly.

Maybe your baby has a tongue tie.

Yeah, and there is rising conversation now around birth trauma.

We know how frequent it is for people to experience birth trauma.

We know how frequently that is at the hands of the system, as well as occasionally the kind of physical experience, sometimes a combination of both.

But it feels like the conversation around grief and trauma in someone's feeding journey isn't something that is happening.

But similarly, you hear, you can speak to people, my mum, my mum's age, and it stays with them.

My mum's in her sixties, and she can recount her first difficult breastfeeding experience to me, like it was yesterday.

And these things do stick with us.

And it's that validation of, yeah, of course you're happy that your baby is healthy and that they're getting milk.

And to suggest otherwise, I just think is quite insulting.

And similarly with birth, you know, you've got a healthy baby.

Yeah, well, obviously, like, of course I'm happy with that part of it, but the other emotions that you feel are really valid.

And sometimes they get kind of brushed aside because you're expected to kind of get on with life.

It seems like, oh, well, I'm fed is best anyway, isn't it?

And happy mummy, happy baby.

And you'll start there.

I remember starting to think about, I'm not happy.

I wanted to breastfeed my baby, you know, like, and it's that, and they're well-meaning.

I don't think anyone's ever being unkind when they're saying to their mum, you know, well, fed is best.

You know, you did your best.

I think they're trying to make her feel better, but what they're doing is shutting down that conversation and not allowing her the space to talk about how actually, no, I'm really sad that it didn't work.

I feel really guilty about it, and I want to talk about that.

And when we know that when you talk about stuff, that's when it starts to shift and feel better.

And that is demonstrating, actually, the fact that we need to talk about it.

I don't tell people I'm a lactose-inducing consultant, because if I say what I do for a living at a wedding or a party or something, you can guarantee I'm going to get someone's trauma thrown at me.

And I just go, oh yeah, I support parents and babies.

And that's enough.

Even that can be...

Yeah.

If I say I support breastfeeding, oh, I couldn't do that.

Oh, I tried so hard to do that.

Oh, I could have done with you.

And they just then get into their stories because they're not given the opportunity to talk about it.

So when they do find somebody that understands it, it just all comes pouring out.

And it's not their fault, it's just because, again, society hasn't given them the space they need to grieve properly.

Yeah, well, exactly.

I went to an event yesterday and was sat down next to two people and as soon as they found out my job, obviously I got recounts from both sides and they're both entire birth stories.

And it happens every time somebody finds out what I do for a living.

On the flip side, there can be the opposite emotions.

There can be somebody has finally found a solution that brings them a little bit of peace and they feel so grateful and so relieved and it's exactly what they needed.

The parallels between the experiences of feeding and the experiences of birth are so, you know...

They're very tied up in each other.

Very, very tied up.

What I say with birth is that it's so weird to feel conflicting emotions.

And we often haven't done that at any other time in our life yet to feel like absolute joy and extreme disappointment or trauma and gratefulness.

And to have all of these feelings at the same time and just letting yourself...

There's no correct way to feel about these things.

Apart from to acknowledge the feelings and let them be there.

And if you can, if it's safe to do so, let them out, cry journal, pushing up against the wall can really be feeling angry because you're pushing up against the wall, you're pushing against yourself, you're getting that anger out in a safe way.

And we're talking about relief.

If you've put yourself through pain and anxiety 12 times a day, and you've had 16 different people telling you 12 different things, of course you're gonna feel relieved.

Of course you are, there's no need to feel guilty about feeling relieved.

And again, I remember when I stopped breastfeeding Alfie the first time, yeah, I was gutted and I went on to relax hate, but in that first day, it was like, oh, I don't have to do this.

It was visceral.

It was like, I felt like I'd been led off the hook.

It sounds really extreme, but almost like I'd had a last minute warrant for my death row, you know?

Like you don't have to go through this.

It's okay, you're free.

And for me, it didn't last.

And I went on to relax hate, but for many people, and again, people think because I'm a lactation assault, I'm going to say, well, you must get back to breastfeeding.

Why?

No.

You need to do what makes you feel like yourself and as a good parent and a good mom, because when you feel like a good, happy, connected mom, that helps your self-esteem.

It makes you feel better.

It helps your connection with your baby.

There are many, many, many ways we can connect with babies.

It doesn't have to be through breastfeeding.

Wonderful when it is, but if it doesn't work for you, guilt is the last thing I want you to be feeling.

It's never ever the parents' fault.

I really believe that.

Yeah.

And that is just the message that carries through all of, I know all of your work and all of my work, is that actually, if we can just shake everybody else's opinion and find the kind of confidence and trust in ourselves to go, well, this is what works for me.

My baby, our family.

And stop worrying about, and this is obviously much easier said than done, but stop worrying about what somebody else is going to think of you when you're bottle feeding your baby in a cafe, or when you say that you're not doing something that you wanted to do.

If we can shake that, it sets us up so well, just for the rest of parenting, because it starts with birth.

Well, it starts probably with conception, because everyone's got opinions about that.

Then it's birth.

Then it's how we feed them.

And it can sometimes feel like, okay, well, as long as I've done that, this carries on forever, I'm afraid.

It's childcare, it's education.

It goes on forever.

And the more we can kind of tune into our own needs, our individual family's needs, yeah, the better you're going to be set up from this point and then forever more, hopefully.

If you are dealing with grief and depression and trauma and sadness and shame, you can't be who you want to be as a mom or a dad or a parent or whoever.

Like, it just doesn't work.

So you have to, in some ways, almost be a little bit selfish so that you can meet everyone else's needs.

And that's okay.

And when we're talking about, you know, particularly the topic of combination feeding, breast milk is dose responsive.

So it's not like as soon as you introduce formula, you're undoing all the goodness of breast milk.

It's just that the more breast milk you get, give the greater the health outcomes are, but it's a sliding scale.

You know, you're reducing risks by giving any breast milk, but you're reducing them further and further by giving more and more of it.

Actually, breast milk can help mitigate some of the issues with formula because it's gonna protect the gut when the formula goes in.

So, combination feeding is a really lovely compromise and not something to feel guilty or ashamed about.

If that is something that people are thinking about doing or that they're in the midst of it, I would really, really recommend getting hold of that book in particular, which is called Mixed Up Combination Feeding by Choice or Necessity.

You can get it on Amazon.

You can get your local bookstore to go and purchase it.

And Lucy's new book about breastfeeding grief is available for pre-order when this episode goes out.

So again, if that aspect of things is ringing true for you, that will probably be a really, really helpful read.

We've probably got people listening, having their second baby, and maybe kind of thinking, actually, yeah, that was me first time.

So it's so, so, so much helpful information there.

The work that Lucy shares freely on Instagram and everything is also really, really useful and helpful.

So do go and find her.

So if people would like to find you, either to kind of access your resources, your books, or work with you kind of on a more close one-to-one basis, where can they find you?

So Facebook or Instagram will guide you to my website, but my website is recently changed.

I think it's just Lucy.

If you just search Lucy Ruddle IBCLC in Google, it comes up and weirdly, and this is just a random side tangent.

If you ask Alexa who I am, she tells you, and that is the weirdest thing I found out recently.

Oh my God, that is so cool.

I'm gonna do that.

I'm gonna do that at the end.

You can ask Alexa, apparently.

Yeah.

I will post links to your Instagram, your website, your books in the show notes of this, so people can just click through as well.

And the book is fully evidence-based as well, and it's not gonna push you one way or the other to just formula feed or just breastfeed.

It is designed so that if you want to combination feed, breast milk and formula, it will allow you to do that.

Amazing.

Thank you so much.

Thank you.

Thank you so much for listening to today's episode of The Birth Ed Podcast.

It's my actual life mission to get these conversations in front of as many expectant families as possible, and you can be a part of this mission.

Don't worry, I'm not recruiting you into my cult, but if you leave a five-star rating and review of the podcast, then we creep up the charts, get in more ears, change more births, change more lives.

And come on, you know you want to be a part of that change.