The Great Pretenders

Who are the ‘Great Pretenders’?  These are babies born between 34 and 38 plus 6 weeks. They might be multiples, pre-term babies, late pre-term babies or early term babies. Lactation Consultant Kathryn Stagg calls these babies the Great Pretenders. They might appear to be ‘full term’, but often struggle to establish breastfeeding because of their prematurity.

In this episode, Kathryn helps me explore the challenges and joys of these babies. We talk about the hospital experience, techniques to try to ensure that sleepy babies receive enough milk, and how to support breastfeeding going forward.

My new book, ‘Supporting the Transition from Breastfeeding: a Guide to Weaning for Professionals, Supporters and Parents’, is out now.

You can get 10% off the book at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me on Twitter @MakesMilk and on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com

Kathryn Stagg IBCLC is an author and founder of an amazing charity, Breastfeeding Twins and Triplets UK. You can find out more about her on her website https://kathrynstaggibclc.com/

Resources mentioned - 

Breastfeeding 36 or 37 week babies article https://kathrynstaggibclc.com/2019/04/06/breastfeeding-babies-born-at-36-or-37-weeks/

Breastfeeding Twins and Triplets article https://breastfeedingtwinsandtriplets.co.uk/

Kathryn’s book - Breastfeeding Twins and Triplets https://uk.jkp.com/products/breastfeeding-twins-and-triplets

ABM Beyond Bottles video https://www.youtube.com/watch?v=PLGqB3kaP6s

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

Hi. I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time, because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end. And I'm big on making sure parents get support at the end to join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly about that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk.   

Emma Pickett  00:47

I'm very excited today to be joined by Kathryn Stagg. She is an IBCLC and an author and we'll put a link to her book in the show notes. She started an amazing charity, Breastfeeding Twins and Triplets UK, which originally started as a Facebook group, and is an example of a little teeny organisation that grew and grew and has absolutely changed lives and really has affected the way multiples are breastfed in the UK. I'm not going to gush too much about that, because one day, I might try and get her to come back to talk about multiples. But today, we're actually going to be talking about another aspect of her work. She's part of the team that runs the national breastfeeding helpline. And we first met through our work for the Association of Breastfeeding Mothers. She's a trainer of health professionals and families and is really big on education, and supporting other people to have the expertise to help families. Today, we're going to be talking about a group of babies that Kathryn calls the Great Pretenders. So some of these are multiples, but not all of them. These are babies who are born just before term. And because of that many people feel Hey, you know, they're close enough. These are not the teeny tiny babies and incubators, they're fine, they'll be going home before long. They don't necessarily need a lot of help. But as we'll talk about today, this is a group who really do need our support. And we really do need to know how to help them. Thank you very much for joining me today, Kathryn.

Kathryn Stagg  02:10

Lovely to be here. I'm so excited. 

Emma Pickett  02:12

Good. Nothing like a bit of extra high expectations. So let's start with the glossary. What actually is a premature baby? And what is a late term baby and what is an early term baby?

Kathryn Stagg  02:26

So premature babies, it's quite a sort of generalised term, it's actually any baby born before about four to six weeks or so. And you know, there are lots of subsets of those sorts of very, the very, you know, that kind of stuff, where they're sort of born before 28 weeks and such like that. The section that we are talking about at the moment in this podcast is late preterm and early term. So in late preterm, the definition of that is babies born between 34 weeks, and 36 plus six, and then early term babies, which are born between 37 and 38 plus six, so just a little bit early. So they're still there sort of clusters full term, but they're just a bit early, basically. 

Emma Pickett  03:12

And it's that just a little bit early that can sometimes make life a bit more complicated, which is what we'll focus on today. Yeah, just to clarify that term term as a helpful way of saying it. Yeah, that term term. When you're talking about twin pregnancies, there's a different definition for what's term. Is that right?

Kathryn Stagg  03:26

Oh, yes, this one gets on my nerves slightly. So it's one of my slight bugbears about supporting twin families. So when you're expecting twins, you are told that a twin pregnancy is full term at 37 weeks, okay? What this actually means is that they have worked out through lots of research that it's probably safer to birth your babies around 37 weeks than it is to keep them in longer. For many people, not everybody, but for many people. And so, you know, at that point, the risk of leaving them in is greater than the risk of taking them out, basically. So, so that's what they mean by that. But the actual the babies that are born are not full term. And so it's actually very misleading. And a lot of parents and healthcare professionals don't understand that the babies that are born are 37 weeks, even though the pregnancy is deemed full term, let's say. 

Emma Pickett  04:16

So it can be very confusing for everybody, really, potentially, if we don't define things correctly, you're even less likely to get help because Absolutely, Hey, you're term you're completely fine. Okay, okay. So let's talk about the experience of giving birth at 34 weeks. Now, I'm aware that for some people of listening, who are listening to this, who have had this experience, it will have gone alongside a challenging pregnancy, potentially a traumatic birth, you know, a difficult time. And, you know, I'm aware it's difficult to necessarily reflect all those experiences in this conversation that we're going to have today. But we're sensitive to the fact that that's not necessarily just a number on a page. Yep, that represents a whole experience. If someone did give birth at 34 weeks what To the first few days for them normally look like and what are the first few days for their baby normally look like? 

Kathryn Stagg  05:05

Yeah, at 34 weeks, it's pretty likely that they'll probably go to the special care baby gestation, there may be a few that might go to transitional care. So there are some parts of some hospitals have have a department called transitional care, which are for those babies that have slightly higher needs than, you know, your your healthy full term, baby. So need a little bit more help support but don't need the full sort of neonatal support basically. So some some will go to transitional care, and some will go to the near to near that gestation. And they will often begin with some tube feeding. And we would support the parent to begin to handle expressing quite quickly after birth, we try and get them started, you know, within a couple of hours after birth, certainly within six hours. And then we would your intention to handle stress quite frequently. And they can use the colostrum down my feeding tube, and then once their milk begins to come in, we would move to pumping. And as soon as the babies are stable at 34 weeks, they should be able to have kangaroo care quite quickly. As soon as the mum the parent is able to go up to see them is upstairs in our hospital, I would say up might be down. But yeah, I don't see them in there. And they should be able to have kangaroo care, which is basically skin skins. That's what they call it in the neonatal unit. This can really kind of kickstart babies, you know, sort of innate breastfeeding tendencies, let's say at 34 weeks, they can latch and route and take a little bit of milk, you know, I mean, so it's something that they can start working on but it's very unlikely that they will be able to take full feeds at that gestation. So you know, I had a supporting a set of twins as as I do quite a lot online the other day and the hospital we're putting pressure on them wanting to be discharged home, you know, in the next week and why weren't they fully breastfeeding yet? You like their first four weeks?

Emma Pickett  07:00

Wow. Expectations really do vary? Don't know I do. Okay, so right. So I have no shame in asking the dumb questions. So here we go. tube feeding. Yes. That's an NG tube. That's a nastro gaze, gastric tube, yes. Which means a tube that's going through a baby's nose, down into the oesophagus into their stomach. 

Kathryn Stagg  07:21

Absolutely nasogastric that's what it's called, nasogastric tube.

Emma Pickett  07:24

What did I say? Nasogastric tube, and that tube is in there all the time. I mean, it gets changed sometimes, but it's not getting put in for every feed, it's there, it's in the baby's nose the whole time. Yep. And when it's cut comes time to give the baby milk, you're essentially syringing milk through that cheese for it yet, but that baby may also be doing suckling may also be doing potentially getting some milk orally as well. 

Kathryn Stagg  07:49

So they sort of use it for you know, for this gestation, if the babies are beginning to breastfeed, they will use the tube feeds for for sort of giving the extra milk that the baby needs to you know, so baby may take a little bit and then they will sort of give them the rest via the tube. You know, that's kind of how it works when the weather is just okay. 

Emma Pickett  08:06

And if you're giving birth at 34 weeks, chances are you will not be sleeping in the same room as your baby for a chunk of time.

Kathryn Stagg  08:12

Yeah, not very much at the beginning. Although if you're in transitional care, you may be lucky, you know, to go to transitional care and actually be able to do that, as well. It's been tube fed, I believe they usually go to the next unit. But if they are sort of okay, and started to take oral feeds, and they will sometimes also pressure them to introduce bottle quite quickly because of course the babies will be able to take an oral feed more quickly from a bottle than they can from the breasts, which means they can get discharged home and you can get their bed back basically. They've been discharged home quite early nowadays. Right? Okay, so So 30. So it's not like if you give birth at 34 weeks, you'll be in hospital for six weeks? No, absolutely, you're likely to be home relatively soon and people go home. With the nasal gastric tube still happening. Some hospitals do have that setup, where they will support parents to be discharged home with their babies while still have a tube in place. And for me, I think that's a really positive thing, actually, because it means that you don't have that pressure of trying to introduce a bottle in order to get discharged home you can get discharged as soon as they're happy. And as soon as the parents have been shown a tonne of how to do the nasal gastric tube and how to do the feeds, then, you know, actually, why not be able to do them at home. But for me is it would be a really positive step for most hospitals. So there are a few hospitals that will do this now. But not every hospital was doing that moment.

Emma Pickett  09:34

And if you go home with the tube, tell me if this is way too much detail, I'm just gonna we're wanting to paint this picture. If you go home with the tube and the tube gets pulled out accidentally, you're not going to be putting it back in because you may possibly get it down the windpipe by mistake 

Kathryn Stagg  09:47

so you need a specialist nurse yet to come out so they should be under the neonatal outreach team things like that. So they should be able to kind of get someone quite quickly and in that scenario you you may have to introduce bottles and emergency you know if the baby is still not managing feeds effective. So it's that kind of

Emma Pickett  10:02

I liked what you said about how going home with the tube as a positive because I think that so many people hear about NG tubes and think crikey That sounds scary and medical and frightening. And I don't want, you know, the last thing I want is a baby to have an NG tube. So I'm going to do all these other things instead. But actually, an NG tube can be very supportive to help him breastfeed. 

Kathryn Stagg  10:21

Absolutely. And to help him breastfeeding happen, because you're giving the milk without them having to learn a different set sucking technique. Yummy. So, sucking technique, when you give me a bottle is totally different to the second technique on the breast. And so you know, it can sometimes just get a little bit confusing for everybody. So you know, it can be good to kind of leave introducing a bottle as late as possibly can really, if you're trying to establish breastfeeding, but but for a lot of hospitals where they haven't got the setup for discharging babies with the NG tube in place, then you know, that's something that that it often comes comes up in discussion around that we have to be able to get the babies can't quite take enough milk direct from the breast yet. What are we going to do basically?

Emma Pickett  11:02

Yeah. Okay, so let's imagine someone's giving birth, like 36 weeks or 36, four and four days or something? Yeah, these guys are less likely to be in special care, presumably, more likely to be in transitional care. I mean, do people give birth at 36 weeks and go home? Within a day? I mean, what's what's the sort of range of experience?

Kathryn Stagg  11:22

They do. Absolutely. So if the babies are well, and that they're keeping Yeah, they'll keep they usually, I would say they probably keep them in an extra day or two than the average Judo men, just to kind of keep an eye on them, make sure that they're managing to maintain their blood sugar, make sure they're managing to turn the temperature, that's one of the things when you have a small babies that they find it a little bit more difficult to keep their body temperature going. So lots skin skin contact, and such like that can help with that. But you know, yeah, there are some babies where they're born, you know, four to six weeks, and they're discharged home a day or two later, you know, so if they're, well, then everything's working well. And then there are some that maybe will be kept in a few days, there'll be some that will just be on the postnatal ward with their parents, there'll be some that maybe are in transitional care. And there are still some that needs to go to neonatal at this gestation as well. So that does happen, but it's usually only for a few days, and it's usually around and around temperature is one of the main reasons to kind of get them maintaining their body temperature, but not getting too cold and such like so that's, that's one of the main reasons for going to neonatal units, actually.

Emma Pickett  12:18

Okay. So I know that in your Facebook group, you did a little sort of questionnaire and you asked it the parents in the twins and triplets group, what were some of the barriers to getting breastfeeding established? Yep. And the top answer wasn't having multiples, or having more than one baby. The top answer was actually giving birth to this age range, this sort of 36 to 38 week range. Did that result surprise you? Did you was you surprised by that?

Kathryn Stagg  12:41

It didn't, it didn't. Both. It did in that it was the parents, you know, response was that, for me, as someone who supports twin twin families to breastfeed, I knew it was a massive barrier to getting them breastfeeding. But for them to actually say it, that was really interesting, that they were actually very aware that this was a problem. And whenever I do post on social media about this sort of issue, I get so many comments, and so many messages going, Oh my God, I didn't know why my baby couldn't feed while at the beginning. You know, I mean, and it's just, it's just like, you think no, no, nobody actually tells them that because they've gone a bit early. They might have some issues. So it's, yeah, it's really interesting. So yeah, I was I was quite surprised that the actual parents came up with it. I knew from my support that Yeah, from doing my support that it was that it was a really big issue. So yeah, it was interesting. They're very self aware, I think. 

Emma Pickett  13:37

Yeah, I wonder why that is, that could be something to do with you. Maybe your lovely, your lovely admin team, creating a group where people are really good at kind of teaching each other and sharing stories and experiences. Yeah, I mean, that as you say, that knowledge for someone who's given birth at 36 weeks to know, Okay, hang on. This could be challenging, let me know what could be a problem let me know where to get help. That makes all the difference. And I'm hoping for someone who's listening to this today though, that that will be a click for them and will mean that they'll someone will get the right support. So when a baby is born in this kind of late preterm early term phase, what are some of the physical challenges to a baby of that age that that make breastfeeding tricky?

Kathryn Stagg  14:16

So something that's really never talked about is the fact that they come in a little bit skinny and they haven't really laid down the fat that's in their cheeks you know? So when you when your birth at an early baby and even my twins who were 38 plus five, so they were really on the you know, practically properly filter. They were still really skinny compared to my other Singleton's you know, I mean, and it actually makes latching and feeding and belted drawl and milk more challenging. They use the fat in their cheeks to actually kind of balance themselves on the breast and stabilise themselves and actually make them less efficient. And again, nobody talks to you about this. So soon as you get a little bit of weight onto them and they start to get this nice little round cheeks they start feeling much better. So that's one thing so it's never taught. 

Emma Pickett  14:58

Bucal fat pads. I love saying bucal fat pads, it's a good word bucal fat pads, and they need to be able to create that negative pressure inside the mouth. If they haven't got that buckle fat pad or they're just gonna end up caving in their cheek, not being able to exert the right pressure on the breasts. Yeah, yeah. And that's also what happens actually, later on, when babies lose weight and have a lot of weight loss, they become less efficient, yes, feedings, sometimes just because they've lost some of that chunkiness on the cheeks.

Kathryn Stagg  15:24

So that's one big thing that no one ever talks about. And then the other thing is just actually, they've not quite made enough brain connections to have the coordination needed to, to be able to feed effectively. So there was a study, don't ask me to insight because I'm useless at doing that. There is a study around, you know, the brain connections and sort of when, how that affects feeding and kind of, you know, is there anything you can do about it? The answer is no, it is a completely developmental thing, you just have to wait until they're actually the brain connections are being made. So, so the regulations are around coordination with anything. So babies born at this gestation and just a little bit uncoordinated, they have to do a lot of coordination, when they're feeding, they have to, you know, suck, swallow and breathe each time. And they have to drop the tongue and lift their tongue. And, you know, there's, there's all, a lot of it's reflex driven to begin with, but it's that coordination needed, you know, it makes them very tired, because, and they can sometimes choke for ease, if the flow is fast, and, you know, so it's just a little bit more challenging. They do tie it easily, they also do struggle to maintain the body temperature a little bit as well, which can also make them sleepy, they're very sleepy, they're very hard to wake up. And, you know, so we have to often wake the babies to feed. So you know, we have this idea in our society that the good baby is the one that sleeps. The problem is, is that when you have an early baby, that's really all they do. So they don't do anything else. And you actually have to wake them and remind them to feed to make sure that they're feeding enough. And if you don't weight them enough, their blood sugar drops even more, which makes them even sleepier. And so it's, it can be a bit of a, you know, it can spiral slightly if you're not careful. So, so sometimes you're trying to wait them, we usually say sort of three hours from the start, start which feeders, some, some will need maybe two and a half to kind of keep that energy level up. And a good really good way of waking them up. Actually, we should wait, love, you know, we're talking about I'm saying how distressing things like that later. But if you've got colostrum. In the early days, when we're milk such come in if you're trying to wake your baby up, and you're stripping them off and changing the nappy and they're still completely out of it because some babies weren't even wakes that you know, whether it there's just, if you can get a couple of drops of colostrum inside their cheek just gives a little blood sugar, a little bit of a boost. And then you can do some skin skin. If your baby's lying next to the boob. They're very likely to start opening at night and thinking I might want a bit of that, you know,

Emma Pickett  17:46

that is a good tip. Yeah, a little bit of colostrum in the cheek. That's definitely a good tip, because that sleepy baby problem is such a stress. I think some of the things that that now we've done a lot of work on responsive breastfeeding, and it's so rare now to meet a family who were trying to breastfeed on a schedule from the beginning. I think we have done really well with the UNICEF Baby Friendly initiative and, and recent education to say that we feed in response to baby's cues, you know, we used to call it on demand. Now we talk about responsive feeding. But we always have to have that little little asterisk that says, but we have to get baby's feeding frequently, especially if there's something else going on. So now we just want to double double check. Parents don't go home thinking hey, it's all about the queues. I had that lovely NCL T class that told me about baby queues. We're going to wait for the queues. And then these sleepy little babies, as you say, can go into this almost kind of hibernation mode. Yeah, remember when I gave birth I did a little antenatal class with a local midwife. And she said that she's never run as fast as when she did a home visit. And someone said, Oh, my baby's brilliant. They're sleeping so well. Oh my god. They've been asleep for like 10 hours. So they're just upstairs upstairs right now. They've been asleep for 10 hours. This was like day two. And she remembers kind of running upstairs to check on the baby because yeah, culture says Good baby sleep. Absolutely. And then if you lay on top of that responsive feeding and forget the asterisk, we're in trouble with his little baby so yep, so that battle to wake a baby up. God I bet there are some people listening to this that remember that battle. And you finally you've done it. They finally latched on Yeah, and then they do to sucks and go back to sleep again. And you're like, what have I been doing for the last 45 minutes? Yeah, so finger colostrum. Good, very good tip. I know that's gonna help some people. If you know that you're going to be giving birth at this stage. It's Imagine you've you've been on bedrest they've been hanging on but now you are going to be giving birth at 36 weeks. Is there anything you can do to prepare in advance to make this a bit easier? 

Kathryn Stagg  19:38

Well, I think you know, as with all parents, just learning a bit about breastfeeding is always a good thing. So just doing that thing a bit about milk production,

Emma Pickett  19:46

is there a particular place to signpost them if they for this age group because I mean, then we can signpost them to the sort of bog standard antenatal stuff. We've got the IBM team baby course which is great, but it's not specific to help them in this age range where Would you signpost somebody if they say, right, I know I'm giving birth at 36 weeks, where should I go to get information? 

Kathryn Stagg  20:05

There isn't really anywhere other than my article. There are a few other articles out there as well. But But mine is fairly easy to if you're if you're a twin parent, you can read one on the twins, breastfeeding twins job is not going to UK. There's 1.86 weeks, six foot seven week babies, I think I've called it something like that. Breastfeeding 3613 week babies. Okay, well put that in the show notes. Yeah, and I've got the same version is almost the same article but not quite on my website as well. It's just been I've made it a singleton version they've sort of into it takes all the references to twins out of it, and but generally has the same information. So so there is that if you're, you know, so I always try if you've got parents that are going to be birthing that always send them as at least they can read. It just it sort of explains, you know, what, what's likely to be the case, the problem with babies around four to six weeks is there are some that are actually capable of a fully breastfeeding, I have seen them with my own eyes, I went to see a set of twins who were born at 35 plus five, and they were they breastfed fully from the start. And you're just so some of them can do it, and some of them don't. And so this is where we need that expert breastfeeding support in place for all the families to see whether or not they have got one of the babies who seems to have got it going. And you know, it's a number of things, maybe the baby's just a little bit of head of gestation, you know that, you know, there are some beds that just haven't nailed, you know, a little bit more than others. And also, if you're if the parents got quite a natural, good flow of milk and things like that, that can help massively in this scenario, you know, so for those, those moms that just have a really good natural milk supply do not mean there are some that find it easier than others to make make a good supply of milk. For those, they sometimes find that the flow is enough to keep the babies interested longer to take enough milk. And that kind of just helps everything get going more quickly. And then there are others, you know, where the milk supply is a little bit harder to establish, and, you know, maybe the baby asleep here. And for them, it can take a lot longer. And so yeah, I always have this caveat of babies being able to, you know, they, they're sort of able to fully breastfeed somewhere between 36 and 42 weeks gestation. So it's a massive wide, we shouldn't you know, and it really is, it's somewhere between those two dates normally, for most babies, that they can suddenly get the developmental stuff that you know, going on that they need to actually fully breastfeed. So we have to, you know, we need to assess when we're watching a feed, we need to assess it, how many socks and swallows are doing, we need to assess that we need to add breast progressions with you know, there's all sorts of tricks and stuff like that you can help to get get baby's feeding, and then you know, nappy outputs, and the only one, you know, the normal kind of signs of that things are going well. The only one we have to be really careful of is the contented baby after a feed thing. Because babies have this gestation to we'll see whether they're hungry or not, you know, they would just sleep whether they've taken off milk or not later on once they pass full term, you can usually trust that they will tell you that they haven't had enough milk you know, but in these in these early weeks when when they bought it this gestation, I think it's that's the one we have to be a bit careful of but keeping an eye on wet, dirty nappies and obviously weight gain, they usually kept very close eye on from from a waiter point of view these babies you know, so frequent weigh ins, which can be quite stressful. But yeah,

Emma Pickett  23:18

A little advert just to say that you can buy my four books online. You've Got It In You, a positive guide to breastfeeding is 99p as an e book, and that's aimed at expectant and new parents. The Breast Book published by Pinter Martin is a guide for nine to 14 year olds, and it's a puberty book that puts the emphasis on breasts, which I think is very much needed. And my last two books are about supporting breastfeeding beyond six months and supporting the transition from breastfeeding. For a 10% discount on the last two, go to Jessica Kingsley Press. That's uk.jkp.com and use the code MMPE10, Makes Milk Pickett Emma 10. Thanks. 

Emma Pickett  24:07

So we want parents to know what a swallow looks like. You want them to have a sense of how can you tell your baby's getting enough milk and it's it's, there's a really difficult balance I find between supporting a parent to recognise a swallow and then not creating a world where they're just absolutely staring at that chin. You know, forget the oxytocin I'm in. I'm in observation mode. I am totally looking for a swallow. And then you end up kind of forgetting that breastfeeding is also not the swallows and it's also the times for the fluttery stuff too. But it can definitely be helpful to recognise what a swallow looks like and yeah, and know that I know that you're likely to be able to hear us while at the beginning of a feed and and know what's what's the difference between suckling and swallowing. Yeah, and maybe knowing a little bit about expression and hand expression. Actually, I was going to ask you something you mentioned earlier. So I'm a bit confused because I see different points of view about this. Some people say if you give birth to an early baby, you hand it suppress as soon as you can after birth, and as you said, you wait until your milk has come in before you start pumping. But I'm also seeing in other places in another research studies, try and get pumping within six hours of birth. So still hand express, but add in, if you can hospital grade double electric pumping, just to give that additional stimulation, especially if it looks unlikely that you're going to be breastfeeding directly for a while, we really want to get milk supply up and running up producing a litre by 10 days, whatever the plan is. I mean, how do you describe that? Do you talk about pumping early on? If it looks like you're not going to be directly breastfeeding? How do you what do you say it? 

Kathryn Stagg  25:36

Well, the way I understand it is that the pump, the pump, part of it is more for the kind of stimulation and the hand expressing is more for the collection. Yeah, that's kind of how I would phrase it. So the pump is great, because it gives you that extra massage and suction and stuff like that. And trying Yeah, brings the cluster down a little bit more easily. And you've got that extra and you're having to do loads of how this person which does actually hurt your hand after Well, if you've been doing it for ages kept very strong thumbs if you've been expressing lots. So yes, absolutely. So from a collection point of view is better, you tend to not use the pump until your mill begins to come in, you'll start to get slightly larger volumes. And that's the main reason is that if you're trying to collect colostrum with a pump, it's just as such small quantities and so thick and sticky. It just gets stuck around the edges of the tone and damage job and done thank you very rarely get a drop actually into the bottom of the bottle when you're trying to you know so. So I think that's that's probably the way to think about it. So yeah, so the public can be introduced from a sort of stimulation and massage point of view, sometimes will sit on on that initiate setting the that setting that they have, which is more about massage and less about extraction, and then do some hand dispensing afterwards. And that can sometimes help you get a little bit more, more volume. 

Emma Pickett  26:47

Yeah, okay. Yeah, colostrum is gonna get lost, it's gonna get lost in a pump, it's also gonna let go and get lost in a nipple shield, which is where we're not doing the push. So collecting without expression collecting into a container, or syringe, depending on what you feel confident with. Yep, and then and then the pump for stimulation, and ideally, a hospital grade. Although that term isn't necessarily protecting a double decent pump, it's probably not going to be, you know, the the fancy, more expensive wearable pump, necessarily. 

Kathryn Stagg  27:17

It may be the pump that's not very efficient, effective. Those are, the ones that you get in hospital are going to be a bit more rigorous and get on with it. 

Emma Pickett  27:24

And thanks for clarifying that. So if it's recommended that you need to give your baby some extra milk, if baby's not able to really breastfeed if you're going to need to supplement and give them some extra milk. And we've talked about how some people might be using the nostril nastro, I keep saying nostril nasogastric tube, what other options are there to give a baby extra milk in this in this phase.

Kathryn Stagg  27:48

So there's actually loads. The problem with the UK is that we are boxed in nations who everyone defaults to a bottle. And if we do give a bottle, we need to make sure we properly paste feed, especially for this gestation, absolutely essential because, again, that they can be very overwhelmed by the flow of milk or not careful so so we have half the bottle. So that's an option. But there are loads of others. We have literally as as the association pressing mothers, we've just made a lovely video.

Emma Pickett  28:13

Thinking about that video. Yeah, that's a gorgeous video with the lovely JoJo for two illustrations that talks about different ways of supplementing, so we'll definitely put a link to that in the show notes for sure. Beyond Bottles

Kathryn Stagg  28:26

Beyond Bottles. Yeah, so there are other ways basically. So for those babies that are really sleepy, yet the bottle does work. But the other things that can work quite nicely is finger feeding with a with a feeding tube or with a syringe. So finger feeding is when you put clean finger or if you're a healthcare professional, you use a gloved finger up into the roof of baby's mouth with a nail slide down and you trigger their sock reflex, so get baby sucking. And then you can have the either the feeding tube you haven't taped onto your finger when you do that. Or you can also just pop a syringe into the corner of baby's mouth. Sometimes one of the dental surgeons that have a kind of big curvy tip work really well for this to get get them in really easily. Or certainly a setting with a sort of needle point of some sorts yummy, not the actual metal bit of a syringe, obviously, different sorts of

Emma Pickett  29:14

taking the needle out. Let's clarify that we're just talking about plastic plastic

Kathryn Stagg  29:18

bits, yes. So yes, and you just put it into the corner baby. And then as as babies sucking, if you're using the feeding tube version, as the baby is sucking, they will draw the milk through the fin tube and you can lift the container a little bit if you need to add to help sort of increase the flow or you can drop it down if they're struggling a bit with the flow. So you can change the flow by lifting the container up and down slightly. And it means that baby when they're sucking, and there's they can swallow and they sort of they're almost like practising that suck, swallow breathe that they're doing on on the breast. So actually it sort of replicates that quite well and you can really control the flow. If you're using the syringe we do have to depress the syringe but it's a matter of we don't want to put too much milk in baby his mouth, we don't want to risk aspiration, which is when they swallow the milk down into the lungs. So we have to be a little bit careful about how fast we're depressing the syringe. But when they're the babies is doing a burst of sucking, so they second burst, and then they have a rest in between, basically, you can just depress the syringe fregean and just put a few drops in, and then you wait for them to swallow it. And then you can continue and do another little squirt of the syringe. So you just put a few drops in each time and keep it quite slow like that. But it's a really, really effective way of supplementing babies who really sleepy because you can actually they can suck when they're sleeping, and they can swallow when they're sleeping, they're very good at that. So it's a nice way of supplement supplementing babies that when they're really sleepy, it works really, really well, I'd love to see it used a little bit more in hospitals, I have to say, I think it's quite a positive thing. And it also means that it still feels like you are feeding your baby rather than you know, the bottle feeding your baby, it's sort of slightly different feel about it, it's quite nice.

Emma Pickett  30:57

And when you're on there, when they're on your finger, and you're feeling their tongue movements, and you're getting a sense of when they're being active, you're definitely sort of part of that. 

Kathryn Stagg  31:05

It helps you learn kind of what you're looking for, I think if the babies are Nestle, you can use cups, but they do have to be properly awake to cut feed. You know, so but you know, there are some babies who actually aren't too sleepy at this age. And it's more about the skills of breastfeeding that they're trying to learn, rather than them being sleepy that's causing the problem. So for those babies, you could use a cup, teaspoons, you know, that works really, really well again, if you're just putting some more volumes in that can that can be really good. So they don't need to begin with they really don't need large volumes of anything. So yeah, there's lots of lots of options really around that. So it doesn't have to be bottle this is one of the things that we need to just get that quantities in a bottle is actually quite tricky. 

Emma Pickett  31:43

It's very difficult to do pace bottle feeding, when you've got some more quantities in a bottle, you're going to be tipping it up and it's going to be gravity, not the baby doing the work. So yeah, some these other methods really help. So this if we're talking about finger feeding with a tube, then just to clarify, it's the same tube that would be used for NG feeding. Absolutely. So people might be able to get that from their hospital. If they're not sure how to source it, then they could maybe talk to an ibclc. Yeah, it gets a little bit complicated, doesn't it when it comes to some hospitals are reluctant for parents to use some of these methods, and they seem worried about aspiration, but you you can aspirate on a bottle as well. Absolutely. Yeah, some some parents are told they're not allowed to do syringe feeding. And there's all sorts of messages around that. I mean, what's your experience with the families that you've been working with?

Kathryn Stagg  32:27

Yeah, there's, there's a lot of roles and with healthcare professionals, one of the things that's the bit is a bit challenging for finger feeding with a tube in particular, is that the tube is not designed for that purpose. And so they're actually not allowed to use it for that purpose. Officially, you can only use a piece of equipment for the thing it is designed to be used for. So in those gastric tube is designed to be put through the nasal cavity down into the stomach, and use that way. And so from there kind of insurance point of view, they're actually not allowed to use it in another way. So this is where one of the problems is, you know, it's trying to get around the protocols and say, well, actually, we can use it in this way. And, you know, I think what we could do with with healthcare fresh is actually educating them about why this might be a good thing. And then if they have the knowledge of why it might be a good thing, then they can work on changing the protocols that they're using, in order to make it you know, and how do risk assessments and stuff like that, which is what they would have to do probably to introduce this into their setting. And then do you know, sometimes they have to do a little kind of mini mini sort of study within their hospital to prove that this should be a protocol that they can be using. So yeah, it's a lot more work in an already stressed and stretched system. This is the problem, you know, to kind of get them going. When I was writing in my book, I was trying to find some research around hospital protocols around babies that are born at this gestation. There was another thankfully, it's a lovely one, this one published, which is great, so that there's one of those, but I sort of put a little post up in the Facebook group, which has a lot of infant feeding needs in the healthcare professional such like that in there and said, you know, is anyone don't want they can share with me, you don't mean that be great. One person who happens to be the ABIM, breastfeeding cancer and also an infant feeding. One person said, Yes, we have one of ours. And she said, It's really lovely if

Emma Pickett  34:13

 she wasn't called Sharon by any means.

Kathryn Stagg  34:17

And there are a lot of people going, we haven't got anything, it's something that is kind of on the to do list that we need to do. But we don't have a protocol for for babies of this gestation and the how to get them breastfeeding. And I was like, Okay, right. That's what the issues are here. So that's what I was at any healthcare professionals who are working in providing around this, I would love to take away from this, this session even just to kind of actually go and think about what you do in your hospital and actually, how we can get these babies supported a little bit better, you know, so that would be one thing. There is a lovely study there with it all written out of stuff that you can do.

Emma Pickett  34:53

Yeah, yeah. So people may not necessarily be bottle feeding, but they may also be encouraged to bottle feed and if they do start bottle feeding, it's not necessarily a barrier to being able to exclusively breastfeed later on. It's something in the interim that gives your baby a bit of a kickstart went during during this period. So some parents get themselves into this triple feeding yes system. Tell us about what triple feeding is. And what do you talk about with parents to help make it a bit more manageable.

Kathryn Stagg  35:20

So triple feeding is when we are basically having time at the breast. So practising breastfeeding, hopefully, babies will be taking some milk, which they should do, and then we're having to give extra milk by another system. As we've suggested, it's often a bottle, then we need to establish milk production, so that we don't basically let the milk production go, you know, me, because if the baby's not taking out enough milk, that's going to mean that when that when those supply, which is something that we don't want to do, if we want to, if a parents goal is to fully breastfeed, you know, later on, so we need to pump as well. So we need to add time time at the pump as well on top of this. So there's three stages to this, this feeding. And that's why it is so intense, and exhausting, and horrific, and everybody struggles massively with it. But it's so important to actually do it as well. If your goal is to exclusively breastfeed, it's so important to get get going in the in the first week or two. I think the thing with a with triple feeding is that it is temporary. So we need to make parents on standard, it is temporary, they're not going to have to do this long term. This is not what breastfeeding is going to look like for them long term. Most likely, most babies are absolutely fine to fully breastfeed once they've kind of gone past that kind of 14 week gestation. So it can be maybe a week or two or three of this done and intense regime and then we can begin to back away from it and reduce. So a lot of people, it's good to have an extra pair of hands if you possibly can, if you're having to do just a job that helps you out

Emma Pickett  36:49

if you're a single parent triple feed, it's just a unit up you need a metal. It's absolutely, yeah, I mean, I think it's important that when medical professionals or breastfeeding supporters are talking to parents, I'm sure you do this, you ask the question, what's your support network? What's the situation at home, if you are at home alone, we're not going to no one's going to tell you to pump eight times a day and bottle feed eight times a day, it's just not going to be doable in that situation, 

Kathryn Stagg  37:13

we would do this sort of minimum to kind of you know, just try and pump maybe you know, try and just do it maybe four times three rounds or something like that. But the ideal would be to pump every feed this, you know this, if you're in an ideal situation, you have lots of help. So we get the baby to the breast, they take some milk, we pass to maybe a helper of some sort, then they can they can give the top up. And then you would pump. So we try and we didn't try if you have a single baby, we'd encourage the baby to maybe go on both sides before we bought them over. If you have twins as difficult, especially with tunnel vision, but we tried to you know, have one baby on each breast and then we're twins, it's just have to help us because you can pass one baby to each whilst you've so three adults for twins is I would say it's a must if you possibly can. definitely helpful, but you know, trying to get the pumping whilst the top is gearing up, we'll make it a bit more doable for most people, and especially at night. And when I usually suggest to people, if there's one feed that you, you just think I can't do all three bits, depending on how the baby's feeding, if they're feeding quite well, and they're only taking a small topper, you could just breastfeed and use some milk that you've had previously or something like that and not do the pumping session. If you've got a baby that is not feeding quite as well yet, then you could consider maybe just pumping and somebody else bottle feeding on that feed, you're only doing two steps. But I try and limit that to maybe one feed out of your feed and 24 hours if possible. You know, just to kind of but but some people that's the thing that makes them actually be able to do it, you know, which is like can I have one feed where I don't have to do everything? Yes, I think that's fine. 

Emma Pickett  38:44

So yeah, there's one thing that I was actually reading Lucy Weber's lovely book about breastfeeding and the trimester a couple of days ago. And she said something that I'm pretty sure that we both would say as well. But I was just like, She's so great to explain things in a very straightforward way. If somebody has a baby, that's, that's feeding for a very, very long time, and they're triple feeding. It may be that this is the one moment where we may say it can be okay to end a breastfeed is absolutely to be able to move on to the pumping. We're not the people who are going to say breastfeeding lasts for 10 minutes. Stir that up. I'm gonna be the people that say, get to the 15/20 minute mark, are they still swallowing? Are they still actively feeding? If they're not, it could be okay to take them off. You would absolutely

Kathryn Stagg  39:24

agree with that. And I think that is one of the things that also makes us more doable. Yeah, I try and suggest people try and keep the feed to in total with the bumping. Try and keep the feature an hour tops really if you can, can possibly manage it because that just makes it a bit more doable. But I think it's a matter again of educating and just empowering parents to know what that act of feeding in that second swallow looks like. If the baby's going on to the breast and they're doing some burst sucking, you can hear swallows, often you get you know, for an early baby, you maybe get a swallow every sort of maybe three successes or every one you know so they're not as efficient and you maybe get a burst of sigh Looking which might have, let's say, you know, three or four sucks in it before they have a rest. Whereas, you know, if you have a big full time full term, baby strapping sort of eight pounder, they will go on. And when the milk, when you get your net down, they will maybe do 10 or 15 socks before they actually stop, you know. So there's a big difference, that's one of the main things to look for is those, the length of the bursts of sucking, and how many swallows they're doing per slug as well. So if you're getting three socks, and one swallow, and then they have an arrest, and then three socks, and once one and her arrest, you can immediately see how that baby's feeding a lot more slowly than a baby that's going to suck, swallow suck, swallow sucks, swallow, suck, swallow, suck, swallow for 10 in a row, you know, so that's going to make a massive difference to how much milk they're taking. So, you know, changing that, and then when they do go into that lighter flutter sucking, we can, I'm sure we're going to talk about respirations. And they could do compression and keep them going. And you can sometimes trigger no let down, you can start to see that sucks water coming back. But once the compression doesn't work anymore, the baby is, you know, really has gotten, you know, they don't sleep and they're not really they're just slightly flood sucking, you're not getting any spoilers, you can, you can definitely take them off. And it's actually more efficient. And when you get into that stage where they're beginning to get it a bit more, sometimes actually waking them up and putting them back on the breast at that point, you know, from the other side, the faster flow of milk. But if you wake them up, they'll go back because they're probably awake, they'll go back to sucking more efficiently again, and you can get to take more milk, and we're twins, we quite often get them to go back in, you're putting them on the same breast again, which ones usually. So you know, the flow is not quite as fast, but because they're awake and they're sucking more vigorously, they will trigger a second let down and melt and they will go back into that sort of more efficient feeding again. So that can be a way of sort of beginning to move away from having to do a top up via another system is to try and jam on the breast a second time as well.

Emma Pickett  41:53

Yeah. Thank you. And one more thing about making triple feeding more doable. Yep. I always check and say are you sterilising? The the Oh, yes. Every time. Is that necessary? I mean, it seems that there's a little bit of a difference in opinions. Yes. The CDC in America talk about sterilising the pump as being the ideal that you do sterilise. If you're in a hospital situation. You probably have to be a bit more careful about sterilising because they're hospital based infections. But if someone's at home and the baby's healthy, yep. And they're 36 weeks. What what how, what do you say about sterilising pumps? 

Kathryn Stagg  42:27

Yeah, so I think it's, it's sometimes the thing that breaks people into sterilise them all the time. So I'd quite slapdash generally in life anyway. But I'm definitely of the opinion that, that pumps don't need to be sterilised every feet absolutely not breastfeed, because all of its own self cleaning stuff going on, there are lots of lovely antibodies in it and all that sort of stuff. 

Emma Pickett  42:47

And, you know, it can sit at room temperature for six hours, if the bottle of milk can sit at room temperature for six hours. And we're sterilising a pump every three hours, it doesn't quite fit. 

Kathryn Stagg  42:56

I agree with you totally on that. So you know, actually, if you've got if you're doing two pumping sessions, within, you know, sort of three or four hours of each other, you can even just stand the pump, next to where you're sitting and use it to get German is absolutely fine. As long as you're going to use the milk quite quickly, I think that would be but you know, if you're, if you're trying to store it for a long time, it's probably not a good idea. You could certainly you can keep the pump collection kits. So the bit that touches the milk, so the cones and the tube and the bit that drops into the not the tube, the bit that where the milk drops into the bottle, you know, the valve, all that kind of stuff, and the bottle that's chatting, you can actually keep all that in the fridge, which would keep that any milk residue that's there, we keep it cold. So you know, again, from the guidelines point of view, it's kind of it's a bit vague, but if you look at actual food safety, if you use the food so because it is a food at the end of the day, it's a failure where the actual self cleaning properties as well so but you know, food safety, you should be able to keep that, you know, that pump could technically be still usable, you know, maybe three or 456 days if you kept it in the fridge, possibly, you know, so I wouldn't suggest you leave it that long, probably but you know, it's so you could keep the clutch in the fridge and use it you can you can wash it out with hot soapy water, let it air dry. You know, so I think people find their own little system of kind of doing a bit of everything and I'd probably say to be cautious. It's worth sterilise it once and 24 hours if you're using it and not you know, it's probably worth and if you're sterilising

Emma Pickett  44:18

a bottle anyway, so we do need to sterilise bottles because saliva and bacteria does different things in the presence of saliva and yeah, I guess if you're sterilising bottles anywhere, it's not so hard to know exactly. Every once every 24 hours but you certainly don't have to do it every single time if babies well and if you're at home. Absolutely. So breast compressions I know you're a big fan of breast compressions this great pretenders population are the breast compression group who really really benefit from them. Tell us how they help and and Can you talk us through how you do it. So when you tend that I'm I'm Emma, the mom on the phone or on the national breastfeeding helpline and you're going to describe for me How you do breast compressions? How would you normally outline it to a parent.

Kathryn Stagg  45:03

So just to say we actually train it all our National Breastfeeding Helpline people now to do this on the phone, this is one of the sessions we do just say. So breast impressions, breast revisions are an amazing tool. And they're so useful for all sorts of circumstances, anytime, where it really where a baby is struggling to maintain the feed, or feed effectively, you know, just are a bit inefficient, basically. So it can work for all sorts of things. But for tongue tie can work for you babies. Yeah, lots of stuff going on. Basically, the idea of a breast depression is that you're putting pressure on the tube, basically, the breast, you're sort of encouraging the flow of milk by squeezing the breast. So it's sort of similar technique to hand this person but but you do it further back on the breast, if you try and do hand expressing so it's basically hand expressing was the baby's feeding is the idea. But if you do, you're handing expression position, which is right near the nipple of torso, just knock the baby off the breast, you know, because they weren't built to maintain a latch. So we have to take a tonne of bigger handful of breast back further towards the chest, it just speeds up the flow of the milk. So I think one of the things that people don't understand is yes, the baby suckling at the breast drives the flow of the milk. But also, it is inversely related as well, the flow of the milk also drives the baby sucking. So if we can understand that, you can see straightaway why this works. And that's why things like you know, using a tube at the breast of things can help as well, you know, that's a, that's another way of delivering extra milk to baby, which we didn't mention. But so breast compressions, so the technique we take, we've got baby latching, we tend to not use them at started feeding less babies being a little bit fussy when you're first latching run, or if they go on, and just fall asleep immediately, you can't use it right from the beginning. But if you've got the baby actually doing some socks and sweaters on their own, we let them kind of don't start with, then we can assess and see what the feed looks like. And if it's looking a bit slow. So if you are having these sorts of babies sort of doing a second burst and having a break, and then they're taking a long time to restart another sock investor, it looks like they've gone to sleep. And we can use a compression. So the technique is to take a nice handle for the breast doesn't actually matter too much where you are. So whichever hand you can move easily, it's absolutely fine to use that you can go around the side and go on the top of the breast, either side, the inside, depending on what position you're feeding in, you know, whatever bit of breast you can get to easily with the hand that you have. Spare basically works well. And we we do a non slow squeeze. It's sort of more like a massage actually. So where parents sometimes get this wrong as that they do a kind of fast, a fast squeeze that doesn't actually do anything

Emma Pickett  47:41

like they were hand express. Isn't Yeah, it isn't handshakes, but I sent I sometimes use word clamp. Is that a helpful word? Possibly? Yes,

Kathryn Stagg  47:49

it does feel like you're clamping the breast. Yeah, I use it. I use the analogy of trying to get that bit of toothpaste out of the toothpaste tube. You know, I mean, that last bit where you're trying to get, you know, you I really haven't. So you can

Emma Pickett  48:00

you can tell you're not 25 Kathryn, because you've got, you've got toothpaste tubes in your mind, everyone's got pumps these days,

Kathryn Stagg  48:07

to get the N bit do you get from so? But yes, exactly. So but you know, I'm sure everyone's done it somewhere in their childhood, at least, or, you know, if you're, if you're a cake maker, you know, trying to get that kind of the icing bags flowing, you know, gathering that kind of massage the sorts of techniques that you have to do. So it's not a fast squeeze, it's a really long, slow squeeze, and we and then we kind of maintain it. And the pressure for a little bit was you don't just let go straight away, maybe hold it for 3456 seconds. Sometimes depending on how you feel it's going you know, so you can kind of watch what the baby does when you do it. So sometimes you need to do a couple to get the baby re sucking again. So you might have to let go and then do another one. And then you see the baby go oh yes, I'm supposed to fit in, they restart their second burst. Okay, so you're putting pressure, you're putting positive pressure on the breast, essentially, by doing the squeeze. And you will notice the baby then becoming more active and doing those deep, deeper chin movements. At the time you're doing the squeeze, you'll see those yes, those deeper actions Absolutely. And then they slow down again. And then you you could do another one, sometimes you you you can trigger a second let down by doing this as well though and then then the milk again flowing faster on his own. So if the baby starts to maintain themselves and don't starting sucking again, you can sometimes stop for a little bit and then restart when they get a bit sleepy. So that's one way of using it. And the other way of using and that's another most common way of using them but there is another really useful way of using them for these babies that are a little bit inefficient at breath particularly to not the not just sleepy but they're actually just inefficient when they are feeding. So those babies they as I said they tend to do three or four sucks and the have a gap basically. Whereas a full time baby maybe do 10 socks before they have a gap or maybe 15 Even you know so. So the other way of using compressions, which is very very effective for these babies, is that the baby starts a sucking burst and you put the pressure on the breast and squeeze gently whilst they're sucking and you will often extend the second burst. So they will normally do three if you don't do it. But if you do the pressure as they're, as they are sucking, they maybe do 678 Sucks instead, before they have a rest, okay, and that is actually really, really effective, because it makes each burst of sucking, they take more milk each time, you know, so that that can really help the baby take more milk, and be more effective at feeding. So for me, again, that's actually even a better way of using it for these early babies. So there's two other two ways you can you can use a mixture of the two as well, you know, so a lot of parents are like, Oh, my God, I've got to keep doing this all the time. It's, you know, it's quite a touchdown to watch. And your baby said, it takes all the intuition out of everything. But but it does, it is really, really good. And if you're trying to get your baby on to the breast and breastfeeding more effectively, then it is a really, really useful tool. So you don't necessarily do it throughout the entire feed. You know, there'll be points where the baby maybe can maintain it better themselves. But also, there's a point where you think, you know what, my hands aching. Now, let's just leave the monitors to see what they're doing themselves. And, and, you know, just rest for a little bit, and that's absolutely fine as well. And

Emma Pickett  51:08

it might be different times of the day, you're let down a bit more forceful than other times in the day, you'll let downs a bit slower. And baby seems to be not not as active, daft question. But if you've got twins, and you're doing tandem feeding, to get those spare hands, you're presumably going to need a decent cushion, to be able to do hands free feeding.

Kathryn Stagg  51:28

I mean, this is one of the reasons why a lot of a lot of twin parents who've got this gestation twins, they start maybe single feeding to begin with is because of that, because it is much easier to do compressions and to watch how the baby is feeding, obviously, because you can focus on one baby at a time. So but obviously, then that makes you you're having to feed the baby separately, which makes it slightly more challenging from that point of view as well. If you if you are using if you're tandem feeding, you can do it. But you do need to be able to let go of the baby. So you have to have a really good, firm supportive vision, and you have to have a really good latch. And the babies need to be they just need to be held in the correct position by the cushion. So it really is millimetre This is where twin fitting cushions there are several one on the market, I won't go too much into twins, but there are several out there. But the height of the cushion is a real problem. Sometimes you have to make sure that we get the right cushion for the right body shape, and that kind of stuff. And if you're single fitting and you're preferring rugby holes as well, it can be useful to really just think about how you're supporting the baby as well. But yeah, it's it's you can compress. If you can move one hand, you can compress, you can compress with the other breast with the same hand, if you've got one baby who's not maintaining that actually as well, you may be able to use the other hand on the other breast episiotomy. So that can work quite nicely. But yeah, it says more challenging. 

Emma Pickett  52:44

There are all sorts of imaginative ways to solve this problem. I mean, I've worked with families where mum didn't have the use of a hand and partner did some compression. That's that is a possibility to all sorts of options. Yeah. And I guess one of the things that I'd like people to take away from the session is, this all sounds bloomin complicated. You know, having a baby who's born at 36 weeks Hang on, they may be able to start, they may not be able to serve, I might have to pump I may not have to imagine triple feed, I might have to do compressions. It's there's a lot going on here. And what we just touched on earlier is that this is not your this is not the world of breastfeeding for you forever. No, no, this is not how it's going to be for for all the time that you breastfeed, you might just this might be just be two weeks of your life. Yeah. And then suddenly, your baby kind of gets it and everything seems to fall into

Kathryn Stagg  53:31

place to happen overnight as well, quite often, you know, they're one day they're receiving it in efficient. And the next day, they've suddenly is developmental. Absolutely the next day, they've just suddenly got what they need brain connections, fat pads, the whole lot, you know, everything comes together. And they suddenly have a really lovely feed, and they're settled afterwards. And you think, do they need to top up and you maybe try them with a little bit you'd like, oh, they didn't really take any of that. You know, I mean, it's it you get to stage. And there's also, again, no research in this talk. But because we have a whole Facebook group full of babies that are born a bit early, generally, we have noticed that there is a mega feeding frenzy somewhere around 40 weeks gestation, or they suddenly have a bit of a you know what we call a growth spurt? Traditionally, we would said that, but I don't think it is that I think it's a developmental thing. They suddenly wake up and they suddenly we want to feed all the time. So if you can catch that very somewhere between sort of 38 weeks and 40, maybe 41. You know, that kind of somewhere in that period, you suddenly find the baby suddenly wants to feed all the time and doesn't want to be put down and they basically magically turn into a newborn when they're doing this. Yeah. And that is the point. Although it can be very overwhelming because the baby wants to feed lots if you can kind of change it around your mind. Actually, if we can get the baby feeding more, we won't have to pump as much to start with. That's the first one. That's how I set it to everyone. If you've been feeding more in the breast, you ready this pump to pump as often. They're like Oh yeah, okay, that's all right. Yeah, cuz it's sort of triple feeding. If you've said that you've got a pump every feed and then the baby starts feeding every hour. He's just like, well, do I need to pump? knows the answers? 

Emma Pickett  55:03

Yeah, yeah, for sure. And actually that transitional phase can be quite scary because it started off with this. I know triple feeding. I know how it works. It's awful. It's terrible. But I can see milk going into my baby, I can see I'm pumping it. So actually sometimes lose the pumping and to have a baby that's doing really well ironically, can be the moment when parents confidence get together not because, yeah, now it's about trusting my baby. Now it's about looking at nappies, it's, I can't, I can't see how much milk is going into them. So I think if people want to get extra support at that stage, when ironically, everything on papers going really well, we would completely understand. But yeah, I'm kind of a little bit of a confidence wobble when the things you've come to rely on, can sort of fall away, and you don't need them, even though they don't need them anymore. 

Kathryn Stagg  55:44

But it's actually it's, it's a bit of a leap of faith at that point. And you have to, well, let's just try it for a few days. And then you know, keep it on the nappies and make sure everything's fine. And I'll be okay. And then you know, maybe given ways and make sure that that's okay. And you know, once they kind of action is working, then you can kind of relax and just follow the baby. And you're just like, oh, okay,

Emma Pickett  56:06

this is scary and weird. But yeah, you will get there for sure. And RPN can help you get there people like you, Catherine, thank you so much for for your time today. I mean, one of the last things I just want to ask you, if someone's listening to this, and they work in a hospital setting, or they're a breastfeeding supporter. What's the kind of headline that you'd want them to take away from this session about this these group of babies,

Kathryn Stagg  56:27

it's just I think we need to impart this information to parents that, that their baby just might not be able to just fully breastfeed at the moment, we're just keeping a close eye on them and to whatever your local breastfeeding support network is like, you know, what they do, whether they've got an outreach team where they've got them feeding, lead, whatever that is, to try and encourage them to just reach out if they need it, they're not failing, if their baby's not feeling well, that's has nothing to do that is completely a developmental thing. It's just that baby's not quite ready yet to fully breastfeed. So we need to actually get them to actually discuss this with parents, first of all, because if they have the expectation that they think their baby should be able to breastfeed from the beginning, and they're not able to, you know, then that's where we have an awful lot of problems starting with, you know, just giving up straightaway and things like that. But if they know that your baby probably will be able to breastfeed, but it might take a week or two of you know, kind of practising and hard work and pumping and things like that, you know, they're much more likely to hopefully reach out for support and trying to get help with it. And keeping it's keeping an eye on everything really, as well. So sort of education, I think,

Emma Pickett  57:33

education and that balance of helping parents to feel confident, but also having realistic realistic expectations at the same time. It's that tricky balance. Yeah, thank you so much, Catherine. So I'm going to put your article in the show notes. I'm going to you do you do offer training sessions, don't Yes. of health professionals. So I'll get people to signpost to your to your page to have a look and see what modules you're offering and what webinars you're offering in that. Yep. Because I know you've got so much expertise and I have no shame in saying I would like you to come back and talk about multiples another time. If, if that's not too cheap. I will talk to you about that separately afterwards. Thank you so much for your time today, Katherine, really, really appreciate it. 

Kathryn Stagg  58:09

Lovely. Thanks.

Emma Pickett  58:15

Thank you for joining me today. You can find me on Instagram at Emma Pickett IBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist. And leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media.