Makes Milk with Emma Pickett
Emma Pickett has been a Board Certified Lactation Consultant since 2011. As an author (of 4 books), trainer, volunteer and breastfeeding counsellor, she has supported thousands of families to reach their infant feeding goals.
Breastfeeding/ chest feeding may be natural, but it isn't always easy for everyone. Hearing about other parent's experiences and getting information from lactation-obsessed experts can help.
Makes Milk with Emma Pickett
Lactation and fertility
Trigger warning: This episode discusses fertility struggles, miscarriage and early pregnancy loss.
Fertility and breastfeeding can be confusing, with conflicting information coming from friends, family and medical practitioners, so in this episode I speak to the knowledgeable Carol Smyth IBCLC to try and make sense of the issue. We talk about what effect breastfeeding has on your hormones, when periods return after birth, nursing and assisted conception, charting and perimenopause.
You can find more from Carol, including her articles about fertility at www.carolsmyth.co.uk
The books Carol mentioned are
Taking Charge Of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement and Reproductive Health by Toni Weschler
Fertility Cycles and Nutrition by Marilyn Shannon
Find out more about breastfeeding and chest feeding older babies and children in my book Supporting Breastfeeding Past the First Six Months and Beyond: A Guide for Professionals and Parents
Follow me on Twitter @MakesMilk and on Instagram @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com
This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.
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, will 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. Thank you very much for joining me for this episode. I did briefly touch on the subject of breastfeeding and fertility and conception when I talked about reasons for weaning and thinking through your decision for weaning. But I thought we should really dive into a little bit more because lots of parents do approach me to talk about fertility and breastfeeding and to understand how they can conceive again, while they're still breastfeeding and whether they need to wean. So I thought I would speak to one of the experts in this field as far as I'm concerned, which is lactation consultant, Carol Smyth, IBCLC Carol Smyth, I first came across her because I found her excellent articles online. So she's got these brilliant articles of breastfeeding and subfertility. I think, are there three articles, there's either two or three?
Carol Smyth:There's three.
Emma Pickett:And they're really helpful. They're really helpful for anybody in this space, who is still breastfeeding and wants to understand how their fertility works and what they can do about it. So thank you very much for joining me, Carol, today on this episode, I really appreciate it.
Carol Smyth:Delighted to be here, Emma. It's lovely, it's lovely to come and speak to you.
Emma Pickett:So let's just talk a little bit about you and your practice. Tell me about what you're doing where you are. You're not just talking about fertility and conception and breastfeeding. I know you do lots of other things as well to tell us a little bit about you.
Carol Smyth:Yeah, I've a bit of mix of things. So I am an ibclc. And I'm also a CBT therapist. So I have a met a practice that mixes, infant feeding, and that CBT. And within the CBT I have some work that's in primary care, and then I have some work in private practice, it probably doesn't surprise you that the private practice work tends to be focused on the perinatal community, because that's where my real passion lies. So yeah, I work in Northern Ireland. And with that mix of private practice and primary care work, I suppose I combined a lot of it together, because even in the work on infant feeding, I will bring the mental health stuff into it as well.
Emma Pickett:Yeah, very much part and parcel that sounds like a really useful, multi strand practice that you're providing there. Yeah. And I found her articles completely by accident, I was literally just Googling and thought, Oh, thank goodness, this clever person's got all this information about hormones and conception in one place. What originally led you to write this articles?
Carol Smyth:Gosh, well, really, this was very hard learned, personal experience. And for me. So just to give you kind of a brief, brief overview of what was a very long, multi year story, I have two children, I have two boys. And with my first I got pregnant really quickly, had a really straightforward pregnancy, breastfeeding went really well completely fell in love with it. And so I fed much longer than I ever intended to. And I was involved with literally at the time and seeing lots and lots of people who were timed and feeding and feeding in pregnancy and continuing to be for long periods of time. And because it all gone. So simply for me, I just assumed that that would be the case, again, that I would be able to keep feeding my toddler and I would just get pregnant, and I would be able to tandem feed. And that is not how it worked out for me at all. My period didn't return whenever my friends and peers, their periods were returning. That didn't happen. I was searching for blogs, like I have written I just didn't find any. You know, all the information was basically saying oh, there should be no problem, you should be able to get pregnant, you should be able to, to have have babies. And it took me quite a long time and a lot of tinkering with our breastfeeding pattern in order to get pregnant again. And I mean, even when my period did come back, it looked different than it had before. So I had to do a lot of tracking a lot of reading. I had to dive into the research to find out this information for myself. And I had two miscarriages while breastfeeding. And I suppose each time I hit one of these obstacles, I just dove a little bit deeper into the research to try and find out what on earth was going on. Eventually I did have my second little boy and which is wonderful, but I suppose it was that that really inspired me to write these blogs, because I couldn't find the information. And I knew that there were other people out there who were like me and needed to get that information as well.
Emma Pickett:Yeah, I'm sorry to hear about your your miscarriages. And I'm sorry to hear about your challenges that you went through. But I guess you gave a gift to lots of other people as a result of that. And that, you know, that gift is carrying carrying on giving, because there are people who are losing months and years not really understanding what's going on with their fertility. Yeah. And you're helping them to come to a place of being informed which and you know, make decisions from a place of, of information, which is so valuable and so important. So thank you on behalf of everybody that who your articles are helping, and for anyone who's googling Carol, I mean, there'll be in the show notes, a link to these articles. So you can just click on the show notes, but it is Carol Smyth with a Y instead of an i in the Smyth, if anyone's looking for you. So there's so many things we can talk about today. But I think maybe we should go in chronological order. So let's start with early breastfeeding. So you've given birth through in the first few weeks of breastfeeding. And people will come across this concept of LAM. And I'm really bad at pronouncing it lactational amenorrhea method, we're saying that right? Yeah, because I can never pronounce that word. I'm gonna read it. That means that means periods, doesn't it? That means menstruation?
Carol Smyth:Menorrhea is periods. Amenorrhea is without periods, basically. So it's that area of time or periods of time, where we don't have periods, you know, when you have your baby. And what nature I suppose has designed us to do is to really devote ourselves to this little baby, that we've got to put lots of energy into this baby. You know, raising a small baby is a very energy intensive process. And at that time, we really do not have the resources to look after this baby, and be getting pregnant and just starting a new baby at the same time. So nature has designed this process where the suckling of a new baby that actual suckling on on the breast has a suppressive effect on our hormones. And it's simply stops the normal secretion of hormones, stops, ovulation stops a menstrual period, and prevents you from getting pregnant. And the idea is that as the baby gets bigger, and their needs for you gets less, and their suckling gets less, there's less of a suppressive effect. And the less that the less of an effect the breastfeeding has, gradually, your hormone production begins to come become more normal again. And as it becomes more normal, your cycle begins to return and to normalise, and fertility then returns. But it returns in a gradual, phased process.
Emma Pickett:So LAM is that contraceptive method of using breastfeeding as a contraceptive method. And, and correct me if I'm wrong, a bunch of people got together in a conference and said, Let's look at all the evidence. And these are the conditions that must be met. So somebody wants to use contraception as a breastfeeding method. It's only sorry, if it were someone who sees breastfeeding as a contraceptive method, along with complications for breastfeeding as a contraceptive method that's only going to be valuable for the first six months, you shouldn't rely on it being the first six months, you can't be mixed feeding or giving solids, it's exclusive breastfeeding. And then tell me a bit more about that third condition, something about the intervals and how you frequently you've got to be feeding your period shouldn't have returned. That's one of the other three conditions. Yeah, so the three conditions a period shouldn't have returned under six months exclusive breastfeeding, but then what happens when somebody is exclusively breastfeeding, but their baby sleeps? 10 hours at night? I mean, some four month old baby sleep 10 hours at night is that how do we define what we mean by exclusive breastfeeding?
Carol Smyth:Well, exclusive breastfeeding just means that all of the babies, all babies milk is coming from you. And if a baby is under six months, and exclusively nursing, all their milk is coming from you. Probably they're not that likely to be going 10 hours at night. Now you may get some babies that are but you know, LAM is not 100% effective. What it is doing here is creating rules that are going to apply to the vast majority of people. It is about 98 to 99% effective. And there probably is a very tiny, tiny number of babies who are actually going 10 hours at night. So those three rules are going to apply to the vast majority of people. If a baby is under six months old, getting all their milk from you. The likelihood is that they are going to be feeding at least once in the night they're somewhere that they're probably going to be having at least eight feeds a day or a roundabout, maybe even seven, but they're going to be having good frequent number of feeds and the day and if those things are the case, then you are 98 to 99% covered as a contraceptive.
Emma Pickett:Okay, which is more reliable than condoms, which is more reliable than diaphragms and a lot of other methods out there that, that culturally we're very happy to accept as a reliable method. What about pumping if somebody was exclusively pumping wood? Could they would they be meeting LAM? If somebody was doing half of their feeds in expressed milk in a bottle?
Carol Smyth:Yeah, you see, this is really interesting, because I don't think there has been any good research that has really looked at that. However, what we do know is that it's the suckling stimulus that has that suppressive effect. So, I mean, although we don't have the research, I think we can sort of theoretically say it probably has a similar kind of effect. Now, whether it's just the same, I don't know, I don't know whether the hormone suppression is quite the same. If you've got a real life baby there, and all of the, you know, all of the kind of oxytocin and everything that will be produced with the flower than you're getting from from a pump. But you're still, if you're, if you're still exclusively feeding, you're still producing lots of milk, and all of that milk is having to be removed. And if it's being removed regularly throughout the day, in a similar way to what a nursing baby would do. I think the likelihood is that those rules still apply. But I don't think we have good research that says yes, absolutely, definitely. No, there hasn't been that conference where other people have sat down and said, Okay, and what about if they are, if they are pumping out? What if they're pumping this many feeds in the day and giving this many feats and the date that just hasn't been done?
Emma Pickett:Okay, but I guess it would make sense if somebody was expressing, and their night feed was expressed milk, and they would not then doing any suckling for a longer block of time, there's probably going to be a correlation and the less of an effect, I guess, on like, on the contraceptive ability.
Carol Smyth:There probably is, but there's always that that third rule there about whether your period has returned or not. If your period has not returned, you're not ovulating, you know, you're very unlikely to be ovulating. So, you know, even if a baby is sleeping longer periods at night, if you are not having periods, you know, you you are still covered for that period, that's more under lamb. So you baby might be sleeping long stretches. But if they're under six months, or you're nursing exclusively, or pumping exclusively, I think your period has not returned. I think there's a very good case to say that those rules will still apply.
Emma Pickett:Okay, thank you so, so months go by, and you're not no longer covered by LAM? And when do most people have their periods return? What's the kind of normal experience for most people and when periods do return? What does that normally look like for most people?
Carol Smyth:You see, I think this is a this is a fascinating question, because it looks very different for different people, because feeding looks very different for different people, someone who is combi feeding right from the start and is using, let's say they're using dummies as a way of meeting scuttling needs, let's say that they're feeding on equate sheduled kind of rhythm, and they start doing very parent lead solids. And so they're giving lots of solids at six months, that baby is probably going to transition much, much more quickly to having you know, less than 50% of their intake being from milk and more than 50% Being from solids, their period is likely going to come back quite early. So maybe it's going to come back somewhere between six and nine months. Then if you take someone who is exclusively feeding, all of babies suckling needs are being met at the breast and they're doing baby led weaning, so that baby takes a lot longer to kind of get on to their solids, they're probably going to be into the second year before their period comes back. And that's, that's really normal. And then you have people way out on the kind of fringes of that, where you may get someone who is explicitly breastfeeding, meeting older babies sucking needs, yet their period comes back at three months. And you'll get another person on the other hand, the other end who might be three years. So there's a lot of variation.
Emma Pickett:Yeah, that's, I'm glad you reminded me of the people whose periods return really soon you find them in Facebook group. So like, hang on, I literally just finished, you know, my postpartum bleeding. Are you honestly telling me that three weeks later, here's my first period, and people often panic, that means they're not going to have enough milk supply that it has an implication in their breastfeeding? I mean, if you know the answer to this, I'll be super impressed. But I'd love to know your thinking. Why do you think that for some people, even if they are exclusively feeding their parents come back so quickly? What's going on there?
Carol Smyth:I don't know. I think there's an awful lot of individual variation here. I think, you know, there's so many factors age may be a factor. So it may be that people who are younger when they have their baby, maybe fertility is not going to be suppressed as much because there's also a question of just how much resources you have in your body to give and how easily you're producing these hormones. So your age, your diet may play a role, your genetics may play a role. How much work your baby actually is. Some babies need a lot more than others. What kind of stress levels you have, I think there can be so many kind of different variations there that play a role. You know, we make have differing hormonal responses to that suckling stimulus as well, it may be that some people have a much larger suppressive effect than others, in the same way that for some people, you know, their milk supply increases extremely rapidly to suffering, they jump into oversupply very quickly, and others take a lot longer for their milk supply to come up. We're having, you know, differing hormonal responses to the saplings. I think it's something in around that individual variation.
Emma Pickett:Yeah, and if suckling is so key and the and the amount of time and 24 hours that a baby suckling is what's producing that, that prolactin? Is it possible that someone's got a very quick feeder, if their babies are super fast feeder and any feeds for, you know, five minutes, if and then 24 hours, I've got less suckling time, could that maybe have less of a suppressive effect?
Carol Smyth:I think that's a possibility. I think it's a yes, it's definitely a possibility. And again, we don't have brilliant evidence that tells us about this. So a lot of this stuff is anecdotal. We have some studies that look at length of suckling. So we have, you know, we have one study that finds that six feeds a day, lasting 80 minutes or more in total was enough to keep sup to suppress a menstrual cycle whether or to suppress ovulation. But yeah, there's, there's probably other people that's, you know, it's less than that, and other sorts more than that.
Emma Pickett:So, yeah, it's really helpful for you to remind us that we've got people at the ends of the spectrum. And when you read in, you know, a La Leche League article, or the average return of a period is 14.6 months, actually, that's really pointless information in a way, because, you know, that's all the people who got it three months. And that's all people have got three years, and we've just lined them up. And we've just done a mouse salute some, and we've just come up with a mean average, which really doesn't tell you very much. So if your period has not returned, at two years, you're going to look at that and go, Oh, my God, I'm abnormal, yes, 14.6 months, but actually, you may not be abnormal at all that average wasn't normal, that average was just a mathematical calculation that someone did about what's in the middle of all the people lined up
Carol Smyth:With that mathematical average that they've taken there, there's going to be a very large number of people there that haven't been breastfeeding in a kind of, you know, biological way. So there will be lots of people there whose periods have come back really early, because they were, you know, maybe holding all feeds, or they went on to solids very early, or all those kinds of things. So that skews that data as well.
Emma Pickett:Yeah, that's important to know. I mean, I'm guessing quite a few people who listen to this podcast who follow me are more likely to be at the sort of responsive breastfeeding end of the spectrum. But that's certainly not the norm for the UK, if we think only a third of babies are getting any breast milk for six months. There's a lot of people who aren't doing that when they're breastfeeding. Yeah. So if someone does if this period does start, is it common for it to maybe not be there the next month, maybe if baby's feeds have ramped up what would what would is it is the first period particularly heavy, what's the sort of normal pattern for people when their periods return.
Carol Smyth:So when it returns, actually, the first period that returns is usually an affiliate race, and normally you haven't ovulated before that first period. And so that first period is sort of like a breakthrough bleed, you know, as as your fertility is beginning to return. And then usually, the next period after that, you will, you will ovulate and, and that first proper kind of cycle there is usually a bit longer than average as well. So if you consider an average cycle being around 28 days, the average cycle whenever you're breastfeeding, to begin with is about 37 days. And the longer period of time is that bit at the start. So our cycle is broken up into two halves, we've got this half at the start, which is about an egg maturing and then releasing. And then that second part is about, I suppose maintenance of the uterus and that nice, healthy, rich thick lining environments so that an egg can get fertilised on them plant. So what normally happens during breastfeeding is it takes a lot longer for that egg to mature and be released. Because your every time you sit down or, or lay down or stand up, every time you have, you're doing it every day, every time you feed that baby and there is the suckling going on, it's just having a slightly suppressive effect. So your egg is trying to mature trying to mature and you've just got this slightly suppressive effect that's happening all the time. And it just takes longer to overcome that. So instead of it taking, you know, 14 days to mature at that egg, it may take 20 days or slightly longer. And then there's a shorter period after that ovulation as well. Okay, so it's really complicated. I know I'm using the word period as well. It's complicated to say there's this period there's its period and then there's your menstrual period. So hopefully people are following
Emma Pickett:Yeah, no, I think we'll go down into a bit more into the details about the sections of the settlement so sections the sections of your of your of your monthly cycle. So if let's imagine somebody is 18 months plus postpartum, they really want to have a baby. Again that baby number two, there's no period, what actually is happening in terms of their hormones. What's stopping that period from happening? How, what hormones are we talking about here?
Carol Smyth:So essentially, you're really talking about oestrogen levels, or estradiol levels, which is what really needed I mean, you've got follicle stimulating hormone, which starts this process of maturing the egg, or as the egg starts returning, it starts producing oestrogen estradiol, and then that this kind of speeds up the process further. And then when that gets to a certain level of maturity, and there's enough oestrogen there, and there's the surge of luteinizing hormone, and that is what causes the egg to ovulate. Essentially, when it ovulate it late leaves behind this sort of Shell called luteal body. And that luteal body then produces progesterone. And it's supposed to stay alive and produce progesterone for around 14 days. And you need that nice section of time there, but 14 days, because the egg has to have it has to travel into the fallopian tube, then it has to get fertilised, and then it has to keep travelling down, get to the uterus, and then spend a few days implanting there as well. So it's quite a long process. It takes quite a few days for that to happen. And so you need to have this progesterone that's being maintained there creating this nice, stable environment, I suppose in the uterus, because once that luteal body breaks down and stops producing progesterone, that's whenever the lining of the uterus sheds. And if the egg hasn't been planted in there by that stage, it's going to be shared as well.
Emma Pickett:Okay, and the hormones of breastfeeding the disrupting this process, it's prolactin that's produced by the suckling that's causing the problem. What's the actually, the barrier to conceiving?
Carol Smyth:The barrier is, so you've got this master hormone called gonadotrophin releasing hormone, and it is sort of the master switch, which it then turns on things like follicle stimulating hormone and, and all these other things. And it does that through its its secretion. So it has a pulsatile rhythm, and it pulses a different patterns. And one particular pulsing pattern will say to release follicle stimulating hormone and a different pulsing pattern will tell it to release lutinising hormones. So that's suckling actually suppresses that gonadotropin releasing hormone. So it basically turns down the dial on the master switch.
Emma Pickett:Okay, so, so someone's 18 months plus they want to get pregnant again, they haven't had their period. Is it as simple as you just got to reduce your breastfeeding? And what does that what would you recommend they do? First, let's imagine they are responsibly feeding a toddler they're feeding through the night as well. They're co sleeping, they want their period to return. What's their first step do you think?
Carol Smyth:Yeah, I mean, it's sort of is it sort of as as as simple as the breastfeeding is having a suppressive effect here. And in order to increase your fertility, you've got to reduce that suppressive effect. So there needs to be some kind of change to the nursing pattern, so that there's less suppression that's going on. For some people, that's going to be very little, you know, it might be just maybe reducing one feed, that might be all that it takes. And for others, it's going to be a lot more. But usually, the first step is going to be to try and create some kind of a gap somewhere. For a lot of people, a six hour gap seems to work quite well for them. For others, it needs to stretch a little bit longer, I think at eat org out works for the vast, vast majority of people. So that I think would be the first the first thing to try and figure out a way that you can get that sort of length of a gap. Most people will try to get that at night because they'll get more sleep. And also your prolactin levels will be really high at night. And that it maybe it's possibly the case that it's going to be more of an effect. I don't think we know that for sure. I think a lot of this is guesswork, but I think lots of people will try to make that step at nighttime.
Emma Pickett:Okay, so first, maybe start with your six hour gap, see what happens. How many months would you say you need to know if that's made the difference? So let's imagine you've got your six hour gap. Now the next month you still don't get your period? Does that mean the six hour gap didn't work? How long do you think you'd bleed recommend someone leaves it before they then go to eight hours or make more significant changes?
Carol Smyth:I think that probably you should know within kind of six ish weeks or so I think if there hasn't been you know, if you have got consistently that six or gap, things should be starting to kick into place. So you know if you're not seeing any thing happening within, you know, six, maybe eight weeks, six to eight weeks, I think you know, you should be seeing something happening in that state at that at that stage. Even if you haven't got a period back, you should be seeing something that might be indicating that it's coming. Maybe an increase in cervical mucus or you are getting just twinges are feeling a bit more hormonal, there should be something that's making you feel them. Yeah, I think something's changing here. Okay.
Emma Pickett:Yep. Cervical mucus. Let's talk about that in a minute. Because that's where that's really useful. One of the things that's slightly something that rubs me the wrong way. And I'd be interested to know what you think about this is I do come across some people saying, Oh, don't worry, you don't need your period to get pregnant again, when you're breastfeeding. You know, you can catch the first egg. You know, my cousin caught the first egg and didn't have a period. And so did my neighbour. And I just think, Oh, I really wish people wouldn't hammer that home because it's so unusual. Am I right in thinking that it's really rare?
Carol Smyth:Yeah, you are, you are. So there's rare. And there's uncommon, though, I don't think it's I think it's not rare. And that's why this myth kind of stays alike. But it is not common. It is definitely not common. And there is a little bit of research on this night. It's old. It's all research. But there's three or four studies or and all of them seem to suggest that it's about 5% of people that get pregnant and managed to catch that very first egg. But the vast majority of people first time they have their period, there is not going to have been an egg before it. And I think it's really unfair to tell people you can get pregnant anyway, just keep going. Just carry on and and see what happens, you might catch that first egg, because the likelihood is that that is not going to happen. If you're not ovulating, there's not a chance that you're gonna get pregnant. And it's very, very unlikely that you're ovulating if you haven't started menstruating again.
Emma Pickett:Yeah. So let's let's talk about cervical mucus. So signs of ovulation. Tell us about how someone can know that they're ovulating.
Carol Smyth:So I think cervical mucus is one of your best indicators to know that fertility is increasing. What you're looking for is that egg white, sticky or egg white cervical mucus that people were talking about. So it should look like egg white, it is clear and it's stretchy. And it's slidy. And that's that's a really good indicator that you have reached a fertile period, or photo section for a few few days in the middle of your cycle. Because that that mucus is produced there to help to help the sperm swim. And to get them to that that egg successfully. And is a good indicator of what your oestrogen levels are like. Because if your oestrogen levels are good, you should be getting copious amounts of that mucus around that fertile time. If your oestrogen levels are not quite so good, it might be very scant. And you might only get very small amounts that you might only get it for a day. Whereas if your oestrogen levels are very good, you should be getting lots of it, and it should be lasting for several days.
Emma Pickett:And what about charting, I know in the sort of non breastfeeding world, people talk about temperatures and taking charts and your temperature bounces out when you're when you're ovulating. But then they also say, you know, you've got to lay in bed and you've got to be asleep. And obviously breastfeeding co sleeping parents have often been up and down and, you know, slept for 14 minutes before they wake up in the morning officially, does that mean charting doesn't work and taking temperatures don't work for breastfeeding parents?
Carol Smyth:I think you can make it work. If you're getting a little bit of a stretch, it's not going to work. If you're getting 40 minutes. If you're getting you know, if you've been woken, then you've got a 40 minute sleep and then you're waking again, there's no point in taking that temperature, what you're looking for is your basal body temperature, which is the lowest point that your temperature gets to at rest, and you must have been properly at rest for a period of time. So I think you need to be getting at least three hours before you take that that temperature. And you have to have it thought out beforehand. So your your thermometer needs to be sitting somewhere where you could just reach and get it without really moving, all you're doing is your arm to get that thermometer so that you can use it there, you know, no more kind of moving about in the bed, no setting up nothing like that. So you've got to be able to get that section of sleep, you know, good three hours and be able to reach that thermometer immediately. If you're able to do that. It can work. You also don't you know it doesn't need to happen at getting up time. It doesn't need to happen at 7am in the morning. It could happen at four. If you're if you've got to if you've got to stretch your sleep from one till four. You could be taking it at 4am. So I think you can make it work. You just have to fit it in around what we sleeping looks for you.
Emma Pickett:Yeah, that's helpful because from four to seven, you're probably leaping up and down and sang songs about Peppa Pig and doing all the rest of it. So you could do the temping at four o'clock. That's good to know. And then tell us a little bit about the luteal phase. Am I saying that correctly? Yeah. To your phase. What does that mean? And I know that for some people, the short luteal phase is the barrier to conception. So people think I've got my period, I'm ovulating. Why am I still not pregnant? What's going on, they've got ovulation sticks that shows they're ovulating and they're still not getting pregnant month after month. Talk to me a little bit about what luteal phase is and what the short luteal phase means.
Carol Smyth:So if we go back to, you know, talking about these two sections of your menstrual period, you've got this first section where your egg matures. And ideally what you want is get a really nice mature egg, and then it ovulate and you're left with this luteal body which produces the progesterone. So the thing with breastfeeding is that you're always getting this little bit of a suppressive effect. So your fertility is always slightly affected by the breastfeeding. Even if you have got your cycle back and everything looks good, there's always some slight effect. So in many ways, you're sort of sub fertile for a period of time and the sub fertility becomes more and more like normal fertility as as time progresses. But to begin with, when your period returns quite often, what happens is that you are getting the hormones up enough to actually all feel it. But the egg isn't just quite as mature as it would be if you weren't breastfeeding. It's a slightly sub mature egg. And because it's a slightly sub mature egg, you're leaving behind a slightly sub mature luteal body. And that slightly immature luteal body is not able to produce progesterone for quite as long. So ideally, it wants to it needs to sit there and be producing progesterone for two weeks, so that you have got all of this time for an egg to move down the fallopian tube, travel all the way down, get into the uterus and spend a few days implanting there. But with breastfeeding quite often, what happens is you get a much longer section at the start where it takes a lot longer for that egg to mature, it sits still slightly sub mature whenever it actually ovulates. And then because you've got this slightly less mature luteal body, it doesn't quite manage 14 days or progesterone production. Maybe it only manages 10 or 11, or 12 days of progesterone production. And it's much harder for that egg to get well and planted in during that time. You kind of need to be getting 1112 12 days, ideally, you really need to be getting 12 days much harder to get pregnant if you're only getting 11 days. Harder still, if you're only getting 10. So quite often what will happen for people at the start is they're getting this long, follicular phase short luteal phase. And that's making it much more difficult to get pregnant. And if they're not charting, and they don't know exactly when they ovulate, they don't know that that's what's happening.
Emma Pickett:Now I'm aware we're getting into territory here and reassess the whole subject of fertility and conception can be very upsetting and difficult for people. And I'm aware that for some people this, this is hard to hear, because essentially, they're breastfeeding is is responsible for not developing that mature egg. And I'm just wondering if there's a scenario where people may be getting a positive pregnancy test with very sensitive pregnancy testing equipment. And actually they are actually getting a positive pregnancy test on this sub mature egg that was never really going to mature. Is chemical pregnancy, sometimes a phrase that's used to refer to this situation? I'm, I'm not quite clear what terminology to use. But could we get breastfeeding parents getting a positive pregnancy test on a sub mature egg? Is that possible?
Carol Smyth:I think that is multiple. And I think this is really, really difficult. And something that I find really difficult to deal with during that whole time of my life that I was I was trying to get pregnant was this idea that breastfeeding, which was this thing that was so important to my identity as a mother, it was so important in my relationship with my child, that this thing that was integral to my mothering might also be the thing that was stopping me becoming a mother again. It's a very, very difficult thing to do. There's so many conflicting emotions about that.
Emma Pickett:Yeah, the thing that's sort of magic is also the bad guy. Yeah. And that's, that's incredibly hard, really, really hard. And also, you know, that that spark of joy of seeing a positive pregnancy test and then effectively experiencing a loss, but it is a situation where that egg would never have matured to become a viable pregnancy is that sub mature egg that's just produced just enough hormones to to trigger that positive pregnancy test. So if someone's in that situation where they have had a positive pregnancy test that didn't end up developing into a pregnancy, you then recommend they Need to do the charting they need to work out when is ovulation How long is the gap between ovulation to day one of the next cycle and you're saying 10/11/12 days is danger territory?
Carol Smyth:It's danger territory, you kind of need to hit 12 days, I think if you've got 12 days, you've got a pretty good chance. That's that's what I would see from the stuff that I have read. And I think it is much more difficult if you're getting 10 or 11 days. I think that anyone who is breastfeeding and is wanting to get pregnant really does need to do some amount of charting. They need to just figure out when they're ovulating so that they have a sense of how healthy their cycle is. Because you want to get as close to a normal looking cycle as possible. And that may involve a little bit of tinkering to the feeding so that you get this a normal healthy cycle.
Emma Pickett:Yeah, tinkering is that is a good word in this context. So Hilary flour uses that word tinkering as well. So So let's imagine someone needs to tinker their luteal phase they need to get it a bit longer. Is that going to mean more reduction in the breastfeeding? Or is there anything else you can do to extend your luteal phase?
Carol Smyth:Essentially, that the main thing is probably doing a little bit of changing to the feeding because that is the thing, again, that's having this suppressive effect. No, if you go and Google, you will find lots of stuff online of people talking about different supplements and things that you can take. And I think they're, they can be helpful for people. There's lots of research out there that will say for example, that vitamin B six is very important for progesterone production. And that can be a really helpful thing in supporting progesterone production and making that luteal phase a little bit longer. There's lots of supplements out there. So people will talk about agnes castus or vytex as as a way of supporting your cycle. And there's evidence behind those things. I think the difficulty is there's no real good established protocol that's written out there for what to do in any one individual case. Because we do have very different individual variation in our in our hormone production. And I suppose in the same way as we were talking about earlier on there that people vary on our, our responses to suckling berries, and when our period compact berries, I think the same thing can happen when you're taking supplements and act this cast is for example, it's it's one of those herbs or supplements, that's known as an adaptogen. So it adapts to whatever is happening for that individual person. So you might not get exactly the same results with each person. And, and that's something that I find myself so I whenever I went initially Googling and looking at agnus castus or vytex, I find protocols out there that said you took you took it once a day for your whole cycle, I find some that said you took it twice a day for your whole cycle, I find ones that said you should only take it after you ovulate it. So it was very difficult to know. And I, I played about with it, I tried a few things that I find very, very different effects, I find that for me personally, taking it once a day, I seem to get a really good healthy cycle out of that when I took it twice a day. I didn't ovulate at all until I stopped taking it. So I think if you're going to go down that road, I would consult a herbalist or nutritionist to get some advice about your individual situation. Because it is very, very frustrating if you start to take a supplement, and you find that it actually has stopped you from ovulating, because that's a whole month knocked out in your head. It's really difficult.
Emma Pickett:Yeah, I mean, it's the whole thing is difficult, isn't it? Because you you've got this torn feeling inside you about one, you know you don't and restricting breastfeeding further, when you're doing it for a hypothetical is so difficult, you know, you may be this, you know, if I remove this one other feed in the middle of the night, which makes my child incredibly distressed and unhappy, maybe they'll be have a greater chance of a future sibling and in, you know, years time, it's very difficult to deal in those kind of hypothetical. So, you know, we are really feel for anyone going through this this kind of dilemma right now. And I know I know you do too. Do you have any thoughts on people who are going through assisted conception so somebody who have maybe used IVF, first time round, they maybe have embryos in the clinic, they're gonna go back to the clinic, they're going to go through another cycle in the clinic. And the Clinic says to them, no, I'm sorry, we don't accept anybody for treatment if they're still breastfeeding. I spoke to Allie Thomas, who runs the Facebook group for parents in this situation of breastfeeding during IVF and fertility treatment. And she does a lot of work, trying to challenge some clinics, this views around that and making sure that parents know that they have the right to continue breastfeeding if they want to, even though it might reduce their chances. But I mean, what are your thoughts about that about going forward for fertility treatment? And whilst or breastfeeding?
Carol Smyth:I think, again, there's no one size fits all for this that has to be an individual decision, you're when it comes to those consultants, what they're trying to do is to have everything about that cycle as tightly controlled as possible so that they can maximise the chances of that IVF being successful. And breastfeeding is just an unknown for them, it's something that they can't control. And just the way that we've been saying that it has this suppressive effect, but we don't know how much it's going to suppress hormones for each or any individual person, that's a difficulty for them. They don't know how much effect this is going to have. And they really want to control these hormones as strictly and as tightly as possible. So I think it is about this balance of knowing that, well, if you give them the control, if you stop pressing, and kind of give all this control over to the consultant, you're probably going to, you know, you're maximising your chances, I suppose, of that particular cycle being a success. But you have to, you know, as I think anytime that you're going to make this decision about weaning, there has to also be, I suppose, a coming to terms in your head that I might win, and nothing might come off this? And am I going to be okay with that anyway, I think that sometimes you can find consultants out there who are willing to work with you. I think it depends on what area of assisted reproduction you are in as well. Because sometimes you sometimes people will need their entire cycle controlled, you know, and maybe all they need is a little bit of hormonal support. And sometimes that can be given along with breastfeeding very, very well, you know that there is a case where if someone is keeping an eye on hormone levels, if you're getting hormone levels tested, and you're getting maybe some progesterone supplements during the second half of that cycle, that might be a way that one consultant might be prepared to work with breastfeeding. So it's again, it's difficult. It's a difficult question.
Emma Pickett:I'm just hearing you talk about the progesterone supplements. Is there a situation where somebody who's breastfeeding and wants to get pregnant doesn't want to give up breastfeeding could take progesterone supplements, even if they haven't had a history of infertility? Or is that not very ethical? I mean, does that ever happen?
Carol Smyth:Well, I think there are certainly cases where people get progesterone supplements. I mean, if someone has a history of miscarriage, for example, that is a common treatment that they will get progesterone supplementation, and that has been shown to reduce miscarriage. I think if they have if they are if they're tracking their cycle, and they can see that they have a short luteal period, but they've managed to get pregnant. I think, you know, it's probably possible to find a an empathetic consultant, who would be prepared to work with you with giving progesterone supplements.
Emma Pickett:Yeah, thank you. Are there any myths about breastfeeding fertility we haven't talked about yet. Is there anything that you've come across that you really would just like to put on the table right now that people are struggling with and not not understanding or being told incorrectly? You know, am
Carol Smyth:I really I think it's that first egg one, that one drives me up the walls, I just think it's so unfair. And I see it all the time, you know, on online forums, when people are talking about wanting to get pregnant, you can always guarantee that at least one person is going to jump onto that thread and say, I got pregnant and never had a period or my friend or my sister or some you know, someone. And I think that is probably the most difficult one. Because I think it is, I think it is unfair, because it gives this hope. Where that hopes not really justified.
Emma Pickett:Yeah, it's that false hope, isn't it? That's the cruelty of that. And I tell you, what else connects to that, for me is when I see on forums, people saying, oh, you know, breastfeeding is never a contraception. It's, you know, don't listen to people talking about lamb. You know, I got pregnant three months when I was breastfeeding, you know, I know someone got pregnant at five months, it's never a contraception. So people exact have an exaggerated notion of fertility while they're breastfeeding. And they imagine that breastfeeding really isn't a barrier to conception at all. So why am I not praying again, but nature has designed it to be a barrier to conception for very sensible reasons. It does repress your ability to have another baby. And it does need some thinking about as a result.
Carol Smyth:It's a very effective contraceptive, you know, and for the vast majority of people, it's a very, very effective contraceptive for a you know, quite limited period of time, you know, that maybe that first six months or, or a little bit longer? I think it's a I think it's probably a very effective contraceptive for the vast vast majority of people until the baby is taking more calories from solids than they are from milk. But there is a reasonable cohort of people where it continues to be a very effective contraceptive for a long time and I happen to be one of those people.
Emma Pickett:Yeah, actually, I'm just going to ask you, are there some people who would have to give up breastfeeding entirely? So with all the tweaking in the world, they're still not going to retain full fertility into the breastfeeding. Is that true for some people? And if so, how many people? would you guess that's true for?
Carol Smyth:I think it's probably unlikely, but see, it's difficult question, because over how much time, you know, you know, at what point do you say, okay, they're going to have to clean completely, because the likelihood is that if you give them enough time, their child or nursling, is going to begin nursing less and less and less, eventually, at some stage, it's going to reduce down enough, you know, that they're going to be able to get pregnant again, it's just that for most of us, we've got an internal clock, that's clicking in our hand, and we're not prepared to wait to between three and four years old, where, you know, for that, to really reduce Stein, we either have an actual time pressure, because so many of us know or are starting our families later. And so we feel this, this pressure, or we just have an internal idea of I will this kind of a gap between my children, I want a two year gap or whatever it might be, and therefore I'm on a clock. You know,
Emma Pickett:I mean, I've had a couple of clients recently who have started to hit perimenopause while they're still breastfeeding, much to their surprise. And I know we weren't necessarily planning on talking about today. But does the act of breastfeeding affect whether you go into menopause or it's just going to happen anyway, whether it would?
Carol Smyth:Well, is it I think it's a really interesting crossover because breastfeeding is a lower oestrogen state, and that's what perimenopause is, you know, it does make me wonder if someone's experiencing perimenopause symptoms when they're breastfeeding. Is that partly because they're breastfeeding? And if they stopped breastfeeding, would they still be in perimenopause? Or actually, would they have a bit of a rebound in their oestrogen levels? And would would they have a few more years before? Before they actually did enter a period mammals?
Emma Pickett:So I think it's a really interesting area that potentially one will learn more about as more people have assisted consumption in the future and technology improves. And we'll we'll see what happens. And then we've also got obviously the issue of HRT alongside breastfeeding, which some people are choosing to do and other doctors are a bit more uncomfortable about, but if you know that is definitely a possibility for some people. Are there any particular resources that you would point people to I've definitely, I'm going to highlight your articles in the notes for the show any other resources that you particularly would recommend if someone wants to learn more about this.
Carol Smyth:I think when it comes to things like tracking your cycle, there is a fabulous book called Taking Charge of Your Fertility by Toni Weschler. And I would really recommend that book. I think for anyone who is wanting to look at supplements and diet and vitamins and that kind of thing. There's another really good book called Fertility Cycles and Nutrition by I think it's Marilyn. Yeah. Marilyn Shannon. And that's a really good book as well.
Emma Pickett:Okay. And actually, one other quick question on resources. I did see one comment on Facebook, where someone thought that breastfeeding gave you a false positive on a pregnancy test because of the breastfeeding hormones. And breastfeeding also means ovulation sticks don't work. So can we just get out there that you're not going to get a false positive on a pregnancy test? Nancy test ovulation sticks, they're all going to work in the same way they would whether or not you are breastfeeding. Yeah. It's not looking for a hormone that's affected by whether or not you're breastfeeding.
Carol Smyth:No, absolutely not. I mean, what a pregnancy test is looking for HCG, which is human chorionic gonadotropin, and that is only going to be produced whenever an egg becomes fertilised. So that's, that's not going to be produced by breastfeeding at all. And for your ovulation stick, it's looking for nicing hormone. And breastfeeding is not going to produce that you're not going to get that would be unusual.
Emma Pickett:Yeah. So we've talked a little bit about that chemical pregnancy loss. And I don't know if that's the right way to say it. And I hope that's not upsetting anyone, if I do that, where you you get an early positive pregnancy test. And it wasn't actually a mature egg. But once somebody has a pregnancy that's established, you know, once they've had first scan was six weeks in continuing to breastfeed doesn't then affect the health of your pregnancy. Should we just end on that notion, there isn't a reason to believe that you're going to have an increased miscarriage risk once you have a viable pregnancy that's been established and, and your egg is mature enough to get started on pregnancy?
Carol Smyth:You know, and I think this is another really difficult issue because it's very difficult to tell. Pregnancy is such a it's an amazing, it's an amazing thing that happens. I remember sitting in a physiology lecture years ago, where we were getting a lecture on all the things that could possibly go wrong with this with a pregnancy. You know, that could cause a miscarriage. And I remember coming out of that lecture thinking, How does anyone ever managed to have a baby? This is incredible. And miscarriage risk is unfortunately A really high anyway, you know, it's one in four pregnancies end in miscarriage, even when you're not breastfeeding and age makes a difference. And thyroid takes a difference and your your body mass index and all sorts of things make make a difference there. And for someone who is who has a miscarriage, and they are breastfeeding, there is never going to be a way to know whether the breastfeeding had any effect on that or not. So we don't have good research that will say, Oh, yes, this is never going to make a difference. It's absolutely fine. What we can say is, you know, whenever I went looking for research on this, whenever I was, I suppose looking for myself, the only research that I could find was talking about your own contractions, you know, that whenever you were breastfeeding, that you could use the oxytocin will cause uterine contractions. And that is not going to be a risk to your pregnancy. You know, if you haven't been advised to not have sex or anything like that your these contractions from from breastfeeding is not going to be a risk. However, I think it is possible that there is a hormonal risk for some people, and we're not going to know who those people are. But let's say I think there is a theoretical issue where if you have a shorter luteal phase, but that egg has been mature enough for you to get pregnant, and to implant. But that, that you have a feedback mechanism that happens whenever you get pregnant. So if you don't get pregnant, that corpus luteum that's producing the progesterone less for a couple of weeks, and then it degrades. If you get pregnant. There's a feedback mechanism which keeps it alive and keeps it producing progesterone. And it needs to keep producing progesterone until the placenta takes over, then that placenta needs to take over. You know, a placenta is not fully capable of taking over that function until somewhere between eight and 14 weeks, but it might be 14 weeks for some people that that placenta takes over. So that luteal body needs to be mature enough to make it that entire length of time. And there was a Cochrane Systematic Review, which found that having a short luteal phase was a risk factor for miscarriage.
Emma Pickett:Okay, that's useful information. So So let's end on it's the short luteal phase. That is the risk factor. That's the bit we need to pay attention to. That's what people need to inform themselves about. That's why charting is important. And if you go into pregnancy with still a short luteal phase, that's possibly where the risk lies.
Carol Smyth:Yes. Yeah. Yeah. So charting is important is really important. Getting that cycle looking as healthy as possible. And in that Cochrane Review, as well, they did find that supplementing the progesterone was a way of reducing that miscarriage risk. So that's why I was saying as well, if you can find a very kind of compassionate doctor or consultant, that if you do have a short luteal phase, and you have managed to get pregnant, if you were able to find someone that was that was willing to prescribed supplements, that might be a helpful thing as well.
Emma Pickett:That's a very good tip. Thank you. Thanks, Carol. I really appreciate your time, not least because you can pronounce all the words I can't pronounce that which is incredibly helpful. Not only do you know all the stuff, but you can pronounce the word. Thank you so much for this so people can find you through your website and contact you obviously you do lots you do lots of stuff in your practice. But I think if people want to get your support in this area in more detail, they can they can reach out and find you. Absolutely. Obviously I do weaning support, which might also help somebody in as part of this conversation as well. And, and I really appreciate your time today. You've you've answered lots of useful questions and thank you so much, much appreciated.
Carol Smyth:You're very welcome. I'm very much enjoyed. It's been great.
Emma Pickett: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.