Dealing with infection - Chloe's story

This week’s story from Chloe is about not just breastfeeding through pain and discomfort, but also a wound that seemingly would not heal. Chloe dealt with repeated bouts of mastitis, and an infection, before finally being pain free after 8 months of breastfeeding. She is also a nurse, specialising in wound management, so she’s uniquely placed to talk about how infection and pain affected her feeding journey with her daughter, Nova, and how they overcame their challenges to continue feeding for almost two years. 

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

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

Transcript

Emma Pickett  00:00

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  00:46

Thank you very much for joining me for today's episode. I'm very happy to be talking to Chloe Cox, who is a wound specialist nurse, or tissue viability wound care lead. There are lots of technical words, am I saying? Am I saying it right? How do you describe your job?

Chloe Cox  01:04

Yeah, that's right. So I'm a I'm a specialist nurse that manages a team of other specialists, nurses in an acute hospital. And we look after people who have any kind of degree of wound essentially, like leg wounds, wounds related to being in bed too long, anything really. 

Emma Pickett  01:23

Okay, so today, we're actually talking about your own experience with an infection or a wound that didn't heal, obviously, in a breastfeeding context, because it would be surprising if this was an episode about ankles. And you've got that unique perspective because of your professional background and obviously having colleagues to refer to, but yet you still dealt with this situation yourself. And we're going to be talking about how that affected your breastfeeding journey, how you overcame it. And also a little bit about your weaning at the end, because I always like to talk about weaning. And when we get there, and how you when your daughter when she was when she was around two, before we get started, you were a nurse while you were pregnant, I'm guessing. Did that change your views about breastfeeding? Did you have particularly strong feelings about whether you wanted to breastfeed or not? What were your thinking? And tonight, what's your thinking? antenatally about breastfeeding?

Chloe Cox  02:09

Yeah, so I always wanted to breastfeed, and it was kind of a very strong desire, I had read a lot of research, I've got an autoimmune condition or sort of colitis. And I'd read a lot of research about how breastfeeding kind of can reduce the risk of that child having autoimmune disease later in life. So I felt a very strong kind of drive to be able to breastfeed from the get go. I looked after women that had had problems, post birth with soul, you know, sore nipples, leaving areas that attract referrals into us. So I knew that there was potentially going to be a problem, but I was absolutely adamant that I was going to be able to do it. 

Emma Pickett  02:52

Okay. And you did, which is the sport spoiler alert, but it wasn't necessarily super easy. Now, tell me a little bit about a little bit more about colitis, ulcerative colitis, I'm not very good at saying medical words, as an autoimmune disease, does that mean that the symptoms tend to alleviate during pregnancy? Is that Is that right?

Chloe Cox  03:11

So I was told by my consultant that it would go one of three ways, like I get better, I'd get worse or it stayed the same. And I found my symptoms were so much better. I was really well through all my pregnancy, I had had extra monitoring that nothing specifically related to the colitis was was an issue. So, you know, potentially I had the risk of preterm labour or low birth weight, baby, but none of those happen. So.

Emma Pickett  03:42

Okay. Okay. Um, because of breastfeeding and breast milk, and obviously, the friendly bacterias and breast milk and how it affects gut gut development and gut repair. That means that a child who's breastfed has reduced risk later in life?

Chloe Cox  03:56

exactly. And if they did, then I think there was a paper that said that it would be unlikely to be in childhood be more likely to be later on. And we have a really strong genetic connection. My family, my mum has also colitis, my brother and my first cousin. So when we're thinking about getting pregnant, that was sort of one of the things we considered was do, you know, the ethical pneus of passing on potentially a long term, chronic condition, but I figured, well, if I can try and reduce it in one way, with the breastfeeding that would help. 

Emma Pickett  04:26

Yeah, yeah. So tell us a little bit about about your birth. 

Chloe Cox  04:30

I opted for an elective C section, I ended up with gestational diabetes and high blood pressure, not preeclampsia, but high blood pressure towards the end of my pregnancy. And she was growing very quickly. So they had kind of given me the option of having a section or being induced at 38 weeks. So I had never had a single twinge no Braxton Hicks contractions, nothing at all. And I just had a lot of friends, colleagues Some patients that I looked after that had been induced had very, very long, prolonged Labor's and then potentially ended up with an intervention anyway either, you know, an instrumental delivery or C section. So I guess I wanted to have a good night's sleep and start from a right fresh. So I had the elective section which was born at 38 weeks plus five, I think off the top of my head. And it was absolutely great. No issues at all. I lost quite a lot of blood in theatre, but didn't need a blood transfusion just took some iron tablets for a little while. And she was great when she came out. She was lovely, healthy, normal weight, baby. So the birth itself was great. Really enjoyed the C section process. My niece was absolutely lovely. words of encouragement from the top of the bed was just amazing. So yeah, it was a really good I, despite it being very medical, it was a very nice birth experience. There's no fear at all.

Emma Pickett  05:58

Oh, that's lovely to hear. So nice to hear somebody say I loved my seasick. Yeah, it's just really great. Because it's often a lot of people obviously have them under emergency situations. And, and we often think of a C section as being that emergency C section. But obviously when you're planned and you're rested, and you know you're in that mental preparation state, it's you know, can be very, very different. So did you get to have skin to skin how was that first breastfeed? 

Chloe Cox  06:20

Yeah, skin to skin I didn't get to. So reflecting back now, I actually think that, that experience probably pre you know, going into recovery wasn't the best. So she, they were very worried about her dropping her blood sugar because I was I had gestational diabetes and because of the medication that I had been on, and so the midwife insisted that she had formula because we couldn't get her to latch on straightaway. So she had, she gave it to an oak in a little cup. So I was pleased that you know, the bottle wasn't introduced straight away. We eventually did get her latched on she had loads of skin to skin. I think my just boob nipple anatomy, it just made it a bit more challenging. I had one very flat nipple on the left hand side. So it was a challenge to get her on. But we we got there eventually with the right. And I think maybe we didn't persevere enough with the left, which then came on to all of the issues we had later on. 

Emma Pickett  07:19

Okay, so you're giving them a little bit of a clue that something was going to be happening with positioning attachment. And your left side was the side that had the difficulties. How quickly did that develop? 

Chloe Cox  07:31

Well, I mean, so we had weight loss issues with her when she was first born. So we ended up readmitted two days after she was born, she was kind of borderline dehydrated and losing a lot of weight. So we readmitted just for 24 hours to see I ended up triple feeding her so I was pumping feeding. And given her those bottles after the feed. When I went back in the midwife gave me a nipple shield for the left side to try and make it a bit easier. Which initially for the first kind of tough couple of weeks, worked fine, didn't really have any issues. I was so relieved that I was able to feed her off that side, I was very anxious about the fact that she was on a bottle. So I was desperate for her to just be slowly brassfield I was really worried I'd let read loads about her potentially ended up with a bottle preference. So I was really wanting to wean her off the bottle as quickly as I could. And then I guess it was about two or three weeks later, and she I was having a lot of bleeding. And from both sides. She was feeding continually, which you know, I was trying to be common sense and think well, she's a new baby, she's, you know, going through cluster feeding. And this must just be her normal. And I remember my all of my family from Shetland. And my granny came down with my mum and opened the door and I just burst into tears because I was in so much pain. And I just could Yeah, it was just a nightmare at that time. So I think it must have been kind of two or three weeks postpartum, that I really started having the issues kind of began I guess.

Emma Pickett  09:17

So when you say that you started using the shield on your left foot she had attached at all on that side, really she had

Chloe Cox  09:24

I had been expressing into little syringes. So I was given when I was at home, I bought loads for Amazon. I was expressing those and given her them from the left side and then managing to get her fairly well touched on the right. 

Emma Pickett  09:39

Okay, got it hard. Got it. And just imagine how tough those first few weeks I mean, triple feeding is hard under any circumstances. Triple feeding plus pain and damage is just the nightmare scenario. What kind of support were you getting? You've mentioned your midwife. Were you getting any other breastfeeding support at this point?

Chloe Cox  09:57

Not particularly I think I think I don't think at that point I'd reached out to a lactation consultant. Yeah, that was maybe I kind of persevered for a week or two after then. I had been to the health visitor was coming to see her quite frequently because she'd lost a lot of weight. And she'd had to be admitted, every time. And this is kind of the theme throughout the whole story. Every time someone saw me feed, they said that her attachment was fairly good. The way that she was positioned, you know, her nose was up, her chin was in. It wasn't too bad, but she was putting on weight. So that's why I just persevered. I think I'd become quite fixated about how many wet nappies she was having, was she at risk of dehydration again, and that kind of just scorned our initial breastfeeding period? I guess. So I was just so worried that you know, that I had caused this dehydration. And because I hadn't been able to get her on. And then I'd had to go to bottles. And it was just that whole feeling of disappointment that I hadn't been able to do it straightaway. It was a really, really, you know, reflecting back on it now was a really difficult time. 

Emma Pickett  11:03

Yeah. I know, it's easier said than done. But you've done it. You're really tough on yourself in those early weeks. When you look back now. Do you look back on that, Chloe, and think, oh, Chloe, my love, you know, you're trying your best? Or have you come to peace with that period? Or do you still find yourself thinking, Oh, if only I'd done X Y Zed?

Chloe Cox  11:21

No, I've definitely come to peace with it. And I've realised that, you know, it's not to be negative, or people that end up solely breastfeed or bottle feeding or doing combo feeding. But I thought, you know, thank you did persevere, you've managed to get all the way to nearly two years. And that period was still lovely. She was it was still amazing, you know, we'd have fertility problems to begin with. So to have a baby in the first place was amazing. And you know, me being in a little bit of pain, it was all worth it. She's so happy, healthy and happy now. 

Emma Pickett  11:54

Yeah. I think sometimes our brains are quite good at forgetting how much pain we were in. I mean, obviously, if you burst into tears, the minute your mom and your granny come to the door, you were in quite a lot of pain by the sounds of it. I think what you just touched on, there is something I think it's important to reflect on quite often when people have that readmission in the early days. It's quite traumatic. And I would you know, I'm not a psychologist, but I'd use that word. And it can be quite difficult to relax after that. Because especially if you weren't necessarily really clear about why did I get to this point? It's kind of like, well, what's going to stop it from happening again? Am I going to be readmitted? Again? I can I trust my own ability to to assess what's going on? I know, it's scary. It's a really scary experience to go through. So you've got family with you. We're in sort of week two, week three, what sort of happened next weekend,

Chloe Cox  12:42

she was feeding continually, which was fine. I think, you know, the pressure kind of my graph is excellent enough 78 from Shetland. Very, you know, when she fed, it was every four hours, and you did not give in in between times that, you know, is that talk of she doesn't need to be fed, you know, she doesn't need it. She's just been fed. So it was a lot of trying to re educate as well to say, actually, this is normal. Most I think this is what I think is normal. I've, you know, I went to NCT and I did, I've read loads about it. And I think this is normal. So that was a challenge to begin with. And then they went home and like for most people, you know, that postpartum period, people are going back to work and you're kind of just with you and the baby. And I still was having big problems. And I had read loads and I thought, Well, maybe it's this nipple shield. That's what's causing the issues of pineapple is not actually really in there. She's just essentially sucking on the very end rather than getting a good lap. So I contacted lactation consultant, because I was still having a lot of pain. And it was a video consultation. And she really kind of reassured me and made sure the attachment was right. And we had lots of follow up with one another. And that was really great. But it just still wasn't quite right. She was absolutely fine. Thriving, putting on loads away. We were under the midwives quite, I think up to maybe nearly six weeks to make sure she was back to birth weight. And over. And I just persevered. I think by that by the time she was about to birth, where I completely weaned her off the bottles and had stopped expressing and then I ended up my first birth and status. And I think on reflection that was not really understanding the whole essentially creating an oversupply with the pumping and then also feeding. So I had weaned off the pumping had a situs but was able to recover really quite well from that I didn't need antibiotics or anything. I was just in bed for 24 hours with paracetamol trying to keep my temperature down. And that recovered fine. But that really seemed to affect the left side more than anything. She was feeding an awful lot was really painful to feed on. that side. And I thought I had the milk bled on that side, but I never managed to clear it. So I tried all of the treatments, you know, hot flannel, various, you know, I didn't pump? I don't think so I was scared of ended up with mastitis again. But she, she didn't clear it. And actually, in hindsight, I think that probably was the start of this little wound, and it was actually a little bit, we would use the word sloughi. So it's kind of like a buildup of not so healthy tissue that just sat at the top of an apple. And that stayed for a really long time. And it was, it was yeah, very painful, to be honest,

Emma Pickett  15:37

That's a deep sigh there, Chloe, I think that sigh, you're just remembering that long period of pain. Before we talk about that in more detail. I'm sure there are some people listening to this who work in the world of breastfeeding support who are going, has anyone looked at novice anatomy up until now? Is there anything going on with palate or a symmetry or tongue function? Has it was that something that had been examined? 

Chloe Cox  16:00

So I had another breast feeding consultant again, and this was face to face. And this was probably a couple of months down the line now. And she did she did a full kind of checking, there was no tongue tie. And there was nothing she never had any problems whether or not to be because, again, yeah, that's why I assumed 

Emma Pickett  16:18

good to rule that out. I mean, in a way, it's kind of where the if there was something super easy that we could say, oh, it's that easy off you go was sought you out, that might be one thing, but I guess it's good to know that wasn't missed anyway. So you have to settle Blab, let's get a bit technical. Now I'm gonna get you to put your nurse hat on, you talked about sloughi. So that means kind of what kind of dead skin that's not moving off. And as Yeah, sort of slightly blistered to describe for me a little bit more what was happening visually?

Chloe Cox  16:43

So it was kind of a yellowy type tissue, that is kind of a build up of the so when you have a blue and then you have all of these white blood cells or I can have bulk fighting cells that travelled to that wound, and there's a lot of protein and there's a lot of fluid that comes out from that area. And sometimes, if there's a problem with the healing phase, then it just sticks in this inflammation phase, you've got lots of these little white blood cells that kind of build up on the on the tissue, and it covers the tissue with this kind of yellowy colour tissue. And until that's removed, it's unlikely that wind is going to heal. So in my world, people get very fixated on using dressings to remove this dead tissue. But actually, we know that unless the underlying cause is addressed. So for example, infection, friction, you know, maybe if you've got problems with your ability to heal, so say, for example, someone with diabetes would be classic example of that, then it's going to be very difficult to treat the underlying cause. So unless we address those, it's not going to get better. So that would be kind of the nurse hat that I would have on everything. You need to think about those books. 

Emma Pickett  17:59

So you've obviously got ongoing friction, there's something happening on that side that isn't being resolved in terms of the positioning attachment. Your Diabetes didn't turn into type two diabetes or anything. So gestational diabetes has gone away, there's no issue there. You don't have any immune conditions that would affect healing on that part of your body. So that should all be fine. So yeah, it's interesting to talk about yellow Enos is not necessarily yet being a sign of infection, because I think a lot of people think, oh, yellow, that must be you know, Staph aureus, it must be an infection, you can potentially have a yellow tinge to healing tissue. But you are stuck in that phase. Now, I'm guessing, you know, you're obviously, you know, medical professional, you're someone who looks at research, what were you doing for your wound care where you kind of because one of the things that I find very difficult as a lactation consultant is there is not one answer for this. So when there is a damaged nipple, it's not like we can go okay, look at you know, look at that piece of information off you go. The breastfeeding network information doesn't quite correspond to what you'll read in the womanly arts of breastfeeding. You've got some people saying, you know, wash with soap and water to break down bacterial biofilms like Katherine Watson Genesis, then you've got the rest of the network saying don't use soap. You've got some people say use lanolin you've got some people say don't use lanolin because it increases thrush infection. You've got the Cochrane Review saying nothing or breast milk and you've got other people saying hydrogel dressings and say line soaks. I mean, I could let's go on. I mean, I've even talked about you know, Minton, coconut oil and all the rest of it. Where did you end up in that? So you're not yet necessarily dealing with an infection? Yeah, but you know, you knew you had damage that needed to be hopefully resolved. Did you go down the moist wound healing route? Were you using your silver cups? I mean, there's so many things people are using. What did you choose to do at that time?

Chloe Cox  19:42

I think I tried basically everything so I, you know, keep in my mind, my nurse hat on I thought, well, there's no other obvious signs of infection. I haven't got spread and redness. It's not hard to touch. Yes, it is very painful. But I think that's just because it's being you know, she's feeding constantly. So I tried hydrogel dressings, my kind of critical thinking thought, well, I'll, I'm gonna give silver cups ago, but I'm almost certain it's not going to help because how can a piece of silver donate silver to a wound? You know, normally we would have it in some sort of impregnated dressing, but my sister in law had recommended it and she was a midwife. And I thought, well, you know, I've got nothing to lose here. So I tried those, to be honest, I think it made it worse because, you know, it was still leaking at that point. And the skin would just become very, really we use the word mass aerated, so kind of over hydrated.

Emma Pickett  20:36

Yeah, actually, just to say that that word lacerated is a word I've been using a lot in the context of these, these silver cups. There are people who listen to this, who absolutely will swear by their silver cups. Yeah, but I've had two cases in the last month of overuse, and just very soggy, soggy skin, that was never getting a chance to get any oxygen to it. And one particular moment, she won't mind me mentioning this because because she gave me permission to mention to generally had an extremely red nipple that she thought must be developing into an infection. And she literally took off her silver cup for a few hours. And it was, it got better within a few hours, she just just want it too much. We can't be wet. So moist, we're tailing doesn't mean soggy and wet. And sitting in milk. I mean, can you describe for us what moist wound healing means is with a sort of a nurse hat on?

Chloe Cox  21:23

Yeah, so we would, you know, the olden days, we've talked about, we want to let things get to the air. And there's definitely a certain element of that. But when you've got a chronic wound that is not healing, we need to get the balance right between we like wounds like moist, warm and clean, that's kind of their ideal hitting conditions. But you adjust any of those factors, and that's going to affect your wound healing. So too much fluid is going to damage those cells that surrounded that wound, so your healthy skin that's around it, and it will never be able to close over. So when we think about wound healing, we want the base of the wound to be up to surface. And we want the cells to be able to migrate and travel across that wound and make new skin basically, and if the wound is too wet, the skin cells are oversaturated with fluid, and they're not going to be able to migrate, migrate and kind of create new cells. So there's definitely a balance. And I had been adamant with my lanolin sticking to it. To be honest, in hindsight, I think that made it worse. I ended up with a patch of eczema underneath my eye sensitive skin anyway and had a patch of eczema underneath pineapple. And I think that was probably the Long Island because when I stopped that and had a bit of a steroid cream that sort of that I had tried. I'd contacted a rep from one of the companies that make our dressings and asked about this special wound gel that we use sometimes that's completely non toxic. And I thought well, maybe I'll give that a go. It had a book frightened property to that dress. And so I thought well maybe if there is a bit of a biofilm there, like you mentioned, and that might get on top of that. That didn't really help either. 

Emma Pickett  23:11

Any honey, I know medi Honey?

Chloe Cox  23:14

honey, we're using Yeah, I tried many honey, I'd used medihoney on notice nappy rash as well. And that was when that very occasionally happened. And that worked perfectly I thought work if I go because I've got that in the house. And I was consistent with things that's a big thing, wouldn't it you've got to be consistent with whatever you try because we've chop and change then we've got no idea what was going on.

Emma Pickett  23:34

You talked about keeping it clean. Did you go down the route of sort of say line and and soap and water? What are you doing with the cleaning?

Chloe Cox  23:41

I didn't bother because it will be all wounds and all of our skin have the natural flora that live on it. And you know, the minute that I then put a brass pad back on or she latched back on that would introduce probably the same bacteria that was probably fairly happily living there. So I would just wash as normal in the shower. Make sure it's changed my brass pads really continue. Initially I started off as wanting to really be very eco friendly and started off with reusable brass pads. But I just found that they were just sopping wet all the time. They didn't work the moisture away. So I switched to kind of plastic backed brass pads and they did have a little bit because the skin wasn't constantly wet. But it would it started to dry and scab and it would catch on the brass part and that would be really sore. So it was just all a bit of a balance really. 

Emma Pickett  24:33

Oh there's not much worse than when a wound sticks to a breast. You have to peel it off. Yeah I'm sorry to give you a bit of revisiting this moment but when you see like skin coming off onto a breast that that is just absolutely so you're still feeding through all this. Did you go did you try the giving it a rest thing? I'm in inverted commas where you don't feed on that side?

Chloe Cox  24:54

I didn't because I think I was still so had. I don't know if it would be trauma most also anxious about the fact that she'd become dehydrated. In those first initial couple of days that I was, I was fixated on making sure that she was getting enough. And I think at that point, I think I maybe tried pumping, and then trying to give her a bottle that she didn't take. She was probably about five or five and a half months old at this point. And I pumped and I ended up with status again. And I it was only one pumps, I'm not sure why the pump just seemed to really upset. It was always the left side that would end up. So I gave that a go. Coming from the status. She didn't take the bottle anyway. So I just carried on to be honest, that

Emma Pickett  25:39

that one pumping session triggering mastitis is something I've heard people describe before. I mean, I think some sometimes I think it is potentially about the flange itself. Maybe there was pressure from the flange that was causing an issue or, you know, the funnel wasn't the right shape size. And, and it does seem to some people are just very sensitive to overproduction, and that sort of it can sort of tap into that. So you said five and a half months. So you've you've not been pain free on that side, really, for five months. 

Chloe Cox  26:09

Plus, I then started really bleeding from that side. So I was it. It was at the same time that she'd had some vaccines, I think so she must be in kind of that was a bit of a rush about four and a half months, had some vaccinations. And she had very, how would we describe it, we would, it was bloodstained, poo basically from her and, but dark blood, which would mean that it was from further up. And at the time, I didn't put two and two together because I wasn't always seeing that I was bleeding when I was taking her off. But that kind of settle down again. And then it was happening on I was bleeding from both sides, because the right side had taken a bit of a knock .

Emma Pickett  26:52

Chloe There are people listening to this, putting down their toast and thinking how, how are you managing to survive at this point? I mean, you must be such a strong person and such a determined person. Are you? Are you getting any other support? So you've mentioned the lactation consultant, he did the zoom with you mentioned someone who saw you face to face? Are you getting any ongoing support, were people continuing to try and investigate what was going on.

Chloe Cox  27:17

So I was seeing the health visitor occasionally you could go for these monthly weigh ins and I would speak to them. And they had gotten me a lactation consultant through the NHS and she saw my position and she was really happy all look great. So we just carried on and then I sold health for so again. And she basically told me there was nothing that they could do for me and that they I'd need to just try and get on a bottle basically. And and that just made me more stubborn and thought no that this can't be right. We're just going to have to persevere. It will be right. Eventually.

Emma Pickett  27:50

Five months, five months on. Yeah. I mean, God, it's such a long time to be in pain. I mean, what was that doing to your mental health? I mean, we you? You said that you were enjoying her at the beginning. You said the times when you was painful you were you having a positive experience. So it sounds like you were okay mentally but I can't imagine it was easy. 

Chloe Cox  28:10

It was okay. I think at that time she had done this thing that these little babies seem to do where she was sleeping through the night. So that would at least give me a while she was sleeping from can attend all types of really lovely long break. And that was given me a nice, just a couple of you know, been able to get some sleep and not be in pain. I think that's what got me through that period, to be honest, because I think if she was latched on all night, plus all day, it would just have been you know, I remember being awake during the last feed and just crying to my husband. I just don't know if I can do this anymore. Jamie. It's just so painful. I'm so worried about the blood. She was a bit constipated as well, because I guess she was having so much blood. You know, those are in levels. I taken at a&e to check that she was okay. They were happy. And we just persevered. 

Emma Pickett  29:04

I think that word persevered. It's a lot. A lot going on there. I mean, thinking you mentioned Jamie, did he ever say play by love? What are you doing? You can stop now. I mean, would Did you ever have that kind of conversation?

Chloe Cox  29:16

I don't think he did because he knew that I was just so picky about it. My mum had had a few times said you know if you need if someone needs to give you permission to stop, I give you permission you can stop now. But in my head I was just thinking well, I'm never gonna get on a bottle now. You know, she's not on solids yet. I'm just gonna have to carry on because what is the alternative? There's either breastfeeding or a bottle and she might have taken a cup. Possibly at that age but yeah, yeah, I reflected I don't think he did ever really say you can just stop 

Emma Pickett  29:54

because he knew and did and you didn't even come close to thinking about yourself. You know, it was not an option. Your head. 

Chloe Cox  30:00

No, I just had to do it. It was like a strong urge. I just had to do it. I couldn't kind of fight off

Emma Pickett  30:12

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  31:00

So are you visiting your GP at this point? Are you getting? I mean, you mentioned you haven't using the steroid cream? Are you getting any other sort of prescription treatments or you're trying sort of different creams and things?

Chloe Cox  31:10

I'd been to the GP I managed to get face to face, which was great. And she said, Well, why don't we try thrush cream? Why don't we give it a go because it doesn't look infected. So to be honest, I I finished the course. But I was never really convinced that was thrush. She never had any whiteness in her mouth apart from kind of that normal milky Tang. And I just didn't have those thrush based symptoms. So it, it didn't work. I didn't kind of have any relief from that. And then I contacted that lactation consultant again, and she was just such a great advocate. And she really pushed She was desperate to try and she couldn't believe that I was phone her again, so and help me. So she we made another appointment with the GP. And she recommended that they did a wound swab to see if there was any, anything there that we could try and treat. And the GP was really reluctant, they were very anxious that I'd have to come off from feed in to be able to have the treatment that we waited for the wound sort of anyway, that came back with staph aureus. And so the lactation consultant had written a letter to the GP to say, you need to just treat this woman, you know, the breastfeeding network, the drugs page says they absolutely do not need to wean off to be able to have it was only I think it was fucidin cream. So it was like an antibiotic used all the time. 

Emma Pickett  32:35

So yes, feeding all the time. But I appreciate you know, doctors may not know that. So they have to be reassured. Can we give a shout out to the lactation consultant that helped you What was her name?

Chloe Cox  32:45

Laura, she was brilliant. She was really, really great. She just, she just got it and she knew how much I wanted to feed. And, you know, I think that's the thing is when you're a medical professional, you're a nurse, whatever, Doctor, you think that you should just be able to push through, you think that you should be able to do it. But actually I needed someone to back me up and say, No, this is right. She doesn't know what she's doing. She can still feed. And I had that ground this point. novacyt, six and a half months old. And I had it and it healed. 

Emma Pickett  33:20

Like I said it was it it was bacterial. Yeah, it was a bacteria. Yeah. Gosh. And that was the so you force it in for the first time? Yes, six, six and a half months? How quickly did it heal up?

Chloe Cox  33:31

It was gone within, you know, I could get I could see it again, smaller every day. It was gone within the week. And I really,

Emma Pickett  33:40

so what a relief that must have been that must have been such relief. Did part of you go? Why the f? Did I not do this three months? Was there a bit of you thinking that?

Chloe Cox  33:49

Yeah, absolutely. I just because like I said, going back to the nursing world, you know, I barely ever take a wound swab of anything, because it's all about being able to clinically assess somebody. And my assessment was that it probably wasn't infected. But it was obviously, you know, it was colonised enough with those bugs to be stopping that wound to heal. And just that local antibiotics or applying directly to the area was enough to just get rid of that infection or allow it to heal.

Emma Pickett  34:20

So you just tip the balance just enough where your body could then start doing its job. So you didn't have kind of read angry patches, you didn't have a temperature you didn't have, you know, really obvious tonnes of yellow gooey stuff. Yeah, it was just enough and actually, Staph aureus, on my right lives on all our bodies anyway, and it's quite normal. You know, some people say that's why we don't bother doing swabs because you're gonna find stuff or is but in your situation, if you add up all the factors, you weren't healing, something must have been delaying your healing. And so adding that in that cream made enough of a difference and I think it's also important to highlight that you didn't take oral antibiotics because I think some people go straight to that, that you needed something on that spot didn't need you kind of got to be changed, you needed something to be changed on that local area. Gosh, what a relief few everyone's like, thank goodness. But you mentioned you were you were still bleeding on the right that was. So you're still in pain even though even though this infection had gone, you were still in pain?

Chloe Cox  35:20

Yeah, it had, I think, as she got older, she just wasn't, there wasn't enough to anything in the end, I don't know. But she just seemed to be able to have got quite large boobs. And she just be as she grew older, she was able to just latch a lot better, she just managed to get more of that breast tissue in her mouth. And she was still at that point feeding an awful lot, you know, it was probably normal, but you know, an awful lot. So that eventually just resolved and I think I stopped fully being in pain and, and having any bleeds in about eight months. 

Emma Pickett  35:55

Okay. Let us just pause for a moment and say, Mrs. Chloe Cox, eight months of pain, eight months. I mean, that is extraordinary that you were able to continue breastfeeding through eight months. Thank you. That is amazing. I wish that hadn't been your experience. But I want you to look back on that and feel so proud of yourself. You so for persevering and hanging on? I mean, if we gave up medals for breastfeeding, bloody hell, I mean, you will certainly need need one is just amazing. You must must have been such a determined strong person. I mean, did you have support that around you from friends and family that got you there? Or was it? What do you think it was about your inner drive? What do you think made you continue through all that? 

Chloe Cox  36:43

I think it was probably a combination, I had that kind of like, want to know what the word would be. But that urge. And you know, my mum, she blessed her had grown up in Shetland, there was barely any support at that time and had tried to feed and had a very similar experience. You know, two weeks in with me, she'd stopped because she was in so much pain, bleeding continually, and she'd swapped to bottles. But she could see that I really needed to do this. And, you know, we all could see how happy and healthy Nova was. And it made it feel worthwhile. Jamie was really supportive, his mom was really supportive. My sister in law had had problems as well. And she understood that need to just be able to keep going. So it definitely had really great support, you'd get the occasional comments of religious wise hollering nurse, you just need to stop now. It's it's getting a bit silly, you know, you're crying, whatever you're struggling to go out, because you're worried about now be able to get around properly. That was probably more in the early days, but generally had a really good support system. And I'd made sure to follow people on Instagram, who were psychic confirmation biases and who were confirming what I was doing was the right thing. And I would, it was the same, you know, her sleep, that lovely period for sleeping through the night stopped and she started sleeping as a normal infant does. And again, rather than reaching out for those kinds of sleep training pages, I was going for those normal sleep pages. And I think that really helped as well. Because when you're awake and three o'clock in the morning and thinking God, this is so sore, should I just stop and you know, somebody flipped, pops up on Instagram or something. And then I had a similar experience I carried on it did get better. That just makes life so much easier.

Emma Pickett  38:35

Yeah, let's just think of them sort of on a micro level for a moment. So you weren't as healed now, but you're still in pain. So what was sort of taking sort of eight months or so seven, eight months? You're not quite pain free? Did you have sort of a routine inner feed to sort of help you get through a feed? We use somebody who listened to music? Or did meditation? Or what were you actually doing? Because you were in pain multiple times a day, at the moment when your baby's feeding? What were you doing to get through those painful feeds.

Chloe Cox  39:08

I would just play games on my phone. To be honest, I was playing a lot of kind of what's called to do Ko, that kind of thing to try and just avoid this structure. We don't have a TV in our house. So in hindsight, I kind of wish we did because that was at least something that I could have just sat and not glued to my phone. But yeah, and I would just make sure that we were in some are really comfortable. So I would feed on the bed quite a lot. I tried different positions that we found that crossed credo was was the best one that worked for us. So we're always just make sure that she was in the exact right position. Sometimes I would unlatch her towards the end because she would just be kind of comfort feeding and that would be the most painful, where she would kind of fall asleep and then realise that she still had to open her mouth and wake up and she wouldn't be on quite right. So sometimes they would just make sure to unlatch her and try and settle her With other means. Yeah, it was mostly just playing that little game. So silly but it was just the mind isn't a

Emma Pickett  40:09

distraction is such a valuable tool. Lots of people who struggle with aversion, say, distraction is definitely make what makes a difference to them. Were you taking pain relief? Did you use to take paracetamol and, or occasionally paracetamol. And you can't take ibuprofen? Presumably? colitis? Yeah. But it would take the edge off. 

Chloe Cox  40:28

Sometimes if it was particularly bad, then I would, but by that point, her feeds were getting a bit shorter. So it was not quite so long of a time to tolerate. And because I knew that wound was healed, that kind of just gave me the despair that this surely will get better now, I've managed to heal the site, we should be able to sort out the right.

Emma Pickett  40:47

Yeah. And when you got pain free, was it kind of suddenly one day? Oh, my God, this doesn't hurt or did it just very gradually, and then you sort of think hang on this. I've had a few days. It's not her. How did it go? Yeah.

Chloe Cox  40:57

It was it was that exactly. It just I suddenly realise, Oh, I haven't. I don't think I've been any pain today. And, and she's not, you know, I don't think I've pledged she's not come off. And I can see any blood. So I felt sorry. So I think, yeah, it was just a very gradual change in the way that we did that feed those feeds.

Emma Pickett  41:17

Yeah. So when you get to sort of eight, nine months, and you're pain free. Did you feel like right, I'm bloody FiVER, this now I'm going to breastfeed so she's 10 years old. I'm gonna stop until that you dare tell her to stop. Freaking Come on, tell me. Did you then sort of think right, I'm going to make most of this now pain free breastfeeding, I'm going to enjoy this did it sort of change your feelings around breastfeeding? 

Chloe Cox  41:38

I had always wanted to try and get to yours anyway, with like the WHO recommendations I'd that was kind of my aim. And then I thought, well, now you know, there's nothing holding us back. It's I've come to terms with like I said the sleep had been normal, really, but at the time felt her and I'd come to terms with that. I knew feeding was the best thing. And we just persevere. We just well, not even breastfed, we just did it. It just kind of happened.

Emma Pickett  42:04

So let's fast forward towards the end of your journey. And things go towards the end when you're weaning Nova.

Chloe Cox  42:10

So she I'd had I still get the odd bouts of mastitis. So I'd had another bout of bursitis in the November 2023. And I think my boobs are just very sensitive, I think she'd be really poured in should be led on one side kind of cooked up. And that was enough to give me the status that at that point, I'd had to start immunosuppressants for my ulcerative colitis. And that infection hit me like a tonne of bricks. I was so unwell, got over that. And I thought, well, this is just this is really hot. So I started weaning her in the day. So I, I researched loads about it. And again, really kind of reaching out to kind of Instagram pages where, well what when you first try and look at weaning a toddler, there isn't very much talks all about babies. And you know you it doesn't really talk about that habit stacking thing. So I'd find patient like yours, and had looked into the habit stacking. So I initially stopped when feeding her for naps. So we talked about the pros only for a bedtime. And at that point, she had weaned herself mostly down, she was really only feeding for naps and for sleep. So we introduced like music, sleep times and a Teddy and we'd still have a cuddle in exactly the same position that it would feed her just have that kind of closeness. So we come right down and she was absolutely fine. And then I had another bout of mastitis in January this year. And that one I was really, really poorly ended up in a honestly, and I was really really unwell.

Emma Pickett  43:56

Can I ask you about that? I never took sort of dwell on it too much. But for those of you who are listening when was the threshold for you to need to go to a&e to do you have like symptoms of sepsis? What was your tell us what was happening? 

Chloe Cox  44:07

So I had woken up that morning just feeling flu like symptoms, and then I my my heart rate was like 130 and I just kind of go, you know, really very, very hot temperatures like 39 and I found the GP went and saw them. They wanted me to go in an ambulance. But as we all know the NHS is struggling a bit. So Jamie drove me to a&e and then yeah, I was very quickly seen because that kind of borderline sepsis and because I was immunosuppressed that was going to that was the pushing point. I think for me I think probably most people you would be able to mostly be managed at home but I think the status can just it can come on so quickly and it can just make you so unbelievably unwell. Till then I had a night or two in hospitals and IV antibiotics and I just reflect on this and just I didn't know I became a very big breastfeed not forget, I was absolutely adamant everyone should do it and I really supportive and but understand if you couldn't. And then I saw a breast consultant like a medical consultant who was like, well, you need to stop now you're only doing one for you today why are you still feeding? I thought God if you have breasts often don't even advocate for, you know two plus feeding then what hope has anyone got off? You know you've got some you go into hospital and in a lot of people take I don't know why but medical professionals are in this kind of superior. I don't know people rely on them for for the opinions and I think well, you're gonna ask it to for what, what if we got so he told me to stop. And at that point, I think and I think I am gonna have to stop because this, this medication is making the society periods just a really a lot harder. But I very much did that in a long, prolonged phase. And I've spoken to a lot of people who said, Well, you just need to have a couple of nights away and she'll have forgotten, I thought I know she will have not forgotten exists. You just need to stop or just get Jamie to put her to bed a few times and and she'll get better. And to me that was too close to sleep training x aspect, which is not kind of my bag. So we just vary in the day, we would talk a lot about stop feeding, we would talk about we would kind of use her babies and her dolls to say like how would How else would you put to sleep and she would do lots of like patting on their belly, which is really sweet. And one night I just said that Nova had managed to finish all of the booby it was all done. And that was it with it. There was no more left that we could still have lots and lots of cuddles. And you could still control your Teddy's and you can still use your muse box. And she was absolutely fine. And she very occasionally will ask now. Or she'll reminisce about the fact that it happened I have this little album that we look at of like pictures of us feeding together. But it was a lovely I never thought that would happen because she was such like booboo monster would say, in like the months leading up to that I never thought it would happen. But it was so easy to wean her off. It was lovely.

Emma Pickett  47:12

That's lovely to hear. And, and that is credit to you. I mean, all that talking and roleplay and preparing and, you know, habit stacking and keeping a close. That is what made the difference and keeping a close, you know, physically and emotionally as you know, if you've read any of my stuff. I'm a bit I'm a big fan of not using separation as a winning method. Because I think emotionally they need us to be there. And and that was a lovely version of how that can go when you are close. Were you worried about getting mastitis at the very end of your breastfeeding? Was that something that you were nervous about?

Chloe Cox  47:42

I wasn't too worried because I'd done like alternate nights to like Jamie had put her to bed one night because I think I was late at work or something and then I'd done it. We just slowly wind it down that phase and I was holding out for it potentially happened. But it was fine. I didn't have any insights. I think I was pretty dried up by that point. To be honest, there wasn't too much left

Emma Pickett  48:03

good. I'm glad you didn't have any more. She definitely definitely had more than your fair share of Crikey. So if you look back at that whole journey, then very nearly two years, if you look back at the whole thing, how do you feel about your breastfeeding journey? How would you feel looking back?

Chloe Cox  48:18

 I feel really positive about it. Regardless, I think, you know, when I reached out to yours, thinking back about all the little bits, and there's lots of bits, I think it probably wasn't ideal. And maybe if healthcare professionals had done that slightly differently that I maybe wouldn't have been in this situation, but I feel really proud of where we are, you know, she's such a happy, healthy, and I'm not saying babies that former friends aren't, of course, that's not true, but she's just so happy and healthy. And it was totally worth it. And I definitely will still breasts you know, if we have another baby, hopefully, then I will try and breastfeed that baby too. So it was the best thing that I ever did. And I feel proud myself that hopefully I've set her up for life. And, you know, that initial podcast you did when you first started that was just oh, it was just last about to hear all of I love the medical side of like, why you should try and do something, you know, all of the really great reasons for caring for breastfeeding and, you know, to feel that you've achieved some of those is just the best thing ever. 

Emma Pickett  49:25

Yeah, well, you definitely should look back with pride for sure. And so you don't have a bit of you that goes if only I'd started boosted in a month. Yeah, you're you're at peace with that 

Chloe Cox  49:35

I'm at peace with that. Yeah. If anything, I kind of sometimes have those feelings about those very initial few weeks and that like readmission for her losing weight and I think well, if someone had just looked at the position properly or they maybe shouldn't have given me that nipple shield or they should have told me how am I going to wean off of this nipple shield properly? Or how am I going to wean off triple feeding and pumping properly and not end Not with the slightest, which probably didn't help the whole wound healing thing either. That maybe would have made a difference. But I think like you said earlier, you just your brain protects you from a lot of that stuff for the future. And some of it, I don't really, I remember it was hard, but I don't necessarily remember the detail of how it was so hard or why it was so hard. So generally, I have very fond memories of it, and it saved us. And so in retirement, you know, we went on a big cruise digitally, and I was able to feed her the whole flight and the whole time, but she was far too hot and Rome. And it, you know, it made her go and back to sleep a lot easier. And it was like my little magical secret weapon, I think. And that made it easier.

Emma Pickett  50:43

Yeah, no, I definitely. High five for that feeling. It's a Yeah, it's gonna be magic. So good for travel. Gosh, breastfeeding. Yeah, we could do a whole podcast about that. And I like how the universe said, You know what, Claire, we're gonna give you some sleep for a few months. Yeah, even though it may not be what happens forever. Right now you need a baby that sleeps from 10 to five. So we'll sort that out for you. Thank you sleep angels, wherever you are. Getting that to happen. It was such an honour to hear your story, Chloe. I'm sure you are such a great nurse when someone's got a breastfeeding issue, because you will be absolutely there with all your empathy and your experience. And I'm just really honoured to hear your story and warehouses. You are obviously a very strong person. Have you ever thought about doing any breastfeeding support specifically like becoming a peer supporter?

Chloe Cox  51:28

So I did. Yeah, I did look into it. And it's something that I think I'll see how we get on with the next one. And then that definitely, because I really loved I love talking to people about breastfeeding, because I just think it's the best.

Emma Pickett  51:42

Yeah, well, you could be an ibclc with it. And you know, it's if you've got a nursing degree, it's not it's certainly something you know, you just need the breastfeeding experience and a little bit of lactation education. But that is something No, no pressure, no pressure. That's something you could also do well, thank you so much for sharing your story to take it away. I am so grateful. Really appreciate it.

Chloe Cox  52:02

Thank you so much. It's great.

Emma Pickett  52:08

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.