Breastfeeding in the neonatal unit

This week, I’m delighted to speak to Sam Petridis, a neonatal nurse and IBCLC, about her breastfeeding and neonatal care. She is Baby Friendly Initiative Lead for her hospital, so we discuss what that means, and what the UNICEF guidelines mean for breastfeeding.

Sam explains the different levels of neonatal care (Levels 1, 2, and 3) and the importance of early breastfeeding and skin-to-skin contact. She talks about leading the way on Baby Friendly accreditation, the challenges of balancing medical protocols with parent-led feeding, the benefits of donor milk, and how COVID-19 impacted life on the neonatal ward. 

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

For more information about milk donation after loss, contact https://www.milkbankatchester.org.uk/donationafterloss/memorymilkgift/

https://humanmilkfoundation.org/hearts-milk-bank/donating-after-bereavement/

For support for premature and sick babies, contact https://www.bliss.org.uk/

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  00:48

 Thank you very much for joining me for today's episode. I'm really pleased to be joined today by Sam Petridis. She is a nurse and an IBCLC, and she specializes in neonatal care, working in Shropshire, and she's going to join me today to sort of unpick the world of infant feeding in a hospital neonatal setting, and we're going to be hearing about her experience of supporting families and also supporting colleagues. She's won awards for improving the experience of families in neonatal units, as well as being a driving force behind her unit going for Baby Friendly accreditation and and she just did a little humble look because she didn't want me to mention the awards, but I saw them online. Sam, you have won awards, so you're a good person to talk to about neonatal care. Thanks very much for joining me today.

Sam Petridis  01:35

Thank you so much for having me. I'm a big fan, so this is, yeah, fantastic opportunity for me to talk to you.

Emma Pickett  01:41

Oh, thank you. So let's start with the with the bog standard stuff, before we get to some of the more details about the neonatal care. What's your professional background? How did you get to where you are today?

Sam Petridis  01:52

Okay, so I trained as a nurse quite young. I was 19. I hadn't really thought of any other career, to be honest. I just always really fancy to doing nursing, yeah. So I did my training. I think I started when I was about 19, quite a long time ago. Now I qualified to think about the age of 21/22 it was in adult nursing. And I yeah, I enjoyed it. I Yeah. I wasn't sure where to settle, to be honest. So I worked a mixture of kind of medical wards, surgical wards. I hadn't really found somewhere that I was really passionate about and where, you know, really wanted to stay. But my sister actually had a baby, a second baby, and then that got me a bit more interested. I was a bit older at this point, a bit more interested in maternity care. And I ended up doing an 18 months conversion to Midwifery, which was, you know, fantastic and really insightful. Again, I did this in Shropshire Staffordshire, so I worked as a midwife for a little while, and then I saw a job advert for a neonatal nurse. And I remember when I was a student spending some time on a neonatal unit, and I really enjoyed it. So I thought, oh, okay, I might, I might give this a go. There were kind of full time hours as well, which, yeah, was important to me at the time. And nine years later, I'm still here. So I've been a qualified itu neonatal sister as well for, oh gosh, for about five years. I've worked on the neonatal unit for nine years, a sister for about five years. And then I, four years ago, I applied for the baby friendly initiative lead for neonates, and that's, that's basically my proper title now, is Baby Friendly Initiative Lead. So I'm basically making that big push to UNICEF, kind of change the way that we approach our care for neonates and families. It's a, yeah, big detailed program, and it takes up a lot of my time. 

Emma Pickett  03:44

Okay, okay, so, so yeah, I mean, that's a great journey to get to this spot. I mean, to have that experience of midwifery as well, it must be really give you that kind of wide perspective, which is, which is brilliant. So, so obviously not, not all neonatal nurses are ibclc, sort of goes without saying, and they're not all feeding focused? How much of your time is focused on feeding infant feeding? 

Sam Petridis  04:04

Yeah. So quite a lot, really. So when I'm at work, I often get asked to kind of help a mum on the unit, or mums on the unit to help with feeding. Staff refer parents to me who might need that extra bit of support, like advice on increasing milk supply, position and attachment, especially trying of transitioning those babies from tube feeds to breastfeeds. A lot of the issues around around transition, although staff are kind of trained to support parents with this, sometimes they just don't have, you know, the confidence, or they might come across issues like tongue tie or babies just not wanting to latch and tiring, yeah. So that's kind of when I get involved.

Emma Pickett  04:46

So you're doing the hands on stuff with the feeding hands on, doing the sort of unit level, hospital level policy stuff as well. That's right. So two, sort of two halves of the of the story, which can't always be easy moving, but 

Sam Petridis  04:57

yeah, oh, it's absolutely not so kind of my. Aim is really to educate staff and give them the confidence that they're able to support. You know, the more bait, you know, the more basic. So helping with that transition to breastfeeding, and then coming to me when you know they're really stuck and just need that extra support. But yeah, my role as Baby Friendly lead, it takes up a lot of time, so I run like training sessions for staff on breastfeeding, expressing milk, colostrum, the importance of fats. And I've also worked on other side projects as well to provide kind of information for staff and parents.

Emma Pickett  05:30

Okay, let's, let's do a glossary for a minute. So you referred to an itu a moment ago. To tell us what that is, I would put, I'd say, ICU, but I'm guessing that's not a thing anymore. Is that? Is that the same thing as an itu? 

Sam Petridis  05:44

Yes, it is, yeah, I would just say itu, 

Emma Pickett  05:47

I'm gonna guess. Is that intensive treatment unit? Intensive Care Unit? 

Sam Petridis  05:51

Yeah. So itu, it's just the same thing. 

Emma Pickett  05:53

Okay, cool. So what is a neonatal unit? So, so what's a NICU and what's an SCBU? Yeah. And also, can you tell us what are the different levels of neonatal units? Sorry, to kind of get you to the glossary straight away.

Sam Petridis  06:13

No, no. It is confusing. To be honest. It can be so. So, yeah, no problem at all. So there are three levels of neonatal unit, with Level Three being the most specialized. So level one units are called scaboos, so S, C, B, U, S, or special care baby units, and they just tend to be care for babies that are born kind of after 32 weeks. So they kind of treat babies who might have blood sugar problems will need tube feeding, and then will help transition to breast or bottle feeding. They might have low temperatures. Some babies might need phototherapy. On the unit will support with feeding, so tube feeding, breastfeeding, bucket feeding, etc. So I actually work on a level two unit, which is between a level one on level three, obviously, and that's known as an llnu or or a local neonatal unit. This is for babies who need a higher level of care than what level ones can can support with. So the babies that might be admitted will be will usually be from 27 weeks upwards, and we're kind of equipped to support with that short term ventilation CPAP, also known as continuous positive airway pressure or high flow therapy, so giving the baby some extra breathing support 

Emma Pickett  07:30

the mask essentially on their on their face. Yeah, okay, 

Sam Petridis  07:33

that's right, yeah. And we also will babies might need IV drips to maintain their hydration, support with blood sugars. They might be having some apneas, so where they just stop breathing for a few seconds. They might be on antibiotics for infections. So yeah, so most of our babies are actually pre term, but we also care for term babies who become unwell soon after birth. So again, that can be respiratory problems, or it can be blood sugar problems, or perhaps they've been born with a syndrome, perhaps. And then we've got level three units, NICUs or neonatal intensive care units, and we often refer to them as level three, and they are, like I said before, they're much more specialized, and they help, particularly poorly babies often before born before sort of 27 weeks, and they might perhaps be needing surgery of some sort. But yeah, it is confusing. So that's kind of just an overview, really. 

Emma Pickett  08:31

No, you overview is not confusing at all. You've made it really useful. So, so I'm guessing that the some of the babies that start off in the most intensive unit can then move to you later on, and we've got a little bit absolutely, you know, graduating from one unit to the next, is that, is that quite obviously, that's quite common, 

Sam Petridis  08:48

that is quite common yeah. So we might have perhaps a baby, a family that will be, you know, supposed to deliver at our hospital. But perhaps, you know, they might be at risk of delivering sooner, so they are then kind of moved to a different hospital who can accommodate that, that baby that's, you know, going to be born at an earlier gestation, and then when they're kind of stable, and yeah, they're improving, they're a bit older, then they will move to us, and then we can support, then with, with the rest of their care, and the rest of them kind of neonatal journey.

Emma Pickett  09:23

Okay, so not every hospital that has a neonatal unit will have all the levels. Not all hospitals will have the intensive care option. So there's a little bit of moving around in hospital ambulances with very carefully trained paramedics,

Sam Petridis  09:38

absolutely. Yeah, we've got our own kind of transport team, absolutely. And they're, they're very, very specialized,

Emma Pickett  09:44

yeah, okay, so if we were going to visit your unit, your level two unit, and we were doing a little bit of a guided tour, what would it what's the room like? Has it set up? What would we see in the room? 

Sam Petridis  09:55

Okay, so as we so as we come through the double doors, we. Just opposite labor ward, obviously just for easy admission, making that transfer of baby straight across if needed. And as we, as we go into our unit, we'll have a very helpful Ward clerk, normally on the on the on the desk, and they provide lots of information for for parents, and very personable, so they can help with car parking and other little questions as well and paperwork. So as we go into the corridor and up into the unit, there are four big bays. So the first one you come to, which is obviously nearest to labor ward, we've got itu. So that's a six a six bedded Bay. So there's room for six incubators or six cots, and that they will be set up ready for any admission. So they'll have all the breathing equipment ready. It'll be the incubator. Be nice and warm, ready, ready for the baby to come across. It'll have all the equipment that we need. So chest leads ready to pop on.

Emma Pickett  10:58

So a chest lead is something that monitors heart that, heart rate, yeah. So that's attached to baby. And there's a, yeah, there's a little, I'm guessing, a little tiny little incision in the skin that, or does it always all external.

Sam Petridis  11:10

It's always just external. Actually, they just stick on and then they'll have a SATs probe on there. So that's a little thing that go a little oxygen monitor that goes around their foot or their hand, and that will just monitor oxygen levels. So everything's all ready. They'll have a big screen that will tell us, we'll have the readings on it as well. So there's six of those already. They'll have the breathing support ready if needed as well. So babies stay in ITU until, until, you know, for at least a couple of days, until they're improving and their care needs are lesser. And then they'll move to the next bay, which is we call high dependency unit, where babies are basically needing just that little bit less intervention. So they're still having close monitoring, they still might be having some breathing support, but they're usually now trying to establish feeding. So they'll be having nasogastric feeding or breastfeeding bottle feeding. They might be having treatments such as phototherapy. And then as we move down, we've got two more bays, and again, that's for recovery and support, and it's basically our nursery bays. So they're getting ready for discharge.

Emma Pickett  12:18

When you say bays, they are lift, they're slightly separated, are they? 

Sam Petridis  12:21

Yeah, they are, yeah. So they're basically big rooms, big rooms inside. Inside each room will be a little fridge. So in that fridge we'll store mum's milk or parents milk, and they're in little lockable boxes that parents can access themselves. So we do encourage parents to be involved in kind of all aspects of care as much as they're comfortable, 

Emma Pickett  12:42

yeah, so I was going to ask you about parents. Let's imagine we're visiting the unit, and it's 10 o'clock in the morning on a Monday. Where will we find parents? And is that going to be different from one o'clock in the morning? 

Sam Petridis  12:53

Yes, I suppose it is. So hopefully they'll be next to their baby, especially in the daytime. We have these lovely, big, comfortable reclining chairs for parents to be able to relax, to have skin to skin to rest, have a drink, look at their baby, touch their baby. So as I said, we just we do encourage parents to be involved as much as they can, really, with their changing babies, nappies, giving mouth care will encourage parents to express next to, next to the the cots as well.

Emma Pickett  13:26

Can I just ask you about mouth cares that that's that's swabbing, that's putting? 

Sam Petridis  13:30

Yeah, yeah. So mouth care sorry, yes.

Emma Pickett  13:34

Apologize. I'm this for you. This is just, this is absolutely bread and butter bog standard. But I have no shame in asking questions, as I asked about the heart monitor, no shame in asking the stupid questions. So tell us about mouth care.

Sam Petridis  13:46

So mouth care, so if parents, if mums are expressing, then we can give little small amounts of what we call buccal colostrum, buccal EBM, so it just goes into the mouth, just into the into the cheeks, and that will then be absorbed, and all those amazing ingredients that are in breast milk will be absorbed, and will be a massive benefit. So we kind of do that every three hours ish, and we'll just moisten the lips a little bit with like, maybe a swab, like you said, if there is no colostrum, we can just use sterile water, which will we'll use a bit of gauze or a little bit of cotton wool just to to moisten baby's mouths, because obviously they can get quite dry and quite Yeah, not very nice for baby at all. 

Emma Pickett  14:29

Okay, so I'm gonna ask you in a minute about skin to skin and other things. But So at one o'clock in the morning, I'm guessing parents will be sleeping, but they could be there if they wanted to be there,

Sam Petridis  14:41

they could absolutely so we do try and empower parents to to stay as for as long as they want. At night time, it's still quite common that parents will will either go down if they've admitted to postnatal wards, so they will quite commonly go downstairs to rest. But we do also have camp beds for. Them that they can stay on next to their baby. And we also have parent bedrooms as well, that they've got three of those that parents can stay in. Otherwise, yeah, often they'll come up to express next to their baby, and then they might go, if they're staying, then they might, then they might go back down to postnatal ward. Otherwise, most parents, they do go home, you know, they do have other, you know, things they might have, siblings at home, animals, things like that. 

Emma Pickett  15:26

So, yeah, okay, so there's a mix of things. Obviously, sometimes, you know, parents have, may have given birth prematurely and might not be well and might be recovering, absolutely, yeah, and then the parent might go home before the baby goes home. And obviously, the that's going to be quite a common scenario. Oh, yeah. And, you know, there's obviously an enormous amount of difficulty in managing having a baby in hospital and having all the logistics and traveling backwards and forwards and things if somebody wanted to sleep on that camp bed for several weeks in a row that that could be an option for them, if they were absolutely, yeah, absolutely Yep, and there's a bathroom and a shower, and they can, 

Sam Petridis  16:01

yeah, there's a bathroom, there's there's a shower, towels, so everything provided little care kits we have as well to give them with shampoo and things like that. And they get food up there. They do, yeah, we have a parent kitchen. So in that kitchen, we have a fridge, a microwave. We have hot water. They can make hot drinks. We have cereal. We also have hot meals as well, if they want one that we can just heat up in the microwave for them. So yeah, we try and try and do, yeah, try and do what we can. There's always room for improvement. But yeah, yeah,

Emma Pickett  16:36

yeah, fair enough, yeah, man, you obviously you haven't got space for everybody to get a bedroom. And, you know, the dream scenario is siblings get to come too, and there's a sort of magic portal into some amazing bed, you know, bedroom, little flat space. But, yeah, obviously there are limits, but it sounds like you're working really hard, which is super special. So we've talked about feeding the parents. Let's talk a bit more about feeding babies, which you've you've touched on. Obviously, depending on how unwell a baby is, or how young a baby is, there's going to be a process. If we looked around all the separate bays, what are all the different ways that babies will be receiving nutrition?

Sam Petridis  17:12

So in those early days, breast milk is always what we recommend. It's the preferred form of nutrition for obviously, those preterm and those sick babies. So you know, the evidence is out there, but we don't. We never push parents. We just make sure that we give them the information so that they can make an informed decision. So in those first days of admission, if mum's expressing, like I said earlier, they'll be having a little bit of cloth from just popped in their mouth, into the mucosa, and then, if baby is quite premature, they sometimes will need to be fed very gradually. So in the meantime, we'll need to use something called parental nutrition. So that's like a food. It's basically a fluid filled with nutrients, minerals that will help support growth and babies development while they while their stomach, while their gut is really immature. So it's called pn, or parental nutrition, and then as baby kind of grows, we'll, we'll start tube feeding. 

Emma Pickett  18:15

Can I just ask you about the the PN that's that's given intravenously, that's given. 

Sam Petridis  18:21

It is yes. So it's given. Ideally, it'll be given through umbilical lines, so through baby's tummy button and through their belly button. So yeah. So when a baby's first admitted, if they do need parental nutrition, often, they'll have lines going into their stomach, and the PN will go through that if they need it for longer term, they will then have what we call a long line. So it's basically a central line that's inserted by by doctors, and that that basically can can stay in for a lot longer than just what a simple IV cannula can.

Emma Pickett  18:57

So this is sort of pre milk. We're talking about this, this fluid that has all these nutrients absorbed into it, and then, but even in that stage we've we're still putting milk into baby's mouth with the mouth care, yeah. And then, so you'll see some babies with those central lines, some babies with the belly button lines, yeah. And then some babies with the with the NG tube, that's right,

Sam Petridis  19:17

nasogastric tube. So, so we have either a nasogastric or a gastric tube, so that they are the same effectively. But if a baby, for example, is having high flow or CPAP, the tube will have to go through the mouth, hence why it's called an orgastric tube. So that is just a little fine, thin, little tube with a little cap on the ends, and that's just inserted either up the nose or in the mouth, down into baby's tummy and then secured on the face, so, like a sticker goes on the face, and then we before any feeding, we aspirate some baby's stomach, so we have to make sure that it's acidic. So we always check what we call the pH to make sure that it's acidic. 

Emma Pickett  19:58

And staff question, but you're doing that. Make sure the tube isn't accidentally in the lungs. Yeah, so we want to make sure the tube is in the stomach. So to do that, you'll suck a little bit out to make sure you're getting stomach fluid, and then you test the pH of that. So you know it's definitely stomach fluid, because obviously, putting milk into someone's lungs is not, not a great plan.

Sam Petridis  20:15

No, no, no, absolutely not. If we can't get any any fluid from the stomach, will baby will need to have a chest X ray, and then we'll be able to see it clearly. Then, if, if the tube is in baby's stomach, 

Emma Pickett  20:26

so that tube isn't taken in and out, it stays there. The same tube stays there. And some people might be like, hang on, doesn't, you know, doesn't it need cleaning? 

Sam Petridis  20:33

I mean, we we recommend that it's changed ever every seven days, however, little babies, bless them, they will often touch their face, and they will often pull it out. So in reality, we are often changing it much more often than once a week. 

Emma Pickett  20:50

So yeah, and then tiny amounts of milk are pushed up that tube, yeah, in sort of regular intervals through the day, 

Sam Petridis  20:57

regular intervals. So if baby's quite premature, we might be feeding every hour or two hours, and it will might just be one mil, one mil at a time. And then very slowly, we'll start increasing the amount. So again, the doctors will think, we'll decide how much baby needs. So for example, we go off in the early days it will be, for example, 60 mils per kilo per day. So then you work that out, and it will be you divide it by 24 and then you get how much you give every hour. Does that make sense? 

Emma Pickett  21:30

Yes, yeah, yeah. So I'm familiar with the full grown calculation, which is 180 eventually tells you how little some of these little guys are and do you get an overlap between the PN and the tube feeding? So some people will be getting the PN at the same time as the big tube feeding starting.

Sam Petridis  21:48

Yeah, yeah. Okay. So as we're as we're slowly increasing with the milk feeds, we will then be decreasing with the with the parental nutrition, and then eventually they'll be on full enteral feeds, or full milk feeds, and the TPN will be stopped. 

Emma Pickett  22:04

Okay, okay, let's, let's imagine little hypothetical baby. I haven't got picked a name. You can pick a name hypothetical baby who maybe was born before 30 weeks. What's the sort of, I mean, obviously there's no typical because every baby is going to be different, and parents will have different feeding goals. But what's the sort of example of a journey that that baby might go on in terms of their feeding and where they'll get to at the end before discharge? 

Sam Petridis  22:28

Okay, so, okay, let's say baby Jack. It's been admitted to the level two neonatal unit, and as long as he's doing well, he'll stay with us, as I've described, baby might be on maintenance fluids. It might just be saline and glucose to begin with, and then perhaps TPN, or total parental nutrition while we establish an increased milk feed. So as baby is growing and getting getting bigger and the gestation is increasing. So we will then be looking for for babies cues. So we'll be looking for opening of our so this is kind of what we're teaching parents, so to look for babies cues, so hand to mouth, tongue poking out. And then we'll be pointing all these out to parents. Obviously they're learning as well. And then we will be encouraging skin to skin. And if parents do wish to breastfeed, then we'll be supporting with with that as well. But of course, in the meantime, we need to make sure that mum is supported to establish that that milk supply. So we recommend expressing, expressing at least eight times a day, ideally, next to their baby. And yeah, we give a lot of support with that. 

Emma Pickett  23:45

And you've got, you've got breast pumps in the unit. 

Sam Petridis  23:47

We do. We have, we have hospital grade breast pumps. We have one per space. So we're very lucky that we've got about 20, 20, odd, 22 pumps

Emma Pickett  23:57

so people can express their milk. And do you have particular volumes that I know people talk about hitting certain targets by certain number of days. It's difficult to talk about that without putting pressure on parents and demoralizing the ones that don't get there. So how do you have that conversation?

Sam Petridis  24:13

So I don't, I don't say figures. I check in with them every couple of days. We will do the UNICEF BFI assessment tool. So we'll go through that myself or my colleagues will, and we will just be making sure that they are doing everything that's recommended. So you know, hand expression, breast compressions, skin to skin, ensuring that they're expressing at least eight times and including overnight, because that's the big one. If baby's not next to you, it's, it's, can be very challenging for parents to to want to express overnight. And I completely get it. It's you tired, exhausted. So making sure that they're getting the support with that, and then we're checking in. So I think we kind of recommend that by day 10, parents should be mum sorry, should be getting about. 700 750 mils. So if they're not quite making that by, you know, if it's not increasing, then we will review that, and we will give extra support if needed. And I can refer as well. I work with the maternity infant feeding team as well. So if we feel that, oh, actually, is there anything else that I'm missing, that that parents need support with, and I will also, yeah, communicate with them, and we'll try and work together.

Emma Pickett  25:27

So obviously little, little hypothetical baby Jack at 10 days is not likely to be taking 750 mils. So that that 750 mils is about sort of future proofing and developing a milk supply for the future, which means a lot of extra milk floating around, is that that's being stored in a fridge, but not for very long, presumably, because your storage guidance is a bit shorter for babies of this at this stage in hospital.

Sam Petridis  25:51

So it's 48 hours in the fridge on the neonatal unit, and then we store in the freezer, and then that's kept for, I think, six months, three. Yeah, six months, I think. And we also recommend, if parents, if mum's got an oversupply or too much milk, once baby is kind of, you know, nearing to going home, then perhaps they might want to, wish to know, to donate their milk. So that's something as well. We we can recommend as well. 

Emma Pickett  26:23

Yeah, I'm a big fan of donation I'm a trustee for the Human Milk Foundation. And, yeah, I'm great. It's great to hear that you are, you know, supporting using, using donor milk, and people becoming donors themselves. Do you use donor milk in your unit as well? 

Sam Petridis  26:39

We do, yes, we do use donor milk. It's not commonly used is medical discretion, and the current guideline that we use is that if babies less than 32 weeks or less than 1500 grams, then yes, it absolutely would be used. We obtain our milk from the Chester milk bank, and we use blood bikers to to to get that for us. So that's, that's a fantastic service. We're really lucky. 

Emma Pickett  27:07

The blood bikers are awesome. I've been lucky to meet lots of them, and they're just zooming all over the country, bringing milk and just making such a difference to people's lives.

Sam Petridis  27:18

We often describe, you know, colostrum, you know, it's like a medicine for that for their baby, it's, it's, it's, it's so important, and that can then just supplement until mum's supply is caught up. 

Emma Pickett  27:30

Really, yeah, I mean, I don't want to kind of get into the details of research, because I'm not expecting to be a research expert, but if, if babies have access to human milk, we know that they're going to have better outcomes. Are you able to talk a little bit about that?

Sam Petridis  27:45

Yeah, so yeah, that I am aware of all the amazing research out there in terms that you know, babies will be able to tolerate feeds much better. They'll be in more likely to go home earlier. They're less likely to be readmitted to hospital, less likely to have respiratory infections or GI infections. And not to say how wonderful it is for mum and her health as well, her mental health as well. 

Emma Pickett  28:15

So there's some lovely research done recently. Amy Brown was involved in that research that showed that donor milk is also, as you say, a big impact on mental health. Not only does it impact on breastfeeding outcomes and the breastfeeding culture in the hospital, but it also it really helps parents that have incredibly vulnerable, vulnerable time in their lives to to feel that you know that that donor milk is making a difference and the mental health outcomes show that as well, and then tell us about neck. What's what's going on there?

Sam Petridis  28:45

So necrotizing enterocolitis is a or neck is a condition, a really serious condition, actually, that some preterm babies might be at risk of. So that's, that's why as well, that if, when babies are born less than 32 weeks, or less than 1500 grams, it's highly recommended to help prevent, to prevent that basically, which is basically an infection of the bowel, where the bowel becomes closed. It can be really serious, and some babies will need so it's usually diagnosed by an abdominal X ray or blood tests, and often they'll be treated with antibiotics. And often they'll the feeds will, will will be stopped so they just to rest that bowel. Sometimes babies will need to go for surgery, and sometimes babies will, unfortunately, won't survive. So yeah, it's that's extremely heartbreaking for parents. Just an awful, an awful, awful condition,

Emma Pickett  29:48

yeah, yeah. I mean, I guess you see so many parents at very, very vulnerable times of their lives, yeah, must be incredibly difficult. The work that you do is just astounding. I'm super impressed that you're able to. Consider it your normal daily life. I'm just talking about actually loss of bereavement. Some of the donors who do go on to donate milk with the HMF are what we call our Snowdrop donors, who have lost their baby and have carried on donating milk. And some have done so for a long time with very large quantities of milk, and some not so long, but in doing so have still made a huge difference to babies lives. Do you? Do you come across bereavement, bereaved donors in your in your hospital, occasionally?

Sam Petridis  30:27

I won't say very often, but we do have bereavement midwives who help support mothers families to do to do this if they wish. We actually have links with the Chester milk bank, and they have an initiative called the memory milk gift, and I think it was created in like 2021 and they have a milk memory tree, or a memory milk tree, and they can offer families the opportunity to have their baby's name added to the tree. And they also have, like a wooden memory milk pebble with their baby's name on it as well, which is, yeah, quite really, really sweet and really precious. So that's my experience. 

Emma Pickett  31:09

Yeah, that's lovely. Let's go back to baby Jack, who has not had any serious conditions and is doing well and is progressing with his feeding. At what stage would you expect him to be feeding directly at the breast. What's the sort of typical age to start that?

Sam Petridis  31:25

That's that is, yeah, that is a good question. So it would always used to be recommended at 34 weeks that babies could start bottle feeding. So, and that is, that is what we stick to at the moment. So 34 weeks, babies basically could start having a bottle because they're better able to suck, swallow and breathe and have better coordination. However, with Express, with breastfeeding, there is so much evidence out there that the earlier that you start breastfeeding or putting to the breast, the more likely that baby is going to establish breastfeeding and will go home, will go home breastfeeding. So at the moment, I teach staff to kind of observe baby's cues. So yeah, so we go off a lot of cue based, really. So parents, mothers will be having skin to skin, they will be then able to pop near the breast or to the breast, and then even if babies are just having a little smell and a little lick, it's all really, really positive. So we start this quite early, you know, anything from 32 plus weeks. And again, it's just observing when baby is, is, is ready, physically ready.

Emma Pickett  32:35

So some, some of these babies will still be tube feeding, might and still be even getting the PN feeds and but they're going to be as part of their sort of kangaroo care, skin to skin. They're going to be hanging out at the breast, and that will include possibly the beginning of breastfeeding. One of the things that some people say to me is, Oh, gosh. You know, these mums are pumping 700 mils of milk in 24 hours. They've got really forceful letdowns. You can't let a tiny baby come on the breast with that sort of flow, they're going to get overwhelmed. They're going to aspirate milk. What happens in that sort of situation?

Sam Petridis  33:07

I think that's probably quite unusual to happen, because I always think that a baby 32/33 weeks going to the breast will the baby has to be able to latch and suck, to be able to kind of get that let down. So I feel that's quite a new unlikely to happen. But what I will say is, if parent, if mums, feel like they do have lots of milk and they are really full, it's just a hand express a little bit off, or just go on the pump and just express a little bit off so that are a bit softer. What I hear often is people perhaps saying, Oh, they need to go to an empty breast. And I was always sort of shake my head and say, look, a breast is never, never empty. And just to, yeah, just to pop to the breast, hand, express a bit off, just try and soften. If Mum does have that forceful let down, yeah.

Emma Pickett  34:03

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  34:50

It's a difficult sort of transition period, isn't I would imagine there must be quite a it's quite stressful to think. Okay, so you know, Jack's had his feed. How much milk did he have? We don't. Know, and we've just spent X number of weeks measuring every blessed milliliter that went into this bloke. And I'm and I'm guessing, and you can tell me, if this is a bit cheeky that you know, maybe doctors will say, No, no, we need to know milliliters. And you're saying we know we need to go with the flow. We need to just see what happens. He's fine. I mean, you're sort of a bridge, aren't you, between that medical doctory brain and the parent to oxytocin brain. And how do you manage that balance?

Sam Petridis  35:25

We actually have quite a good tool that the neonatal network. So we're in our hospitals in a neonatal network. So we're in the West Midlands neonatal network, and they share resources with us, actually. And one of those resources is actually kind of a written guideline, like a chart. So often I will be using this to kind of show doctors. So for example, if baby is having a little feed, a little suck, but then going back to sleep, then we will say, okay, baby will need to have a full full top up. So we will give them the full milk that that baby needs. But then it's just, it is tricky as we're going along, and baby's getting a bigger and he's having a good suck, and he's latching really well. You can see it's beautiful. And he's sucking and he's swallowing, and you can see those swallows, but then perhaps still falls asleep quite soon. So then, then, then this, if we refer back to our feeding chart, breastfeeding assessment chart, that then will will maybe advise us that, oh, let's give a half top up. So I'm trying to use these tools to kind of educate staff on how we make that that jump. But there is still a culture of four hourly as well on our unit four hourly bottle feeding that we're trying to move away from. So if a baby is bottle feeding often, they'll be kind of three hourly feeding, for example. And then, then, obviously, oh, When? When? When they, when can they have four hourly fees? When they, when they can be? When can they be four hourly feeding, and this can be, yeah, quite a challenge. So I'm trying to promote and normalize baby led feeding. And I also work with my colleagues on the unit, who speech and language team, who are fantastic. They only were employed last year, and it's been made such a difference to the staff and family. So I've also got their support as well. So it really helps having that kind of multidisciplinary approach. So it's not just coming from me as a nurse, but also from a therapist, a specialist in their field.

Emma Pickett  37:34

Yeah, I mean four hourly feeding. I mean, I couldn't introduce you to many newborns who are full term and, you know, little chunky chaps getting, you know, doing four hourly feeding. The idea that some of these very small, vulnerable babies should be moving to four hourly feeding is really difficult to get your head around in the in the world of responsive breastfeeding. And absolutely, yeah, so that, um, well, I hope good luck with that, that cultural battle, because it, it can't, can't be easy. Um, I mean, do you feel that sort of breastfeeding gets the focus it needs in the NHS generally. I mean, do you feel like you're sometimes fighting battles, not the fault of any individual staff member, but is it? How do things feel at the moment?

Sam Petridis  38:10

So unfortunately, no, it absolutely doesn't have the focus. But there has been great improvements, especially on the paternity side, which has been implementing the BFI for longer than us on the neonatal unit, but sometimes I still feel like it's one of those extra fluffy subjects. For example, yeah, so people will still think it's, yeah, it's they don't necessarily have the gravitas or the importance that I think it deserves, and that there's lots of research out there. There's peer reviewed evidence that shows that it should. I would say staff numbers is one of our biggest problems. And like I said earlier, I do work closely with the maternity and feeding leads, and they are super stressed, stretched as well. And they run tongue tie clinics, and they see families that come into in for their support, as well as running the BFI project as well. And I think we just need a big overhaul of breastfeeding services, you know, coming from the top down, so the government could do such a lot more as well, especially incorporate incorporating, like the the code, so the International Code of marketing and breast milk substitutes, that would be, yeah, amazing. I don't see it happening in the near future, though, yeah, but I know that Scotland have made a lot better progress than what we have in the UK, and I think it's because the government there is set up. They've got, like, a set up dedicated funding source, and I think 100% of their maternity and community services are BFI. 

Emma Pickett  39:40

Yeah. So you you talked about the standards. Obviously, the maternity standards have existed for a long time. I think of the new and neonatal standards as new, but I guess they're not really new anymore. Someone who doesn't know about baby friendly neonatal standards, what sort of things do they talk about, and what sort of difference do you think they've made? 

Sam Petridis  39:59

So. So, so, yeah, the neonatal standard, Baby Friendly standards are newer than maternity but like you said, they're actually not that new, really. So maternity ones, I think, were introduced in like, something like 1994 and then a review was made, and I think in 2012 It was then expanded to the neonatal unit. So yeah, so the neonatal standards, there are three of them. So standard one is close to loving relationships. So then it's about supporting sort of families to nurture bonds with their baby, and includes things like skin to skin, positive touch, communicating with their baby, responding to their baby's cues and their baby's needs. Standard two is valuing breast milk and breastfeeding. So it's all about understanding kind of why breast milk is so important, and supporting parents to do it as well. And it covers like all areas like sucking and swallowing, latching, expressing donor milk and just knowing how it helps and some of the amazing ways it can benefit baby and family. And then lastly, standard three is Parents as Partners in Care. So this is kind of how we make sure that parents are empowered and feel more in control, and that they are like the number one most important thing in their babies, out healthcare outcome. So they need to be involved in decision making. They need to be kind of in a comfortable, supportive environment. And it can include like little things like getting free parking, which we have for the last three years. We've we've managed to get free parking for parents having meals on the unit. Yeah. So having, you know, pumps by the cockside, able to stay in the flat somewhere, to put their bags and their coats and more kind of complex matters like unrestricted access, so that they're able to be with their baby whenever they want, even if they're undergoing a procedure, for example, if they're having a long line insertion or, you know, sometimes we think it's kind that we we kind of think, or maybe perhaps parents don't want to be here for that, so just ensuring that they're they are here for for everything they want to be here. And quite a few years ago now, we during a ward round. So in a bay there'd be doctors have been doing the ward round and in the mornings. So once the parents had, you know, listened to their babies Ward their baby's ward round, they would then have to leave. So, for example, they wouldn't be able to have skin to skin or express next to their baby. But you know, because of these standards, that's one sort of massive improvement. So now parents are able to to stay for as long as they want, and they're not forced out of the room at all. So they can, you know, we just ensure that we talk quietly, and perhaps, if there is something sensitive, we we talk outside of the room in, you know, somewhere else, private. 

Emma Pickett  42:59

Okay, so all that culture of valuing parents and seeing parents apart as part of the care and and talking about breast milk, you know, all that's obviously about improving physical health, mental health, and it's also going to improve breastfeeding outcomes as well. And I'm guessing your unit measures breastfeeding outcomes. And you know, who's going home breastfeeding, you talked about expressing and you know, getting to that 750 mils, roughly, by about day 10, what is there anything else that we haven't talked about that helps get breastfeeding off to a positive start if a baby's born really early? 

Sam Petridis  43:33

So I think if we, if we are aware that a mum might deliver, a parent might deliver early, then I think it's having that support beforehand, so they might be attending pre term clinics, so the doctor, consultant or midwife there just ensuring that they're aware of how important colostrum is for their baby, and that it's known as liquid Gold, if a baby is admitted unexpectedly, I think updating parents and medical professionals and myself being able to go and discuss, sort of the importance for her, for baby, of colostrum and early expressing. So, yeah, so supporting to be expressing very, very early, really straight after birth, and then understanding the medical benefits of reducing infection and preparing the gut to function. And then there's the psychological benefit that mums get, that they're doing something really positive for their baby. So even if you know the care has to involve doctors and nurses, you know that it's something that they can do for that for their baby. And often we have mums who weren't planning on breastfeeding until they've had a baby that's admitted that's been unwell, and then they go on to do it and they and they enjoy it so early expressing can't, can't promote it enough, really. 

Emma Pickett  44:56

Yeah, and communication and using that breast part, actually, I'm glad you mentioned about. Expressing because, yeah, I think one of the things that I sometimes hear people say is, oh, you know, if you give birth to a term baby, you can't use a breast pump for the first, you know, three or four days, you're just hand expressing the colostrum. It's like, no, no, no. There's very, very few situations in which you wouldn't get a breast pump happening. And if you give birth prematurely, I know one of the one of the guidelines talks about, you know, pumping within six hours of birth if you can, just to really get things up and running

Sam Petridis  45:23

Absolutely. Yeah. So the baptism guideline is recommends within two hours, and then hopefully baby will be then able to have colostrum within those first six hours. So again, it's, it's it's not just that mum's getting a milk supply off to a good start. It's also those immunological benefits for baby as well that's been absorbed in, you know, they're having into their mouth and into their stomach. So, yeah, so you talk about pump pumping that is very old, very old evidence, I believe, for expressing three or four days after. So we recommend, actually, a mixture of hand expressing and being on the pump from day naught, 

Emma Pickett  46:01

that's that's the dream, isn't it? So otherwise, if you just pump, you're going to lose some stuff in the pump, especially when we're talking about small quantities. So hand expressing to get stuff out, expressing with a double hospital grade pump if you can for stimulation immediately afterwards. Is that? How do you describe it? 

Sam Petridis  46:17

Yeah, I think then it's just reassuring parents that please don't expect to get milk in when you're pumping. And day naught day one, because it will just be mostly for stimulation, and it will just help that that milk yield, that milk production. So sometimes they'll be hand expressing, and they'll, you know, we'll be getting naught point four, naught point, you know, little, small amounts, which is fantastic. And then they'll, parents will use the pump and then, oh, hold on, I'm not getting anything. So again, it's just reassurance that it still is really fantastic to keep doing.

Emma Pickett  46:49

Yeah, just about getting that. Prolactin switched on,

Sam Petridis  46:53

lactocytes switched on, absolutely and again, we recommend looking at pictures of their baby. So if they can't be next to their baby if they're not feeling well, if they're on postnatal ward, have had to go home, they're looking at pictures of their baby having a muslin that you can swap over. So we actually give out colostrum packs as well. So in those colostrum packs will be syringes with caps on, and there will be a little instruction of how to hand Express, and there'll be two little hearts, like little yellow hearts. So Mum, ideally, mum would have one. She popped one down her bra, and then one would go next to baby, and then when she'd come in again, they'd swap them over. So we're kind of getting the sense, if that makes sense, that's that's quite sweet. And of course, skin to skin always come back to skin, skin, lots of it. Baby should be naked with just a little nappy for as long as parents want. And this obviously can help reduce babies stress hormones and increase all that oxytocin and that love hormone. And then, you know, will also help increase mum's milk supply and then positioning near the breath so that baby can smell, can lick and nuzzle, and then Mum can talk and sing to baby and just help with that bonding. 

Emma Pickett  48:08

Yeah? And kangaroo care was a term that was used, wasn't it? Is that just because we're being a bit like a pouch and pretending we're kangaroos, which that sounds like a good plan? 

Sam Petridis  48:19

Yeah? Kangaroo care. So it's basically skin to skin contact. It's interchangeable. So yeah, babies placed against parents chest, dads can have skin to skin as well. We do try and promote that as well, which is lovely, but obviously for mum's milk production and to get breastfeeding off to a good start. You know, it's fantastic, really, for mums to do that. Yes. So there are lots of benefits, such as improvements in weight gain, increased lactation in the longer term. It can help bonding. It can help parents feel a lot closer to their baby and more confident in caring for them. Canary care should be direct skin to skin that's for warmth, so that's why we try and, like, not recommend having a bra on or not having going on top of clothing. Otherwise, baby won't be getting that warmth. But they can also have, like, a little blanket over them and a little hat on as well, if necessarily, if necessary. Yeah. But in some cases, like a baby might be too ill or too small, or their lines might be we might be, we might just want to be a bit careful, because we need to make sure the line is secure, the umbilical line, for example, so babies can come out with lines in. But sometimes, if yes, occasionally it might be that, you know, it's quite precarious, so there's a chance of it slipping out. We really need to keep it in, if that makes sense. So sometimes, if that happens, if baby is too ill, we will recommend parents kind of open up the incubator. They can get nice and close to baby. And we recommend something called containment holding, where they pop their their hand on baby's head and hands on baby's bottom. So just quite firm, a firm hold, and that can be kind of soothing. For babies, yes, at least then they're still able to kind of have some contact. We do also support with babies who are ventilated, so they have an ET tube in so they have a tube in their mouth, in their in and they are supported on a ventilator. And we do support support babies and parents to have skin to skin, even when they're on a ventilator. The only thing is, we need lots of staff for that, because there's a lot of equipment that needs to be kind of moved and and supported, because we don't want that tube to be dislodged. 

Emma Pickett  50:35

Yeah, okay, so all these things you're describing are just your everyday job, and I'm just aware that you are meeting people at such a high stress time of their lives, and I suppose that to an extent, that's true of anyone in breastfeeding support. Yeah, you're meeting new parents at a difficult time in their lives, but, but you really are meeting people at the most stressful time of their lives, you know, maybe just having had a traumatic birth and obviously really worried about their babies. How do you look after yourself and how do you kind of look after your colleagues?

Sam Petridis  51:03

I think we're really lucky because we work, you know, I work in such a great with such a great team of people, and we all really look after each other. There's lots of encouragement. There's lots of safe places to talk. We have WhatsApp groups where lots we can post, like positive messages that consultants and nurses and management will put on, and that's knowing that you're valued and supported in that way is really important. But when there is a tragic loss on the unit, which thankfully is isn't very often, it's quite rare, we have a good support system from each other, we will have what's called a hot debrief, so straight after the event, once things have calmed down, we will be able to to Yes, to basically have a good discussion of what's happened. Is there anything we could have done different how we feeling at the moment, but it still, it still hits hard. And then later on, maybe a couple of weeks later, there will be a cold debrief where we again discuss it and see what the outcome of of the situation. There are other agencies as well that support us, that we can be referred to as well, and they will come onto the unit, and they are able to support us as well. And then just ensuring that we all have our breaks, simple things like that. Sometimes, ensuring that, you know, we're able to have a hot drink, or we're able to have a break, yeah, is really helpful. Managers usually aren't on the unit, have an open door policy, so we're able just to come in and just, I don't know, just talk about whatever we need to talk to talk about at that time. So that can be really, really helpful.

Emma Pickett  52:39

I mean, you've talked a lot in this, in this conversation about parents and parent involvement, I'm just thinking back to covid. It must have been so hard to do this job in covid and and help parents to feel involved and and balance that, that sort of hospital again, that sort of hospital admin message with the kind of people, fuzzy message. I mean, would you describe things as being back to normal now, and have there been any sort of lasting impacts?

Sam Petridis  53:02

Things are more or less normal now, if I'm honest. So during covid, it was so tricky, it was awful. I just remember parents only being able, especially in the ITU, because of babies being on breathing support, on respiratory support, so that parents could only actually come into the unit, one into the unit once, and they'd have to leave again, and they wouldn't be able to come in again that day.

Emma Pickett  53:25

And what that's one parent, or could have both parents come in if there were two parents, 

Sam Petridis  53:29

no, just one parent, one parent, yeah, and only one at a time. We couldn't have other parents in as either. So it was, yeah, really, really awful, really challenging, really tough time. I remember having, I remember caring for a baby whose mum who had covid at time of delivery, and she wasn't able to come in or cuddle or feed her baby for, yeah, for probably 10 days or so from, from my memory. So, yeah, quite, quite a while. And yeah, but we did have, we did try to use tools such as we could take videos and we could upload them for parents. So we yeah, we did try to use technology where possible, so at least they could see videos of their baby. They could Yeah. They could Yeah, see, see their baby, basically, and we'd upload kind of little snippets of how their baby was doing, etc, so, but it was tough. And then following, once covid had calmed down, it still took us quite a long time to get our wider kind of visiting policy updated, because on the unit now it's parents. Can come in anytime. They can come in anytime come and go as much as they want. They can stay by their baby. They can have grandparents that can come and go as well, any other kind of relative they want. They want to come and see their baby as well. 

Emma Pickett  54:46

What do you do if somebody's unwell? This is the dark question. But if someone's coughing or spluttering, do you have a quiet word? I mean, whether it's covid or something else, how do you manage?

Sam Petridis  54:55

Yeah, so we do kind of speak to parents, and would would advise. That if, if you're unwell, or if you've got grandparents that coming in that are unwell, that that not, not to come in, really, so yeah, we do need to protect our babies who are quite vulnerable.

Emma Pickett  55:11

And are you wearing masks as standard? And you always have when you're caring for a baby? 

Sam Petridis  55:15

We used to, yeah, so we, we don't, we don't wear masks anymore. So I came back from maternity leave in January, and no, we weren't wearing masks. Before I went on maternity leave, all staff were wearing masks. So yeah, that's it's quite strange. So yeah, so like I said, mostly everything is back to normal. It took a long time, though, for us, we were one of the last, I think, in the network when the last units to kind of allow, allow that to make sounds quite a powerful word. We were one of the last units to to let sort of grandparents or aunts or uncles or even siblings to come in as well. But luckily, now that's you know that we're, we're, we are up to date and yeah, so anybody can come. Yeah, but we just advise that people who are unwell or feeling unwell not to visit. And often parents are happy with that, because they don't want their baby to catch, you know, an infection from somebody else. So they they will be more than happy, you know, to tell their their family not not to come in.

Emma Pickett  56:18

Yeah, that makes sense. Okay, so you've been very generous with your time, samma as we're coming up for an hour now. Okay, so here's the magic question, I'm going to give you an unlimited pot of money. Well, okay, maybe that's a bit of daft, because you like, Give everyone diamonds a big pot of money that you can spend in your unit and in your hospital. What would you be doing with that money?

Sam Petridis  56:37

Oh, gosh, that would be a dream, wouldn't it? So I think high up on my list would definitely be a new block of apartments, or new black block of flats, or some extra places for parents to stay, like some hospitals or children's children's hospitals, they have a Ronald McDonald House where parents can stay, and often, because we only have three flats, often, it's such a shame, because sometimes you have, like, a queue of parents who want to stay, and it can be really tricky. So I would definitely say more flats, more flats on sweet bedrooms. I would also like more support for siblings, so employing play therapists to play with them, to to help care for them, I suppose, yeah, and yeah to help, because then that kind of facilitate parents staying for longer, and help facilitate that bonding as a family. From a lactation point of view, I would absolutely say we need, we need more, more support on the neonatal unit. So ideally, another ibclc, you can just support families, that would be wonderful as well. Yeah, and peer support workers, that would be fantastic. And I'd also love for parents to have three meals a day as well. Because at the moment, we do offer meals, but usually it's just they have the one frozen meal and that's what they'll have. But yeah, to have three meals a day. Some more flats and, yeah, some more support workers to help with with supporting that feeding.

Emma Pickett  58:13

Yeah. I mean, the idea of peer support is, is really special. But, I mean, is there such a thing as a peer support that specifically someone who's had neonatal experience, because I imagine that's that's really special. If someone's gone through the same thing,

Sam Petridis  58:26

it is absolutely we do work with Bliss. So that's the neonatal charity, and they would have bliss champions that would come onto the unit, and they would be able to support families in their journey and their neonatal journey. But recently, we've had the breastfeeding network, have had some peer support workers start on the postnatal ward. So what we're actually hoping to do is have, maybe next year, is to have one or two that are able to come up to the unit who've got a special interest in neonatal care. So that would be wonderful as well. 

Emma Pickett  59:02

That sounds great. While you're doing such special work, Sam, I'm just really impressed, and I'm so grateful for your time, and I just imagine how many lives you must have touched in your career so far, and how many you're going to go on to touch. Is there anything we haven't talked about with regards to your work and breastfeeding that you wanted to make sure we covered? 

Sam Petridis  59:20

No, I don't think so. I yeah, I'm so passionate about my job. I love it. I'm so lucky to be doing what I'm doing. I just wish there was more of me to do it.

Emma Pickett  59:31

Yeah, yeah. I think a lot of people in your job must feel that, and also forgiving yourself for that and making sure that you can switch off and go home and be with your family and look after yourself too, because you are needed to be at your at your very best. So, yeah, so that's self care, and it sounds like you've got a lovely team. I met some of your team not so long ago at a conference and and they obviously have lots of affection for you, because they were like, You need to get Sam on your podcast. And there was lots of enthusiasm for you doing that, so I can see you. I can see you've got great relationships with your colleagues, which is really special. Absolutely. Thanks very much for your time today, Sam, really appreciated.

Sam Petridis  1:00:06

Thank you very much. 

Emma Pickett  1:00:08

Thank you.

Emma Pickett  1:00:13

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.