Breastfeeding and Osteopathy

This week, I’m pleased to be joined by Karly Proverbs, a specialist paediatric osteopath and maternal osteopath. She explains what an osteopath is, what goes into their extensive training, and what you can expect to happen during a consultation. 

We discuss the applications of osteopathy for breastfeeding babies and parents, including treatment of tension, torticollis, back and pelvic pain.

Karly is @‌osteokarly on Instagram and @‌nourishandgrowlondon

Her website is https://www.osteokarly.co.uk/

My latest 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

This transcript is AI generated.

[00:00:00] Emma Pickett: 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 too. Join me for conversations on how breastfeeding Breastfeeding is amazing, and also sometimes really, really hard. We'll look honestly and openly at that process of making milk, and of course, breastfeeding and chest feeding are a lot more than just making milk.

Thank you very much for joining me for today. I'm talking to Carly Proverbs, who is based in Beckenham in the southern part of Greater London. I don't know if that's the way to say it. It used to be a nice little town and now it's part of Greater London. I'm sure it's still a nice little town. 

[00:01:00] Karly Proverbs: Yep. 

[00:01:01] Emma Pickett: And Carly is an osteopath.

So we're going to be talking about how osteopaths work with babies and parents and mums. And we're going to be looking at that whole kind of world of body work and how it fits in with infant feeding. Thank you very much for joining me today, Carly. Thanks so much for having me, Emma. It's an absolute pleasure.

So I was going to ask you, first of all, about your fantastic surname. I have a vision of someone in, you know, in the medieval times, walking from village to village, being an expert on proverbs and being a minstrel and being the person everyone goes to talk to proverbs, about proverbs. You probably don't know if that is the case, but what's the origin of your surname?

[00:01:38] Karly Proverbs: So I'm originally from Barbados. Um, my dad is Bajan. My mum is Canadian. And I am married, but I never bothered to change my surname just because it was a faff. So it's a really common name where I'm from. Um, I've had friends kind of try to look my parents up when they've visited on holiday and they've, they've opened the phone book.

They, they still have phone books at home and um, found a, you know, a plethora of proverbses. So yes, it's quite unusual here, but it's, it's not so, it's not so uncommon where I'm from 

[00:02:15] Emma Pickett: originally. Okay. So. Are the people of Barbados really good at proverbs? Are there lots of proverbs? I think, yeah, 

[00:02:20] Karly Proverbs: they are. We have some amazing Bejan proverbs.

Yeah, we do. 

[00:02:25] Emma Pickett: Cool. Thank you for indulging me on that rather strange question to start us off on. No, not at all. So you mentioned that you spent your early life out of the UK. Tell us about your journey to becoming an osteopath. 

[00:02:35] Karly Proverbs: So I came to the UK when I was 18. I did a law degree originally. Before I was an osteopath, I practiced as a solicitor in the city of London.

And it didn't really fire me up. Um, so I took redundancy in 2008, I think it was, and I retrained as an osteopath. And this year I am celebrating a decade of being an osteopath, and it's a job I absolutely love. It's really fulfilling. Every day is different. If you, I think most osteopaths will say that.

And, yeah, it's, it's an absolute pleasure to do the work that I do. I really get so much fulfillment and joy from it. It's, it's, it's 

[00:03:21] Emma Pickett: really fun as well. And also you're meeting people at some very important times in their lives and, and having an impact which, which feels super special, I'm imagining. So, tell us a little bit about, um, the training then.

So what, what does that training look like? So, I don't think we're 

[00:03:37] Karly Proverbs: very good at telling people what we do, osteopaths. My degree was a full time four year degree, so it was quite full on. I studied, you're in North London, so you may know the British College of Osteopathic Medicine on the Finchley Road. Yes, 

[00:03:51] Emma Pickett: near the O2 Center.

Yes, I've walked past it 

[00:03:54] Karly Proverbs: many times. So that's, I trained there and yes, it was four years. It was really intense. We did, you know, anatomy, physiology. We did dissection for a year and a half. We went down to UCLH to their, you know, and we were there with lots of the med students. We did pathology, pharmacology.

I did a year of pediatrics at undergrad, women's health. Clinical methods. It was a really, you know, in addition to our osteopathic practice in sort of with with our fellow colleagues, and as well as that, we had our student clinic, which we started in our second year with observation. And then from sort of the beginning of our third year, we were running our own case lists.

Initially, we were buddied up, and then we eventually sort of fully supervised, of course, took on our own caseload, and it involves at least a minimum of 1, 000 clinical hours. So it's a, it's a, you know, it's a proper degree and it was a lot of work, it was a lot of work. It's not a 

[00:05:02] Emma Pickett: pretend degree, it's a damn proper degree and I'm glad you described all that because I think there are lots of myths about osteopathy, that's a word I'm not very good at saying, um, and, and you often get lumped together with other people who maybe have not done anything like that kind of training.

So I think it's really important to talk about that level of detail. I mean a thousand hours is a lot of hours. That is a lot of time spent with families and, and actually I can imagine that that experience is super important because you have to feel a lot of bodies to get to know what, how bodies work and what bodies are like.

So you finish those thousand hours and then you are qualified at that point. And is there a, is there a registry? How does it work in terms of sort of protecting families, but also in protecting the profession as well? 

[00:05:47] Karly Proverbs: So we are a regulated profession. Our regulating body is the General Osteopathic Council, and they have a public register, which is available on the internet.

You can just type in the General Osteopathic Council, it will come up. And any qualified, registered osteopath. Is listed on there with, you know, their details and in order to maintain your registration, you need to undertake 90 hours of continuous professional development every three years. So, you know, it equates on average to 30 hours a year.

And half of that has to be, can be on your own, but the other half needs to be with others. And you have to undertake as well an objective, um, sort of exercise. So that can be reflective practice. You can do a clinical audit. You can You know, discuss with a mentor where you think you could have improved on something or where you felt that perhaps your management of a presenting complaint was not, you know, something that you were familiar with.

And that helps to then enlighten the next three years and how you want to develop your practice, if that makes sense. 

[00:07:05] Emma Pickett: Okay. 

[00:07:06] Karly Proverbs: And, yes, I think osteopathy is a protected title, so you, you cannot call yourself an osteopath without being on that register. 

[00:07:17] Emma Pickett: Okay. 

[00:07:17] Karly Proverbs: And it's a registered health profession? 

[00:07:19] Emma Pickett: You're a health professional?

[00:07:21] Karly Proverbs: We are. Um, like. Physiotherapists, paramedics, podiatrists, occupational therapists and others, uh, we are allied health professionals. So there are 14 allied health professionals and we are one of those 14. 

[00:07:37] Emma Pickett: Okay. So obviously some people will be in private practice working in lots of different areas and we'll talk about some of the areas that you work in.

I'm going to ask you some really nickety questions in a minute Emma about what you're doing day to day and what you do when you're actually working on a baby. But before we do that, I'd like to ask you about some of the things that you're not. So what is a cranial osteopath and how is that different from a regular osteopath and what does the training look like for someone to become a cranial osteopath?

[00:08:07] Karly Proverbs: So cranial osteopathy is sort of a style of osteopathy. Osteopathy can look very different depending on who you go to and we're all quite individual in the way that we treat. I did a year of cranial osteopathy as part of my degree in my fourth year. It was optional. I was interested to know what it's about.

It's not something that I would say that I necessarily align with because I use very gentle techniques when I'm treating babies, which I prefer, and for me, feel more sort of, I, I feel that I'm more successful and I get better results. However, there are many osteopaths who are very experienced, who treat in a cranial style and people get great results and they're happy.

So I think it's partly personal preference, um, in terms of the practitioner and the patient, if that makes sense. When I'm treating sort of the general public, for example, I can use really forceful techniques, which obviously with permission, you know, where I use strong mobilization, I can also use things like deep tissue work, neuromuscular techniques, articulation of joints.

It sort of, it really varies on the individual, but I would also really like to make it. sort of clear that it is not simply about passive treatment. For me, That is a very small part of what I do. Education is at the heart of, of the majority of osteopaths practice. 

[00:09:49] Emma Pickett: Okay, you mean, you mean in terms of talking to parents and talking about, about what they're doing at home and, and, okay, okay.

It 

[00:09:55] Karly Proverbs: has to be that 24 hour. I'm, I, I had a chat with Nicola Walker, who I know was on your, on your show, and You know, in some ways it, we're quite similar, you, you have to look at what's happening. Really, I see someone for a very small portion of time and it's really important for me to understand what their life is like as well as I can, so that I can kind of influence and discuss with them how best, you know, lots of small changes can have a great impact.

So it's about giving stretches, exercises. And also management techniques at home, if that makes sense. 

[00:10:33] Emma Pickett: Okay. So let's break this down into a little bit more detail then. I'm just trying to understand if, if a parent's saying, Hmm, my baby is, something's not quite a hundred percent here. I think I need some help.

Do I see an osteopath or do I see a cranial osteopath? What will a cranial osteopath do that's, that's different from what you would do? 

[00:10:54] Karly Proverbs: So, for me, not working as a cranial osteopath, I can't fully describe what they would do. Okay. 

[00:11:00] Emma Pickett: No, 

[00:11:00] Karly Proverbs: absolutely fair enough. Yeah. And I think If you're not sure, it's always best to contact them, ask them how they might treat it, and how, how long it would take for them to see results and, and what it involves.

[00:11:14] Emma Pickett: Okay. And is a cranial osteopath somebody who's also on that same register, they've also done a four year degree? If they're using that word osteopath, that means they are A fully trained osteopath and they've just chosen to go into that one particular way of practicing. Absolutely. And what about a cranial sacral therapist?

What's, what's that mean? What does that mean? So, so 

[00:11:36] Karly Proverbs: as an osteopath, I don't know what a cranial sacral therapist and I don't know what their training is. I don't know what their registration process is. So, it's difficult for me to comment on that. 

[00:11:48] Emma Pickett: Okay. 

[00:11:49] Karly Proverbs: I wouldn't want to cast aspersions on anyone's, sort of, what they're, what they're doing.

I do know that there are lactation consultants in the area who are also craniosacral therapists and people get great results from them. 

[00:12:02] Emma Pickett: Yeah. No, I, fair enough. I totally respect that answer. You know, obviously you're only able to really talk about what you do and your profession, but I think. I'm going to be cheeky and say, I don't think it's a four year degree.

I don't think they are doing the end level of anatomy, et cetera, to quite the extent that you are all the things that you listed in your degree, um, or needing the thousand hours contact time, et cetera. But having said that though, I also meet parents that have positive results. And, and, you know, there are local practitioners who are very experienced in my local area that parents, you know, feel there's a value from and, and the world of alternative therapies and inverted commas, I mean.

You know, we could have a long conversation about what that actually means and how that, you know, that comes from different cultural experiences and things that, you know, we can't necessarily judge in exactly the same way, but, you know, I think, as you say, any parent will need to do some checking to work out who they're meeting and what that person's experience is.

So physiotherapy is maybe a little bit closer to what you're doing in some ways? I mean, 

[00:13:00] Karly Proverbs: I would say yes, but equally I'm not a physiotherapist, so it's incredibly difficult to sort of say yes, I am like a physiotherapist, because I'm not one. But having, having chatted to Nicola, our case history is similar.

We both have an obligation to rule out any sort of red flags, basically nasty conditions that would not be appropriate for us to treat. Obviously, there are some osteopaths that work for the NHS. I am not aware of any that work as paediatric osteopaths, but that, wouldn't that be lovely? Shout out to the NHS if they want to come and chat to any of us.

I would be delighted to be part of a multidisciplinary team on the NHS. I think There is so much that we could offer. I'm obviously biased, but, you know, it's, it's about that 24 hour care. It's about exercises. Yeah. And that's what physiotherapists 

[00:13:55] Emma Pickett: are often doing there. Uh, you know, Nicola talked about it in our episode on Tortocolis.

She's, she's talking about, you know, what people do at home is very much an important part of that treatment. Um, so let's, let's talk about babies. Let's, so I know you work with adults too, and I would love to talk to you in a minute about. When a mother's struggling postpartum, what you can do for that mother, but let's, let's particularly think about babies because when we think about helping babies who are breastfeeding and we think about body work, we've often got this image of, you know, maybe baby's got tension in their jaw or they had a forceps delivery or, you know, something's going on that's making it more difficult for them to gape widely while they're breastfeeding.

And we've got this picture of a baby on some sort of couch and a practitioner kind of looking like they're massaging, but maybe they're, is it massage? I don't quite know what it is. Let's imagine that baby Bob comes through the door. Baby Bob is maybe had a forceps delivery, is struggling to breastfeed effectively.

Let's leave tongue tie to one side just for a minute and just imagine that a baby's got some tension. And breastfeeding's not going well, or maybe they had an assisted delivery and, you know, they're uncomfortable post delivery. Let's imagine that conversation with baby Bob and baby Bob's parents are presumably the ones doing the talking.

What might that session look like? 

[00:15:06] Karly Proverbs: So I will always spend an hour for my first consultation. I always ask about pregnancy. What the birth involves, you know, how it looked, how it went. Um, and I'll ask the parents how they want my help, what they'd like my help with, what they think is going on. And we'll find out whether there are any sort of underlying health conditions with the baby within the family.

We will rule out any sort of nasty things, basically. I'll ask about weight gain, how many wet and dirty nappies. Whether they've lost a significant amount of weight, whether there's any sort of other management ongoing, you know, with other, other teams. And then after that, I will ask the parents to undress their baby down to their nappy.

And I will, you know, I will ask them to place the baby on the couch, but I always encourage parents to be right next to me. Usually on the other side, so that they have the comfort of knowing that they are right next to their baby. Um, I will do a neurological examination appropriate for that baby's age.

And I'll look at 

[00:16:19] Emma Pickett: what their hips are doing. Can I pause you for a second? Tell me about a neurological examination. What are you doing when you're doing that? 

[00:16:25] Karly Proverbs: So, I'm looking for newborn reflexes. I'm looking at their sort of adductor tone, inner thigh tone. I'm checking for atonic neck reflex to make sure that these are all present and, you know, what we would expect.

I check for head lag. You know, is it What we would expect at that age. 

[00:16:45] Emma Pickett: So when you've been, you sort of lift up the upper body to see what's happening to the head and whether the head is really hanging back or there's some neck strength. Exactly. 

[00:16:54] Karly Proverbs: I'm a big fan of tummy time. I will always place the baby with parent's permission or I will sometimes ask them to do that as well.

Um, on their tummy to see what it looks like, how comfortable the baby is in that position. I will see what's going on with their jaw, neck, you know, oral function. I'm not a tongue tie practitioner, but you just want to get a feel of how the tongue is moving. If they are breastfeeding, often baby will want to have a little break.

So we'll look at how feeding looks and feels. I'm an infant feeding coach, which. For me simply means I have just a basic understanding of breast and bottle feeding. I am not a lactation consultant. 

[00:17:38] Emma Pickett: You felt you needed that to be able to have some of these conversations. So rather than absolutely no training in infant feeding, I respect the fact you said, right, I need to get something here to be able to, to have this holistic conversation.

So, so you've done Bob's assessment, Bob says a bit of tummy time and, and let's say that Bob. Maybe does have a bit of asymmetry in their neck movement, or there is a bit of tension, or something is flagging up for you. What do you do next? 

[00:18:04] Karly Proverbs: So I will always explain what I've found to mum and dad, and I'll say, look, this is what I think is going on, this is what I propose to do.

I will always ask them to pass me their hand, and I will say, look, I'm going to use this amount of pressure. And I will effectively just do very gentle massage. And I might pop my finger in their mouth with mom and dad's permission and, and baby's permission. I might, let me just add, it could be mom and mom, dad and dad.

I'm just saying mom and dad. Um, but I'll try and see what their movement is like. And if there is any sort of tension, just. Very gently try and see if we can improve the range of movement appropriate for that baby's age 

[00:18:49] Emma Pickett: Okay, so you're massaging on a muscle and and to all I mean, which body bits are you touching?

[00:18:57] Karly Proverbs: It varies, you know because Some babies have, you know, Bob's had an instrumental delivery. Not every single instrumental delivery will look the same. So, it will present differently in, in different babies. It could be that, you know, they've got tightness in a sternocleidomastoid or a suboccipital. These are just names of muscles.

But I will simply say to parents, look, there's some tension at the front of the neck. There's some tension in the shoulders. There's some tension in the upper back. I think it's really important to keep things simple. We can use names of muscles, but that's not really particularly helpful to parents. They, they, they, it's just confusing.

I think it's important to to sort of explain what's going on, how you propose to, to help the baby and what, what they're going to be doing at home. 

[00:19:49] Emma Pickett: Okay. So you're doing a little bit of massage on the couch, um, and talking to the parents about what you're doing and, and the process you're using. And then.

After that bit of massage, you're then going to have a conversation with the parents about what they could do at home and what sorts, what sorts of things might you talk to parents about doing at home? Tummy time's a big 

[00:20:08] Karly Proverbs: one. I think mums and dads can get really, really anxious about tummy time. And in the first six weeks, I often say, look, contact naps are the best, the best form of tummy time.

It's just allowing your baby to experience the world in a different position. It helps with their proprioceptive development. They're hearing. What does that mean? So preoception is your understanding of where your body is positioned in the world. 

[00:20:36] Emma Pickett: Okay. 

[00:20:36] Karly Proverbs: So they are, because of the back to sleep campaign, babies should be put to sleep on their backs and we've seen that there's been an increase in things like flatness through one side of the head.

As a result of this, so it's just about getting them on their tummies that will help with midline strength, basically getting strong through their abdominal muscles, their neck. And also just getting them not in the same position all the time. I also sort of encourage baby wearing if that's something that parents are happy to do.

And I will always give them details of sling consultants or cafes where there are people who do their sort of drop in sling, sling talks, if that makes sense. 

[00:21:28] Emma Pickett: Tell me a bit more about why you think baby wearing is, is valuable for sort of baby's development. There are multiple 

[00:21:34] Karly Proverbs: reasons. I'm obviously not a sling consultant, but I've got friends who are.

I think it helps if you are breastfeeding. It's really comforting for baby. It helps with sort of that flow of oxytocin. It helps baby to be settled. Babies are, you know, we're basically designed to be carried. And I think having your baby close can feel very comforting as a mother and incredibly comforting as an infant.

You know, you basically, you're born and you don't really know you're separate from your mother. You think you're the same person. So, why not? If, if you're able to and you want to, why not carry your baby? It also allows you that freedom of being able to, to kind of have your hands free and potentially drink, drink a cup of tea in a, in a safe, like a, a safe mug.

And just kind of feel a bit less like, yeah, you're, you're, you have that, that closeness. And it's bonding as well. It's what we're really designed to do. 

[00:22:42] Emma Pickett: And presumably there are some benefits to maybe not being on that flat surface and being upright and, and, you know, that's, that skull can develop in the right shape and the next strength is going to be developed as well.

I'm guessing there are some anatomical benefits too. Absolutely. Yeah. Okay. So, let's imagine that you've looked at Bob, and Bob has torticollis. Now, there's a whole other episode I did with Nicola on torticollis, but, but when you see something that looks like torticollis, what's the next step for you? Are you signposting to other services, or is it something you're able to treat in your setting?

[00:23:15] Karly Proverbs: Osteopaths are well placed to treat torticollis. If it's quite severe, I will often Write to the GP or, you know, just recommend that they self refer for physio. I always think it's great to work in a team, and I am a big fan of saying look, you can have some osteopathy to start if there's a wait time. In many places there is a bit of a wait to see a pediatric physiotherapist.

I worked with a family and there was like a five month wait. 

[00:23:47] Emma Pickett: Oh my goodness, that's pretty darn crucial. I mean, that's the whole shebang, isn't it? Five months of not getting treatment. Okay. 

[00:23:53] Karly Proverbs: It was a difficult time. And it was great because basically, we basically aligned on everything that we talked about.

And they then got the benefit of seeing me. And once they were able to see the physio, they continued their journey with them. But it meant that we didn't lose time. And. We were able to get in and get started so that things didn't worsen. 

[00:24:16] Emma Pickett: Okay. And then talk us through some of the things that a parent with a baby with torticollis will be doing at home.

Again, is it tummy time, but presumably with a particular focus? What are those exercises look like? I will always 

[00:24:29] Karly Proverbs: encourage tummy time. I will ask them to get their baby lying on their side. I will show them how to do that so that they can stretch one side of their neck out. We'll get them doing some gentle stretches on the baby.

If they're breastfeeding, they can do it before breastfeeding. I will also talk about things like where are they sleeping? Are they looking towards that side that they favor? If so, can we swap, swap side, you know, turn the next to me or basically have everything that's interesting on the opposite side to encourage that lengthening.

I also talk about if they're bottle feeding, swapping sides, because sometimes you'll find that the way that they're, they're bottle feeding encourages that shortening through that already shortened side, how they're being held. If they have one preferred shoulder, can you get them sort of on the other side looking towards you?

It's about that sort of 24 hour care. 

[00:25:30] Emma Pickett: Okay. And, and how often are you seeing a baby more than once? And how often will you do just a one off session? What's the sort of typical pattern? Because I work 

[00:25:38] Karly Proverbs: in private practice, I want people to get, you know, the best value for money in the sense that I like to see results as quickly as possible.

So, I will see parents for a consultation and usually one or two follow ups can be all that they need. If it's something like a severe plagiocephaly, I would be referring them. That's a 

[00:26:05] Emma Pickett: flat, a flathead. Yeah, a flathead. Yeah. Sorry. Sorry. No, no, don't apologise. I just want to check what we've got the vocab for people who may be less familiar.

I would be referring to the GP 

[00:26:13] Karly Proverbs: anyway. You know, encouraging them to self refer for physio, usually both, um, because I think it's good for the GP to be aware and hopefully they get picked up in the system so that, yeah, you know, if you can get something on the NHS, we pay taxes and my sort of, I'm here for people, but I'm also conscious that people have budgets.

It's a, you know, we're in a cost of living crisis, so I really try and work with people. To give them the best value possible. 

[00:26:45] Emma Pickett: Yeah, it's a, it's a funny world, isn't it? Private practice, because we feel horribly guilty about being private practitioners. I can hear from your voice as well. You're so, you know, almost wishing your career away and wishing that you were on the NHS.

You gave your plea earlier to be an NHS osteopath. I mean It's, you know, we're in a funny world, I think, partly because babies aren't really valued and infant feeding isn't really valued. So many of the things that parents have to do, it costs money and it's, it's, it's horribly unfortunate. That's the situation we're in, but, you know, people are allowed to pay for their bills and we can hear your lovely dog in the background.

People need to feed their dogs and, uh, that's, that's the reality. But I do respect what you're saying about trying to give people as much value for money as they possibly can.

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 and Martin, is a guide for 9 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 percent discount on the last two. Go to Jessica Kingsley Press, that's uk.jkp.com and use the code. Mm PE 10 makes milk. Pick it. Emma. 10. Thanks. One of the things I'd, I'd love to talk to you about is, um, the breastfeeding parent or the feeding parent getting support and I think so much when we talk about body work.

We just think it's all about the babies and, uh, and, you know, the babies having their treatment and off they toddle and breastfeed. But I think people often don't realize that parents and mums can really appreciate having osteopathy and, and sometimes breastfeeding pain can actually be cured by osteopathy.

Which I think some people are really surprised about. Tell us a bit about some of the work you do on top of that. Let's use the word mum for now, bearing in mind that not all birthing parents will be mums, but but yeah, let's talk about what the kind of work you're doing with these parents. 

[00:28:54] Karly Proverbs: So yes, I mean, it's, it's really common people will come in and they'll just say, you know, I gave birth a couple of weeks ago and my neck and shoulders are absolutely in agony.

And yes, you know, it's, it's really common and it doesn't mean that you're doing anything wrong. It just means that quite often, if we kind of think about the position that we're in, we're sort of, we've got this tiny, gorgeous little human and we just want to get them positioned and we get them on the breast and we think, okay, they're there.

And I'm going to just be really rigid. My shoulders are going to stay perfectly still. And you know, our shoulders are nearly touching our earlobes. And so everything gets really, really tight, so I'll often get mums in and, you know, they're always encouraged to bring their babies. I don't want babies to be kind of an obstacle to treatment.

So we'll just work through the neck, the shoulders, you know, through the front of the chest, obviously not the breast tissue, but the pectorals that the muscle, you know, sort of the big bodybuilding muscles in men. their ribcage, because there's obviously a lot of change that happens through there in pregnancy, the low back, and just get things moving.

And I will show them what they can do when they're not breastfeeding to try and open up through the chest and just get some movement and some mobility to kind of counteract that. Basically you're sat like a bit of a question mark and we want to get them feeling a bit more like an exclamation mark. I will often use that, that phrase with people who come to see me because yes, it's, it's very, that pain can be very real and very debilitating.

And it's such an exhausting time. And when we're tired, that can really heighten our sense of pain as well. There's nothing worse than, than that sort of unnecessary pain. 

[00:30:51] Emma Pickett: Yeah, yeah. And, and I, my one thing I just flag up is that sometimes deep breast pain can actually be as a result of something going on with backs and, and shoulders.

And, and the, and the nerves are not super clever in that part of the body. We get referred pain and, and nerve signals being sent to different places. But I've worked with some mums who thought that deep breast pain must be positioning related, and sometimes it is to do with the breastfeeding, but it can also be to do with what's happening on the other side of their body as well, and, and we can get referred pain happening all over the place.

Do you find yourself, kind of, in coffee shops, struggling to not go up to people and say, Listen, just give me two minutes, I'm just going to put my coffee down, can I just talk to you about what you need to do? Do you struggle on the tube, not kind of bouncing up to people and saying, can we just talk about your shoulders for a moment?

[00:31:35] Karly Proverbs: I think initially when I qualified, it was like I wanted to help everyone, but it's usually worse at, sort of, pick up. People are like, oh, I've just got my shoulders really hurting, what should I do? And you just sort of go, you know, I I'm always, I love helping people. So I will always try and help people, you know, sometimes I'll get emails and people are not local to me and I will try and find a practitioner for them.

Osteopaths, you know, most people that work in healthcare, we just, we're in it to help. And so, yeah, you know, if people want to say, Carly, help, I will, I'll always do 

[00:32:09] Emma Pickett: my best for them. You unprofessional, unboundaried woman, you, I'm just kidding. I totally relate to that. It's so hard, isn't it? It's really hard.

Yeah, you haven't signed a contract. I haven't got your client history. Um, but I'll just tell you informally. Yeah, it's, it's very difficult. So I'm guessing quite a few consultations then are a parent and baby, mother and baby at the same time. I 

[00:32:31] Karly Proverbs: mean, I do, I, I work a lot with the antenatal populations. I saw a few, you know, I worked, I was in clinic yesterday and I, I saw mostly expectant mums, which was lovely.

Um, I see lots of, um, PGP, pelvic girdle pain. Neck and upper back pain, and I have also done training with Molly O'Brien, who's an amazing Midwife, she's developed something called biomechanics for birth, which has been adopted in a few maternity Units, I think what happens with that? What's what's that all about?

It's all about Helping I'll position women who might be experiencing labour dystocia, so I'll teach women about what they can do, and the techniques can also be used in pregnancy just to help with pain relief effectively. Okay, 

[00:33:26] Emma Pickett: so you're talking about posture, you're talking about sitting on bouncing birthing balls, what's happening?

A 

[00:33:32] Karly Proverbs: little bit, you know, it's really if you're, if you're expecting keeping your calves nice and stretched is really important. We talk about, there are a couple of techniques like shaking the apple tree, um, which is a wonderful way of just helping everything to feel good. more supple. 

[00:33:50] Emma Pickett: So you're pretending to shake an apple tree that you're literally standing up and pretending to you're shaking a trunk.

You can 

[00:33:56] Karly Proverbs: Google it. I'm sure that images will come up, but it's, it's great. And it's, it's also. I saw a lady yesterday, her husband joined her partway through the, the consultation and I showed him what he could do, um, it's a lovely thing that birth partners can do to support their other half, um, in labor.

Okay. And it can be, it can be very relieving. It's a really nice thing and it helps them to. to have a bit of agency and, and not feel quite so helpless as well. 

[00:34:26] Emma Pickett: Okay. Thank you. I'd like to ask you a bit more about pelvic pain, if that's okay, because that's something that I think that, that really hits people hard.

Obviously, some people hard at the very end of pregnancy. What is actually happening when somebody has PGP? 

[00:34:39] Karly Proverbs: So a lot of PGP is referred pain. Um, it basically refers to any, anything that the muscles of your glutes, your backside, Uh, your inner thighs, your quads, your hip flexors, they can all kind of refer to the pelvic girdle.

That's where you experience the pain. And it's, in my experience, the way that I tend to work with pelvic girdle pain is just Finding those areas of tightness and imbalance and just helping to release those areas and get things just feeling much freer. Unfortunately, there are waitlists to see the physios on the NHS, and all too often I am seeing expectant mums who come in.

And they're desperate. They're, they're sort of limping in and they're quite heavily pregnant. And they say, look, please, can you help me? I am planning to have a vaginal birth, but the wait list to see a physio is six weeks and I'm due in three weeks time. So, you know, I'm really stuck and I'm really terrified that I'm going to not be able to.

You know, have a vaginal birth and in the majority of cases, you know, they will walk out of the treatment after a consultation. That's not always the case and I'm not sort of, this is not just, this is not just me. This is many, many osteopaths across this country who are very skilled at treating pelvic girdle pain.

You know, you, you don't. need to suffer if you've got pelvic girdle pain. If you can't see your NHS physio, please consider speaking to an osteopath, asking them if they have experience in treating pelvic girdle pain. And get some, get some help because there's, there's a lot that can be done. I 

[00:36:33] Emma Pickett: mean, one of the things that I sometimes hear is someone says, Oh, well, it's about relaxing.

It's about the hormone relaxing that has to do its work prior to giving birth. So your pelvis is opening up. There's nothing that you can do about it because it's about relaxing. You have to wait till you give birth and then the relaxing is going to reduce and you're stuck with that. You're saying that's not necessarily true, that it is actually.

No, 

[00:36:55] Karly Proverbs: there's, there is, you know, sometimes just. doing some, some work on those tight muscles, releasing, just getting the spine moving more freely and not just the low back, but just treating the whole body, treating those curves. Are they very tight? Seeing what's going on can just, it can be, I don't want to say miraculous.

We are not miracle workers. We are just helping to guide the body towards health. But there is a Transformative. Let's say transformative. Okay. Really, really helpful. 

[00:37:28] Emma Pickett: Okay. Really helpful. I mean, talking about relaxing, I don't know if that's something you covered in your training because something I often hear as a lactation consultant is people are being told by medical professionals that if they continue breastfeeding.

They will keep their relaxin hormone levels high and they will have more problems if they're taking part in sport. Uh, they're more likely to twist ankles, they're more likely to have problems with, with other areas of their body. Is that something that you've, you've come across being said? 

[00:37:56] Karly Proverbs: It is something that's said, but there's also now.

evidence. I don't have any of the data to hand, but they're starting to question whether that is actually the case. 

[00:38:06] Emma Pickett: Yes, that's what I, that's what I was glad you said that because that's certainly my understanding is that we don't have evidence for that opinion. That opinion is not based on, on logic in terms of looking at the data and looking at the science.

It's, it's, it's an assumption that's often coming from an anti breastfeeding point of view rather than based on evidence. 

[00:38:24] Karly Proverbs: And I do think that there are so many, if you are able to breastfeed and you want to continue breastfeeding, there are so many. Benefits that far away, you know, sort of this business of relaxing.

Even if that was true, which we're questioning. Exactly. Exactly. Um, so yes, I think always question, I think is, is a good way to maybe answer that 

[00:38:49] Emma Pickett: question. Yeah. I mean, I've even come across people who've been told, Oh, you've got to stop breastfeeding before I can treat this because your breastfeeding is what's causing this particular problem.

And I, I just don't understand how they think it relaxing works. I mean, relaxing has a purpose to do with birth and why would the act of breastfeeding and lactation and producing these, you know, lactating hormones evolutionarily, why would that perpetuate that problem? It doesn't seem to make an enormous amount of sense in terms of the science.

We need more research and unfortunately this is not an area where someone is paying to do a lot of research. Yeah, let's talk about tongue tie. So you mentioned tongue tie briefly and I appreciate, respect the fact you said you're not a tongue tie practitioner, nor am I. I'm also just a general lactation consultant.

But as, as with you, we come across babies with tongue tie and we need to know where to do our signposting. Tell us a little bit about what your day to day support for a tongue tie baby might look like and, and who else you might signpost to. 

[00:39:45] Karly Proverbs: I will always, you know, when someone's coming to me with breastfeeding, you know, they sort of go, I just sort of feel like maybe the baby's tense and they're just not latching on.

I will always ask the questions that relate to the symptoms that cause tongue tie as well as other things. And if it sort of feels like it's pointing to, there can be so many, as you know, there can be so many causes of certain sort of presenting symptoms and signs, but I will try and take a look under the baby's tongue and I'll just say, look, I will make it really clear to parents that I am not a tongue tie practitioner, but I will say, I can't say whether there is one, but I am, I think it would be good to get it looked at, okay.

And I will ask them to speak to the GP because they can do referrals. Or there are breastfeeding cafes which are run by lactation consultants in the area. Um, and I will signpost parents to those. And you can get referrals to Kings from lactation consultants locally. If parents want to be seen very quickly, there are some amazing private tongue tie practitioners registered with the ATP.

that I send people to. I'm also involved in, it's a new venture between myself and my friend who is a lactation consultant and my another friend who is a midwife, a lactation consultant. And tongue tie practitioner. I should probably Leoni Bryan. She's a midwife. I gonna say give, give us names. Yeah. 

[00:41:22] Emma Pickett: So, so Leone Bryan is your lactation consultant.

[00:41:25] Karly Proverbs: She, she's a lactation consultant, uh, a midwife and an a TP tongue tie practitioner. And Sally Rickard, uh, baby Thrive, who is an I-B-C-L-C. Um, so the three of us kept sending people . We'd go, I think you should go and see my friend Sally, or I think you should see my friend Leone. And we kept. You know, it was like this mad circle, we kept sending people to each other because a lot of the time people are just, they're desperate, you know, you want to breastfeed.

And you just will do anything and sometimes the support just isn't there, unfortunately on the NHS. I'm not knocking the NHS. They're amazing. Um, but people want to kind of get on with it because we've got that precious window in which to establish our supply. And, you know. So we were referring people to one another and Leone is brilliant, she's such a, she's our leader.

And she said, come on girls, we're going to start something. So it's called Nourish and Grow London. And what we do is we offer assessments, we have to get restarted for the new year, but we basically have it limited to about five families a session, and we will sit down with those families, we'll ask them about their births, what has brought them to us.

And we have a bit of a debrief, and then it gives these parents and their babies an opportunity to see each of us. So Sally will talk to parents, you know, and cover questions that they have for her as an IBCLC. Leone will do a tongue tie assessment on babies. And from there, they can either see her privately, if there is a tongue tie present that she thinks would benefit from division, or she can refer to local tongue tie services on the NHS.

[00:43:23] Emma Pickett: So Leonie's obviously, she's a midwife. So just as just a shout out to say in the UK, anybody that's doing a tongue tie procedure should be a registered healthcare professional. So they need to be a doctor, a nurse. Osteopaths also sometimes do it, or a dentist, but they need to be a registered healthcare professional.

And in your team, you are offering that sort of multidisciplinary option and one of those options is access to somebody who's a registered healthcare professional, which sounds really valuable. Yeah. And you mentioned the ATP, just a shout out to them. That's the Association of Tongue Tie Practitioners.

Thank 

[00:43:57] Karly Proverbs: you. 

[00:43:58] Emma Pickett: Not everybody who's a Tongue Tie Practitioner is on that, on necessarily on their listing, but almost always. And even if they're not, they should always be a registered healthcare professional. And if someone is trying to work out who's the best person to work with their baby, if someone's looking for a practitioner, I mean, what's the sorts of things that you think a parent should be looking out for?

If someone's thinking, oh, my baby's got some tension, I'm struggling, should I see an osteopath? How would you encourage them to sort of do that investigation if they're looking online, for example? 

[00:44:27] Karly Proverbs: So 

[00:44:27] Emma Pickett: I 

[00:44:28] Karly Proverbs: would always have a look at who's local to you, um, and then check that they are a general osteopathic council registered osteopath.

Um, word of mouth is always great. I think that's kind of the, the, that's where I get the majority of people who come to see me. It's by word of mouth. But if there isn't anyone that you have had recommended to you, general osteopathic counsel, and then contact them and check that, you know, if, if you're wanting to have your baby be seen by an osteopath.

Not every osteopath is a pediatric osteopath. I have done postgraduate. a year of postgraduate training in order to be a specialist paediatric osteopath. So it's worth, it's worth checking that they have postgraduate training because babies are not small adults. Um, they have unique physiology, you know, it's unique to them.

Um, and it's important to, to know about it and then have a chat with them. There are some people who Or perhaps not. They haven't done lots of like a postgraduate certificate, but are very experienced. So just get a feel for that person and then ask them how many treatments they think they'll need. Um, and what the, how they tend to deal with.

Those sorts of issues, you need a management plan, you know, where are you and where do you need to be and how are you going to get there? 

[00:45:59] Emma Pickett: Yeah. So, yeah, I think that conversation about if they've got pediatric training and pediatric experience is so important, so not all osteopaths are trained in, or even presumably in the postnatal period.

I mean, you know, I'm guessing to be a maternal. You know, a post birth specialist also takes a little bit of extra thinking about. 

[00:46:17] Karly Proverbs: Yeah, you know, I've done, I've done pelvic health training. So because I, because we have to do lots of continuous professional development, mine is focused on antenatal and postnatal populations and babies.

Because that's what I love doing and it doesn't it doesn't feel like work. So I love courses. It's good fun That's a good attitude 

[00:46:40] Emma Pickett: to think about and I love the fact that half your courses have to be with other people I think that's super nice. I mean lactation consultants We can just do all sitting in front of our laptops, which is which is a bit of a shame Um, I think I like the idea that you have to be with other people So so how long have you been doing the nourish and grow?

So we started, 

[00:46:59] Karly Proverbs: we only started at the beginning of October because we've been chatting for a while about it. And Leone was like, right, we're going to set a date. My son was recently diagnosed with a chronic condition, so we've had a bit of a break from it because I've, it's okay, I've just been, we've had to kind of learn how to deal with it as a family, but we're hoping to restart either this month, you know, basically in the first quarter of this year.

And it's, it's really nice because we basically charge 100 for people to see the three of us, so it is at a reduced cost. 

[00:47:35] Emma Pickett: Do you 

[00:47:35] Karly Proverbs: do 

[00:47:35] Emma Pickett: have payment plans? 

[00:47:36] Karly Proverbs: We don't, but I mean, if people are struggling, we are still always happy to see them, because I think we're all really passionate about people achieving their feeding goals.

It's a difficult time for people and we just really, we love women and, well, we love people and we just want to help. And I think it's our way of trying to give a bit back to our community, if that makes sense. 

[00:48:01] Emma Pickett: Yeah. Well, that's, that's kind of you to offer that. I mean, I think if I was going to make a suggestion, have a fund.

I know Catherine Stagg does something like this. There are lots of, lots of us lactation consultants. If we will get donations from parents who are better off so we can offer free spaces. Um, so you might even have a, you know, optional five quid extra on top of a consultation that goes into your pot that then can mean that you can see some people for free if that needs to be something that happens more regularly.

That's a 

[00:48:29] Karly Proverbs: great 

[00:48:30] Emma Pickett: idea actually. 

[00:48:31] Karly Proverbs: Yeah, we hadn't, I hadn't thought of that. Thank you. 

[00:48:34] Emma Pickett: Yeah, no, I mean the You know, London's an interesting neighborhood in that you have people with incredible wealth right next to people who are absolutely in, you know, in the lower socioeconomic groups really struggling. So, so sometimes the people with the wealth are very happy to help people who are doing so well.

And, and, you know, those funds work really well. I see people each month who don't have to pay. Based on donations from other parents. So yeah, as I said, it's you need to feed your dog, Carly. Your dog needs to eat so you can't fill every session for nothing. So, um, you know, sometimes contribution from the wider community in the same way that you want to help parents, sometimes other parents want to help other parents.

So take advantage of that. Okay, thanks very much for your time today, Carly. I'm going to ask you one little question. I think sometimes the world of body work, people are a little bit sceptical. I know that there's one very well respected breastfeeding organisation that actually doesn't let their volunteers.

Talk about body work with families when they're in a breastfeeding support situation and they they say that there isn't sufficient evidence And we shouldn't be signposting. Well, first of all, there's the question mark of signposting to private practice that that I think we can all understand But they're also saying even generally it's not something we should be advocating in the breastfeeding support world because we don't have evidence I mean, what do you say to someone who says, you know, lumps you all together in the world of body work and is a bit more sceptical about it?

[00:50:01] Karly Proverbs: I mean, there is some evidence. Um, there are a couple of studies. There was one in 2017. Um, I'm trying to remember her name. It's Hertz, Hertz Affleroy. She's an Australian, um, osteopath, IBCLC, and MD, if I'm not mistaken. Um, who did find that osteopathic treatment was beneficial to breastfeeding infants. And another study in 2019, which found that babies in the NICU in Italy were able to, I think they, they sort of improved their feeding and they were, it shortened their stay in NICU by five days.

The evidence, you know, the sample sizes were small, um, and it was only one practitioner in both instances. So, it's difficult. It's not high quality evidence, but there is some. The difficulty is funding for osteopathic treatment. Um, we are a small profession and it's funding and it's time. I would say anecdotally, many osteopaths have great results and people come to see us.

and are really happy. Obviously that's, that's 

[00:51:19] Emma Pickett: not evidence, but I, I don't think it's There's so many things that involve women where we're not going to get massive research trials and enormous amounts of evidence. I mean, I don't see, you know, huge research trials done on certain breastfeeding pillows and we're all soon to be using those.

I don't, you know, I'm not giving that as a very clear example, but my My point is, in the world of lactation and in the world of maternal health, in the world of baby and mum health, we can't always wait for the evidence. Sometimes we do have to look at what we call best practice and what is helping people and what are people's experiences and, you know, what matters when it comes to word of mouth.

There's that thing, isn't there, about medical treatment either does harm, or it benefits, or it does no harm, or it's neutral, or, you know, there's, and even if osteopathy was a bunch of bollocks, which it isn't, because I wouldn't have spent 15 minutes talking to you. It does no harm to sit a baby on a couch and, and talk to a parent about their history and, and go into detail and all the, you know, all the exercises that you're doing, all the home stuff and even if the massage itself wasn't the valuable bit, even if it was, you say placebo and everything and the conversation around it and the stuff parents did when they got home was the valuable bit.

That would still be valuable. By the way, I'm not saying that when you massage a baby, it's a bunch of bollocks. Um, my, my point is that it's, it's, apart from the financial aspect, it would, it doesn't cause harm. And I certainly have been doing this for nearly 20 years and I've seen lots of families who've benefited from, from doing body work.

And, and, you know, there are some really respected lactation consultants around the UK. Sarah Oakley is one name that springs to mind who uses body work, you know, 

[00:52:55] Karly Proverbs: as part of, you know, as part of 

[00:52:57] Emma Pickett: the way she signposts families and, and, you know, she is so experienced and I trust her very much and she is not about to, you know, point families to something which has no value.

And, you know, that's, that's true for so many very, very experienced lactation consultants. I don't meet. Many lactation consultants who've been doing this for more than a decade, who don't understand the value of what you're doing. And so thank you so much for helping the families that you help and, and helping the babies and parents that you help.

And yeah, I look forward to hearing how, how Nourish and Grow develops and, uh. And if anyone's listening who is in the NHS and management and is in the Beckenham area and fancies a, has a little bit of extra funding and fancies a free clinic, which involves these three lovely ladies, then they know who to get in touch with.

Thank you so much for your time today, Carly. I really appreciate it. 

[00:53:47] Karly Proverbs: Oh, you too, Emma. It's been such a pleasure. Thank you so much for, for having me and for talking to me about osteopathy. I'm really grateful.

[00:54:00] Emma Pickett: Thank you for joining me today. You can find me on Instagram at emmapickettibclc and on Twitter at 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.