Pumping and flanges with Amber Clark IBCLC

Every so often a project comes along with the potential to radically change the experience of lactating parents. My guest this week, Amber, has one such project.

Amber Clark is an infant feeding specialist nurse and IBCLC working in Wessex. Her work, the Early Breast Milk Improvement Project is all about improving outcomes for pumpers by fitting flanges properly and increasing pumping efficiency.

In our conversation, we delve deep into the world of breast pumping and flange sizes. Amber shares her expertise and exciting findings, covering the critical impact of correctly fitted flanges, the challenges of standard pump sizes, and practical advice for both health professionals and parents. 

Find the project toolkit here - https://healthinnovationwessex.org.uk/projects/658/early-breast-milk-improvement-project-toolkit

And the research that inspired Amber here - https://journals.sagepub.com/doi/full/10.1177/08903344241296036

Amber is @‌empoweredbirthuk on Instagram or you can contact her at amberclarkibclc@gmail.com

My new picture book on how breastfeeding journeys end, The Story of Jessie’s Milkies, is available from Amazon here -  The Story of Jessie's Milkies. In the UK, you can also buy it from The Children’s Bookshop in Muswell Hill, London. Other book shops and libraries can source a copy from Ingram Spark publishing.

You can also get 10% off my books on supporting breastfeeding beyond six months and supporting the transition from breastfeeding at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me 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 am 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 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's episode Today, I'm delighted to be joined by Amber Clark.

She's gonna help us do a deep dive into the world of pumping and flange sizes, and she's going to share some details of an exciting project she's been working on, which I think is really gonna help to transform the way we look at pumping in the UK and and flange size in particular. Amber is an I-B-C-L-C, and she's a nurse by background and she's got experience of working alongside a private midwifery practice in her home country of the USA before she moved to the uk and she's based in Hampshire.

She wears lots of different hats, and we're gonna be talking about some of those today. But as I said, we will be focusing on breast pumps particularly. We might refer to brand names for the sake of education, but just to highlight that if we do mention a brand name that doesn't constitute an endorsement, and neither Amber nor me receive any money from pump companies.

This is all about education. This is helping people make informed choices. We're both IB CLCs, so we are covered by that code of conduct and, and the code of ethics. So many parents use breast pumps as part of their daily experience, but there's actually very little discussion on some of the basics of how to use them.

And Amber's project and Amber's work is really looking forward to filling those gaps. Thank you so much for joining me today, Amber. Really appreciate it. 

[00:02:01] Amber Clark: Thank you so much for having me Emma. 

[00:02:03] Emma Pickett: Pleasure. So let's, can I just start by asking you a slightly curious question. So, obviously you came from the States to live in the UK and the way lactation consultants are.

Treated in the uk and the states are very different. The status of them is very different. The health system's very different. What kind of differences are you finding? What, what differences have struck you particularly and how are you finding the lactation support world in the uk? 

[00:02:27] Amber Clark: Yeah, that's, it is a interesting question and it's, uh, a question that I could probably talk a long time about.

So I'll try to be concise, but, um, I've been a nurse, a registered nurse, uh, since 2017 in the States, and I've lived here in the UK for about six years now. To be honest, it, it has been, uh, a transition for sure, trying to find my niche. Um, as you said, the health systems are quite different, so, um, in the US the maternity wards are all ran by registered nurses, so not midwives, and that's a big difference.

Specifically speaking about lactation, um, I think in the US uh, that I-B-C-L-C lactation consultant registration certification has been recognized and, uh, kind of held in high esteem for a very long time. And most hospitals have infant feeding teams, um, that are run by registered nurses that are lactation consultants, IBCLCs, and they must have both of those together.

Uh, for the most part. There might be some rare, some exceptions to that, but in general, that is what you find. And so an infant feeding team there is, is quite different in how it functions than it it would here in the uk. I find that we don't have, you could say as robust standards, uh, here as far as requirements for education for a lactation team or infant feeding team.

But specifically in the US it can vary by location. Uh, but in general there usually is a 24 7 coverage on maternity wards, and those NICUs do often have dedicated infant feeding teams that do not get pulled. And I think that you find here in the uk some areas, uh, have different standards that are different requirements and so it is very variable based off of your region here.

And it can be a tricky, uh, conversation to be had nowhere's perfect. But, uh, we could probably learn from each other, if I'm honest, uh, to bring in different things. 

[00:04:22] Emma Pickett: Yeah, I mean, I, I no, thank you for highlighting that. No one's perfect. We're certainly not here. And, and you know, in the States you've obviously got issues with the not having the code and people being given out formula samples, but it's always intriguing to anyone who does a little bit of a deep dive in the world of lactation how high the breastfeeding rates are in America, and how.

Breastfeeding rates tend to be sustained. So we have really high initiation in England, for example, but the drop off is massive, as you know. Whereas in the States, sometimes the initiation is a bit lower. But you know, at six weeks, at six months when the CDC was counting breastfeeding, let's hope that continues.

Um, we, you know, we found that the rates were actually higher in the states. And I, and everyone is so confused by that because you don't have maternity leave in the same way. You've got formula samples going out. You've got, you know, pediatricians giving out formula samples. But yet your breastfeeding rates are higher.

And I wonder whether something about protecting breastfeeding support in hospitals in those first few days, making sure people have access to Rrb CLCs is part of that. I dunno whether that's something you would maybe say. 

[00:05:25] Amber Clark: Yeah, I would, I would definitely agree with that. And even as we've said, it is a very different system.

But when I left hospital I gave, was given a handout that said you can access an I-V-C-L-C at this local, you know, free support group. You can, and it, and it very much is geared around and if it being specialist, lactation consultant, giving you that, uh, support you need in those first, uh, few weeks or days.

And I think for me specifically, coming from there, I've got a history of needing to express and pump and, and that culture there, uh, is, is a a lot different, as you were alluding to, we don't have very good maternity leaves in the us. And so people are quite quickly having to go back to work. And so pumping is a, a big culture in the US where it's not as much here.

And I think, uh, this project specifically is interesting to me because pumping has been something I've got a lot of experience with just simply from coming from the states. 

[00:06:24] Emma Pickett: Yeah. 

[00:06:24] Amber Clark: And I think that's why this, this specifically is impactful for me to discuss. 

[00:06:30] Emma Pickett: It's possible to be a lactation specialist in the UK and, you know, be a midwife and have worked for many years and never really have had any training in pumps, never any training in flange sizes, you know, and, and obviously that's something your project is looking to address.

And yeah, I mean it's, it's really easy to get into a kind of bashing of a system, but we have to acknowledge that you can give birth in the UK and not see anybody trained in infant feeding. You know, you might ask for help and they say, oh, she only works two days a week, or They're not here today, or they only do nine to five.

Or the volunteer peer supporters happen to not be on the wards right now. Whereas that's unlikely to happen in the States. We've got other problems about people who aren't covered by insurance and bigger issues, but when it just comes to access to an I-B-C-L-C, I think we've, we've got a disparity there.

But anyway, as you say, that's a whole other conversation. I agree. Let's, let's get your, let's try and get stuck into the pumping conversation. Just tell us a little bit about some of the different hats that you're wearing. What, what's some of the roles that you're doing right now? 

[00:07:23] Amber Clark: Yeah. So I primarily work, um, at a large tertiary hospital in southeast England as an infant feeding specialist nurse.

[00:07:29] Emma Pickett: Can I ask you a really dumb question for anyone who doesn't know what's a, what's a tertiary hospital? What does that mean? Uh, 

[00:07:34] Amber Clark: so really large hospitals, so your highest level, you're taking care of the sickest moms, parents, women, uh, birthing people, um, and babies. So, you know, babies born at 23 weeks. So, so that's why this project specifically is so impactful for me, is I'm working at such a large hospital that, um, has the, uh, most vulnerable people in it.

So you've 

[00:07:58] Emma Pickett: got nicu, you've got a special care, you, your tech, you know, babies won't be transferred somewhere else. You're, you're dealing with absolutely. The, the most critical situations. Yeah. Okay. 

[00:08:06] Amber Clark: And they're being transferred to us Really. Okay. From the region, outside of the region. 

[00:08:11] Emma Pickett: Okay. So you've got that NHS role.

Yes. And that's with an I-B-C-R-C hat on. You're in that setting. 

[00:08:17] Amber Clark: I am, and I'm also a tongue tie practitioner, so I, uh, wear that hat as well. And then, uh, I also am working for Health Innovation West Eggs. Um, on this project, specifically as a project manager that we're gonna be discussing today, um, I very rarely work privately any longer, um, as I've kind of chosen to put my efforts into supporting the NHS and building a robust system, um, of lactation support in the region and hopefully nationally.

Um, as I really do believe that all people should have access to this type of lactation support that can be offered by a well-trained lactation specialist. So I've kind of do dabble in private work, uh, occasionally, uh, but it's not my primary focus at the moment. 

[00:09:02] Emma Pickett: Thank you. So we're gonna focus today, as you say, on your work on pumping and flange sizes.

Before we talk about your project in detail, let's just cover some basics. Now, I wanna just start by saying, and I know you would, I totally agree with me on this. You can have a perfectly possible, you know, positive, successful, happy breastfeeding experience and never use a pump. I mean, I've spoken to people on this podcast that pumped maybe once, or you know, for whatever reason, never really got on with pumping.

So we're certainly not implying that pumping is essential for a positive breastfeeding experience, but we are acknowledging that it's often a part of someone's experience, especially if they're gonna be going back to work for those people that do use pumps kind. I'm slightly putting you on the spot here, but can you describe how do pumps work?

How is the milk being removed? What is actually going on? 

[00:09:51] Amber Clark: Yeah, so this question is actually, uh, I feel quite inept to answer it 'cause I'm like, actually I'm like, I dunno, I can't really describe exactly the mechanism behind it. 

[00:10:02] Emma Pickett: I'm not sure. You know what? I'm not even sure that the people who make the pumps can answer that question now, but I think we've just been making the pumps the same way for so long.

And I, I actually dunno if people who make the pumps really understand, because otherwise pumps would look like that, know how they look. Anyway, you have your go. Let's see if we can work it out together. 

[00:10:17] Amber Clark: So I initially, uh, you, you would have that fast stimulation mode trying to mimic, um, kind of the fast stimulation that a baby would give you, um, to initiate a letdown.

And then once that milk has started flowing, you're going to have a stronger suction or vacuum that's often slightly deeper and stronger and slightly slower than that initiate mode. You're working off of suction rather than compression like with the baby's mouth. Um, you've obviously got a mechanical motor that's running or a manual lever that you're pushing down if you're using a manual breast pump.

There's loads of options for pumps. They're not all created equal, but the idea is the same, that they're trying to extract that milk through a suction of some kind. Okay. Um, I ha happy for you to add anything to that. I didn't know how technically wanted to, to be. Well, 

[00:11:07] Emma Pickett: listen, you know much more than I do, but I, yeah, I mean, I think you've described it in, in essence and so I think the key difference is, is obviously we are missing that compression element.

So, so babies do a negative pressure creation, they're dropping the back of their tongue, that's creating a vacuum. Milk is pulled from the breast to, to fill that vacuum. 'cause nature doesn't like vacuums. But also at the same time, babies are doing something which is flattening the breast and compressing the breast as well.

And 99% of pumps aren't doing that second bit. 99% of pumps are just creating that negative pressure. Pulling the milk into that vacuum to, to equalize the pressure. So we're missing the compression, but we're also obviously missing the nice little warm mouth. And we're also missing the emotional connection with the baby as well.

So potentially less oxytocin, which is the hormone that is, you know, involved with the letdown. Who knows? Yep. But there are a couple of pumps aren't there, that are trying to do something different. So I've seen a, um, we know we're not here to advertise particular brands. We're talking about the flange sizes, but I have seen this Israeli pump that has a kind of tongue shape 

[00:12:12] Amber Clark: in it.

Have you ever 

[00:12:13] Emma Pickett: seen anyone using 

[00:12:14] Amber Clark: that pump? No, no, but I have seen it come up. I think, you know, I think because we know compression is part of the thing, missing from the pumping, that is one of the reasons why I, uh, will talk more about this. But it's not, it's a, it's a all-encompassing aspect of how to optimize your expression of breast milk.

And it's not just all about one thing. And so breast compressions and massaging, while expressing can be an effective way to get more volume out because you are trying to manually provide that stimulation rather than depending upon just the 

[00:12:48] Emma Pickett: suction. Okay, good point. So, so the pump's doing the suction.

With hands, we could do the compression side of things potentially. Yeah, absolutely. If the shape of the flange is allowing that. Um, and that's why hands on pumping is so important and we're all signposting to the lovely maximizing milk production video from Stanford University to talk about hands-on pumping and, and we're hopefully supporting families to do compressions during, during pumping.

[00:13:12] Amber Clark: Yeah. And, and breastfeeding too. I mean, 'cause that it works the same, you know, especially in those first couple weeks trying to get those babies to gain more weight. If you can do that hands on breastfeeding, we know it increases that output as well. And that can just help to increase the volume going into baby.

[00:13:27] Emma Pickett: Yeah. And breast compressions increasing volume, but also increasing potentially fat content and Exactly. And helping babies that are sleepier or littler or, or needing help, um, extracting that, that fattier milk towards the end of a feed possibly. Um, yeah. Big fan of breast compression. So breast compressions for pumping and for feeding.

Definitely waving the flag for those. Um, okay, so we've, we're, we're stimulating a let down or the milk ejection flex. We're, we're getting the oxytocin to be released from the pituitary gland, which then arrives in the breast, squeezes the little muscles around the milk storage areas. That's Dr. Pushing milk into the pump and the creation of the negative pressure is pushing milk into the pump.

So, so pumps are doing two things. They've got speed of cycle and they've got strength of suck or strength of vacuum. So we've got two sort of measurable numbers that we can look at. Okay. Let's talk a bit about flanges. So flanges, which is a great word, funnels, sometimes people call them. I mean, yeah. So we're talking about the bit that touches the breast and the nipple is going to be pulled into what happens if that, let's call it a flange.

What happens if that is not the correct size? I. 

[00:14:34] Amber Clark: So I just, I, this is one of those areas that when I came here, I had no idea that that word is sometimes used differently in England. Uh, and so it always has taken me by surprise that, uh, yeah. 

[00:14:50] Emma Pickett: Okay. So you're gonna have to fill me in Amber. What, what, what was the plan flange mean?

No, you just, some 

[00:14:54] Amber Clark: people like think it's a derogatory term. I don't think we could talk about that on this podcast, but I've had people say, oh, no, I think we can. My gosh, what did you just say? Solange is a rude word. Is it to some people in the uk? They, can I say it? I'm not gonna say a bad, it's just some people refer to the vagina or the woman's anatomy as a flange.

[00:15:17] Emma Pickett: Gosh, you know what? I am, I am 52 years old and I have never heard that. Do I not talk about vaginas enough? Okay, I'm gonna have to be Googling this right now. I'm, this is a, this is a live Google. I did not know that. 

[00:15:30] Amber Clark: I 

[00:15:30] Emma Pickett: have heard people have 

[00:15:31] Amber Clark: been like, what are you talking about? And I'm like, well what are you talking about?

Like this is just a funnel for the breast pump. 

[00:15:39] Emma Pickett: Wow, 

[00:15:39] Amber Clark: okay. 

[00:15:40] Emma Pickett: That is so interesting. Well, you know, we have fannies. You have fannies. It all, um, works out in the wash. Okay, interesting. I did not know that. What was what f philanthropy? Yeah. I'm gonna have to go and do a bit more research with the edit things off.

[00:15:52] Amber Clark: Maybe it's just my people, like in my hospital that are, maybe it's a western thing, Hampshire thing. Maybe. Maybe it is. We'll go with that. 

[00:16:02] Emma Pickett: Okay. So are you okay to call it a flange? You're gonna be able to hold, hold you. I'm happy to. I'm gonna be able to hold it together. So, so what happens if, if, if that is not the right size?

[00:16:11] Amber Clark: Yeah, so I think we're more learning more and more about this every day through research and anecdotally on the units. Uh, I think just prefacing, Jeanette's research has been paramount to really pushing through kind of new thinking surrounding this. And so when we see that it's not the right fit, you're seeing loads of areola being pulled into that small tunnel of the flange and causing edema and swelling around the base of the nipple.

And obviously we know that nipples aren't created equal in size. Um, you have got a large range of sizes of nipples on various women, and even within the own body. They're sisters, they're not twins. And so you'll have different sizes on either breast, often, um, and so when you don't have that right size and you're getting that swelling and edema at the base of the nipple, swelling restricts the flow of the milk so that milk doesn't flow as effectively or efficiently.

And through the pump, you might have to spend more time pumping for longer periods of time when it's not the right fit. It can sometimes lead to engorgement or clogged milk ducts, which then could lead to the development of mastitis because you're not able to drain the breast effectively. And some people find that it's really uncomfortable and painful.

There's an element of clinical, like the optimization of the volume of milk isn't as high. But then also you've got this comfort level, um, of when we're expressing, we want it to be comfortable and emotionally like, okay. Because as we know, oxytocin is paramount to that, uh, flow of milk with the lit down re effects.

And if they're pain and pain and uncomfortable, it's counterproductive. And then sometimes when it's a really bad fit or it's been going on for a while, you'll often see damage to, uh, the areola or the surrounding tissue, those nipples just not, uh, healing 

[00:17:58] Emma Pickett: properly. Okay. Thank you very much for that overview.

You mentioned Jeanette's research. Can you just tell us a little bit more about that? For someone who doesn't know that research, what did that tell us and, and when did it happen? 

[00:18:08] Amber Clark: Of course. So, uh, Jeanette, uh, I, I do apologize if she happens to listen to this. Um, but her, I think it's Jeanette mess from, I just don't, don't know about the surname.

And then Lisa Anders have led, um, the research around flange fitting. Um, and, uh, it's been in the works for quite a long time, and it was recently published at the end of last year, uh, surrounding when we have properly fitted flanges, um, does this help increase volume or comfort for a parent? And, uh, more research is ongoing.

Uh, it is being looked into. But this initial research paper on flange fitting, um. It has been published by them. And we'll link to that at the bottom of the show. And then that is also in, uh, the toolkit that I've provided. Uh, but I think, uh, something that everyone has access to in many different languages is something called the flange fits guide that Jeanette has, uh, from babies in Common, um, has developed in the us and she has available for free to anyone who's supporting people with, um, pumping or expressing.

[00:19:11] Emma Pickett: And that's, you've put that in the toolkit as well, if, if I remember. Is that right? Mm-hmm. So the, so the toolkit link that will be in the show notes, that's the, um, you know, the health innovation project that you, you are working on that, that toolkit will have that in there as well. Um, yes. So I mean, pump companies historically have provided large sizes, and when they talk about variation, they're often going bigger.

So, so it's really normal for a 24 millimeter flange diameter to be the standard you get issued if you are renting from modela or, or buying a pump for the first time. It's not always obvious where to get smaller sizes from and where to get different sizes from. I mean, I, you know, I spent some time just prior to talking to you on a major pump retailer site and after five minutes of Googling around and following links, I still couldn't work out how to order a size other than 24 millimeters.

And I'm on that site relatively re re regularly. So there's, there's a heck of a lot of work to be done. So the work that Jeanette and Lisa have been doing, is it essentially, I mean, I don't mean to kind of summarize it, but we need smaller sizes. Is that a way to kind of preface it? Is that what the direction of the research is heading, us heading towards?

[00:20:19] Amber Clark: Yeah, so I think we want to be careful with our verbiage because I think it's more about properly fitting than it is necessarily smaller. It's just that what we find is most people are needing smaller sizes. Um, and so inadvertently we are needing smaller sizes simply because that's the measurement of individual nipples sizes are smaller than 24.

And we're finding that when you have a properly fit fitted flange, it's often smaller, um, than the standard 24. If you're using, say, a model or a kit like that, many of them are doing 26 and some are even doing 28 a standards. Wow. 

[00:20:56] Emma Pickett: So, so Ardo is 26 a standard, isn't it? Yeah. And spec, who's doing, who's doing 28 as a standard?

That's Spectra. Spectra. 

[00:21:02] Amber Clark: Spectra, yeah. And then, you know, some of the other ones that aren't as common are those bigger, you know, hospital grade or you might find in the hospital. Uh, so like Tommy Tippy, those types, uh, Lance, the ano, those are all at least 26, if not 28. Some of them don't even label their sizes.

Which is really frustrating as well, because you, you just don't know what you're working with. So it, it's a minefield to be honest. 

[00:21:27] Emma Pickett: Yeah. So, so we're finding that some people will need smaller, but as you say, the key thing is that individual support and, and people being able to fit you, being trained to fit you.

So let's talk a bit more about this actual project that you've been doing. So the early Breast Milk improvement project from health innovation Wessex that you've been leading. How did that project come about? 

[00:21:47] Amber Clark: I was, uh, privileged enough to have been, uh, chosen to do a leadership development program, um, through health innovation Wessex, and I was attending a mat neo, um, training day, uh, sharing day.

And there happened to be a parent with a baby who was born at 24 weeks and it was, uh, her first fourth baby. And she'd breastfed all of her others, never needed to touch a pump. And suddenly she's thrown into this preterm birth situation, uh, and is is slave to the pump. And the pump. Uh, she ended up develop developing mastitis twice and needing to be admitted to, uh, the general hospital to be treated with IV antibiotics and separated from her preterm baby and her other children because of the size of the flange.

It all came down to the fact that, uh, the flange size was incorrect. She was pumping, pumping, pumping, and then it just kept developing into mastitis because she couldn't drain her breasts well, and I was sitting there thinking, well, my gosh, like, well, we can do something about this. Like, why are we not doing something about this?

And then my brain just started going and I, and I like, well, if I want to implement change, I need to make sure I'm most up to date with current evidence-based practice. And that's when I then started doing my own research into what, you know, has been recommended recently or what kind of is happening in this research realm around flan sizing.

I came to find out I was actually not up to date with what the current recommendations were, and I stumbled across a couple of different options and landed on Jeanette as, uh, because she did have a training program. So I took that course just thinking, okay, I need to refresh myself. And, and it was really through that and that coaching program where I went back and shared, oh, you know, this was shared at this training event.

I then have gone back to my hospital and I'm looking at how we can get different sizes in, I did this course on my own, blah, blah, blah. And they were like, wait, what did you do? And I said, well, yeah, we're, we need to change this. Like, why aren't we doing something about it? And so it was kind of my own personal initiative on wanting to affect change and support people.

Um, that's led me down this rabbit hole. And essentially through Health Innovation War six, we were able to use some funds for inequities to make things more equitable amongst hospitals. This is a, an equitable, uh, issue where if we are not optimizing, expressing for people and telling them, oh, well we have this information, but you've got to go purchase it on your own, that's not okay.

And so essentially we've decided to do this project and, uh, roll it out to support hospitals and, um, people working in community on how to support people with expressing and to optimize it, but then also how to go through procurement to then bring on these additional sizes. And I'll tell you what, I had so many conversations with the manufacturer in Taiwan, uh, because I was like, look, I'm not happy with the pricing that the distributor is giving us.

It's not sustainable for the NHS and I need you to speak to them about it. So I just was like, good for you. And so many different levels. I was like, I need you to do this. So this is. Sustainable as a service, and at these prices it's not. So anyways, uh, it has been a, a year long project, more than a year long project actually.

But, um, to see it kind of finally come to fruition and see, uh, more hospitals regionally and then nationally taking this on has, its been really, um, fruitful in my opinion. 

[00:25:20] Emma Pickett: Yeah, I mean, fruitful is the understatement. I mean, this is, this work has got such an implication. If it, if it, if it is actually carried out and people listen and I, I think they will.

I mean, we're talking about saving NHS massive amounts of money for a start. I mean, when you admit someone from mastitis treatment, that woman sitting in a general ward getting IV treatment, you know, that costs a lot of money. Uh, I know on a very calculated cold level, putting aside the impact on her mental health and relationships with the children.

You know, and when people don't make enough milk and the for, you know, we have to give formula or donor milk, that's money. You know, the, and as I said, the big implications for maternal mental health and parental mental health, it's, it's baby he rehospitalization. I mean, you can't emphasize, you, you know, you can't exaggerate how important this is because it's, it's such important work.

And you might think f flag sizes big deal. But really it's huge. The implications are massive. It's we're talking about some of the most vulnerable babies and the most vulnerable families. I want to tell you about my brand new book called The Story of Jesse's Milky. It's a picture book for two to six year olds, and I wanted to write a book that was about weaning, but also not about weaning, because breastfeeding journeys end in all sorts of different ways.

So Jesse's story is presented as having three possible endings. In one ending, his mom is pregnant and Jesse's going to share his milk with a new baby. In the second, his mom is getting really tired and it's time for some mother led weaning. And in the third, we see a self weaning journey as Jesse's attachment to breastfeeding gradually fades.

There are beautiful illustrations by the very talented Jojo Ford, and the feedback from parents so far has been so lovely and touching and I'm really excited to share the book with you. If you're interested in my other books for Older Children, I have the Breast book, which 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 I also have two books 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. Mm PE 10 Makes milk picket Emma 10.

Let's go a bit more into the fine tuning of measuring a nipples. So I think one thing that people sometimes find a bit confusing, and you are so in deep, you might not remember this because it's not what you see anymore, but when we look at someone pumping and the flange is too big and the ariola is being pulled in, and you can sort of see it, you know, the nipples squeaking past the edge of the flange and it's right pushed against, and it's, you know, there's, it's white because all the blood's being pulled out of it.

You might look at that and think, oh, it's, it's too small. It's too small because the nipple's squashed and squeezed and, you know, it's all, it's right against the side and it's, it's sore and it's uncomfortable. So I think people sometimes look at a nipple and think that a flange is too small. When actually it's too big.

Does that make sense? I think we need to really help people un to understand what happens when a flange is too big and how, why that sometimes gets confused for it looking like it's too small. Tell us what a good fit looks like and how are you gonna measure nipples? First of all, I'm just gonna show you because we can see each other, even though this is a podcast.

Yeah. Look, I bought one of your sizing tools. Oh, did you? So we'll talk about that in a minute when we talk about, um, your measuring tool. But first of all, talk to me about measuring nipples. What does a good fit look like? 

[00:28:53] Amber Clark: So I always tell people, you must do this before babies fed on the breast or before pumping.

So you're wanting to do this prior to any simulation. Okay. Uh, because you don't want it to be, uh, slightly enlarged, uh, from that wrong sized flange, boil, pumping, or swollen or anything like that. Uh, so essentially. What you want to do is you want to encourage the, the expressing parents or you know, lactating parents to stimulate out their nipple.

So you're going to have them. I just tell them, I'm like, come on, just grab your nipple, pull it out gently, just slightly roll it between your fingers and thumb, like whatever you can work to, you know, get that to come out. So you want it to be stimulated to come out, just protruding and you're going to want to measure with some form of measuring tool.

It doesn't have to be anything fancy or special, but um, it can just be a measuring tape and you're going to measure the width of the nipple at the tip rather than the base. Some nipples are nice and, uh, the same width all the way from the areola to the tip, but oftentimes you find that they taper. So you're going to want to go more towards the tip rather than the base, and you're gonna try and go true to size.

Okay. Okay. Now, let's say you measure somewhere around 13 or 14 or something like that. We've got to then know what options you have for your different flange sizes. So oftentimes you, you want to, you know, go true to size or you might have to go one millimeter smaller or one millimeter bigger depending on what your options are.

But it's roughly more true to size than it is adding any millimeters on. We're not trying to do that. So that little tool you have there, uh, the way it's, maybe I'm jumping ahead, but essentially that's okay. 

[00:30:40] Emma Pickett: So let's talk about this little tool. So this is something that you've, yeah, you've developed as part of the project and it looks a bit like a wheel and it's got scoops, sort of semicircle scooped out of it, around the edge.

And we've got 24 millimeter as the largest, and it's going right down to 10 millimeters is the smallest. And because it's this semi-circular shape, you can hold it against the end of someone's nipple. I'm really glad that you emphasized the end of the nipple because I think historically people have always measured at the base of the nipple.

Yeah. And that's been one of the reasons we've ended up with these, you know, massive flange sizes and 30 millimeters flange sizes. 'cause that's what we thought we were supposed to be doing. And you're talking about measuring at, at the tip instead just to come back to the measuring then breast texture is obviously part of it as well, and, and nipple texture.

But that's something you can't necessarily judge until someone's actually using a pump. If someone was using a pump and it was too small for them, what would it, what would it look like while they were pumping? 

[00:31:39] Amber Clark: Uh, so it wouldn't be able to move freely within the tunnel. Um, you might, uh, notice like white, because it's way too tight.

The blood flow does stop to stop. Um, uh, you're not going to have very much mini squirts coming out. Um, and that, that can just be restrictive of the flow can be uncomfortable. Okay. Um, so it really must be comfortable and that nipple needs to glide really easily and smoothly. And so if it's not able to glide smoothly and easily in the tunnel, then then you need to look at, uh, maybe going up one size.

[00:32:16] Emma Pickett: Okay. So the end of the nipple, we'd, I like the word glide. Mm-hmm. We'd expect the end of the nipple to be moving. How f Yeah. What kind of distance would you expect the end of the nipple to be traveling during a pumping session? I 

[00:32:26] Amber Clark: think that's a good question. I think we hear a lot about elastic nipples, and I think actually what, what that simply means is sometimes, uh, when we're pumping with too large of a flange, that, uh, elasticity of the areola really is just like being pulled in.

And I think oftentimes when you have it properly sized, you don't get as much of that elasticity. And so you've noticed that the nipple when you are finished pumping or expressing, uh, comes out looking much similar to how it does when you've finished breastfeeding a baby. Okay, okay. It's just slightly enlarged and it's well protruding, and so it really do, you don't have as many changes as you would without it being properly sized.

Does that make sense? 

[00:33:10] Emma Pickett: Okay. Yeah, no, that's, that's really helpful. So we're not expecting to see swelling, essentially. 

[00:33:15] Amber Clark: You're not expecting it to be going all the way to the end of the pump. 

[00:33:20] Emma Pickett: Okay. So if there's loads of movement that's the size, that's too big. So, so very likely too small, you're not gonna see a movement and it's gonna be, you know, looking constricted and uncomfortable too big.

You may see too much movement. And, and that's, as you say, that's because ariola is being pulled into that space. Yeah. Um, okay. 

[00:33:40] Amber Clark: And not to say that there can't be people who have more elastic nipples than others like that, that there's always variables. But in general, you'll notice that when they're properly sized, do not experiencing as much of that movement.

Um, and as deep, 

[00:33:55] Emma Pickett: and I guess, I mean, not to put words in your mouth, but I'm kind of guessing that this is quite individual and some people may use a size that. On paper doesn't look necessarily like the size you would choose, but they get more milk out, they get better results. We may not necessarily know why.

Um, so that's why the individual conversation, that one-to-one support is, is so important. So the little, the little measuring tool that you, so in looking at your toolkit, you describe how this developed and you're not, by the way, you're not making money from this. You're not selling this to, to get profit.

This is not about, um, any commercial venture. You're just giving an example of the sort of measuring tool that's available. And there are other tools out there that are used for pipes and plumbing and, and engineering and, and you can adapt those potentially to use them for nipple measurement as well.

Pump companies often have their own measuring tools. Yeah. But they don't go down small. They don't tend to go down to 10 millimeters 'cause they're not gonna be selling you something. Yeah. Or very often that's 10 millimeters. So you've got, I mean, you've gone right down to 10 millimeters here in terms of nipple size.

How did you decide what sizes to put on this tool? 

[00:35:00] Amber Clark: Yeah. So, uh, in full disclosure, there's a tool similar to this in the US and uh, the problem with that particular tool that I was seeing is that they weren't standardized to the sizes we have to offer. And so when I was looking at this, I was like, well, well what, what's the point of me measuring you a 14 or 16 or an 18?

But I don't actually have those flanges as available. And so I said, right, what we need to do is design something that is based off of what we actually have to offer people. And so I essentially made it to where, you know, those are the options available to purchase 10, 13, 15, 17, 19 21 are going to be more of the ones that are not Ardo, um, and, uh, are available.

But that 18 and 22 is really all that Ardo has at the moment. That's a hard shelf flange that can go into their 26 and shrink it down. 

[00:35:57] Emma Pickett: Just to talk about, um, Ardo particularly, my understanding is that they are now beginning to offer inserts, silicon inserts. We'll talk in a minute about inserts and what that means.

Yeah. But you know, this is a movable feast. This episode's not going out for a few more weeks. Who knows what, what necessarily might be available. So it's always worth checking with an individual company and talking to a rep and trying to talk to a human being on the phone. Their website may not necessarily represent what is out there.

So this particular tool, people can buy it online, but can people, can you do it with a measuring tape? Can you do it with, I mean, if you're in a hospital and you don't have a tool. Absolutely. 

[00:36:31] Amber Clark: Yeah, absolutely. 

[00:36:32] Emma Pickett: Okay. 

[00:36:32] Amber Clark: Yeah. And, and I think that's really important. Like you don't have to have something fancy this, I just like this specifically.

I don't particularly love the ones that go around the nipple that are like the holes. 'cause I feel like that can be quite. Intrusive, so to say. Yeah. With this I literally just hold this at the, I don't even really need to touch them. I'm just like right there. And I just hold it up at the bottom of the nipple and turn it around.

'cause you know, you just wanna make sure it's right and it's very, it's a lot less intrusive to their personal space. 

[00:37:03] Emma Pickett: That's a really good point. Yeah. Yeah. Those big, that's why I do like it. The full circle ones. Yeah. That is quite kind of, yikes. Where's my nipple going? I mean, they can't necessarily see the end of the nipple 'cause it's hidden behind the whole of the, of that flat surface.

So, yeah, good point. These are, these are, you can keep that eye contact, they can see what you're doing. It's, it's the little half semicircle is all you need really to get that sizing. Yeah. So let's imagine somebody's working in a hospital. They've maybe got modela pumps with the 24 millimeter standard. Or if they're, you know, a hospital that's using auto pumps, they'll have that 26 millimeter standard.

They've read your toolkit, they're thinking, oh my goodness, we've absolutely got to offer smaller sizes. We've got to have a bigger range. We've gotta start measuring properly. Where do they go to get some of these sizes in the uk? I love your big sigh. Was that your sigh of I wish it was easier. 

[00:37:53] Amber Clark: I do and I wish, in all honesty, really desperately need the pump companies to lace with specialists who are on the floor doing this every day.

I think if that is the message I could get out, we need them to listen to us. And it's really hard to get that buy-in. Um, and so my si is such that, yeah, you okay? Uh, so there, there's ways you've gotta be an internet 

[00:38:21] Emma Pickett: detective is that's what's happening. You 

[00:38:22] Amber Clark: do. You do. And that toolkit is, is lined up really well to try and support people to be able to find things that are compatible with these different pumps.

Now one problem with say, Ardo or Spectra is that. And their piece is like all in one. So you can't actually take the flange or the funnel off of the base connector to change out your sizes. So you're trying, and, and Ardo doesn't offer anything other than silicone flange inserts, which we'll talk about in a minute.

But being able to have something that is, uh, detachable that in interchangeable is really important. Mam, om is a company that's currently, uh, working to provide different size flanges, um, that are compatible with these pumps. And they do offer, um, various, uh, pumping kits or things that are compatible with these various, uh, pumps.

Um, and, and you know, I had the privilege honestly, of saying right, for people who have arto. I desperately need them to have a re likeable flange that can be detached from the base connector. And I, and if you're going to create this for me, I want it to be sold in the various, like, I want 10 millimeter kits, I want 13 millimeter kits, 15, 17, 19 21.

I don't want you to send me a 24 and expect me to buy a different size to go onto it. And they've listened and they're like, fine. If that's what you want, that's how we'll provide it. Okay. And that's really what I want those other pump companies to do because, you know, we're seeing this in practice and, uh, and it's, and it's amazing.

But at the moment, there's really that one company that is providing those smaller sizes and they can be found on Amazon. 

[00:40:06] Emma Pickett: So may mom, all one word, M-A-Y-M-O-M, that's where you're getting stuff from? Yeah. And, and they are, their products can be used with an Ardo pump. Yeah. Is that, is that what you're finding?

Okay. 

[00:40:17] Amber Clark: Or Modela. Or Ano or really any of them? Um, they're interchangeable with, uh, if they have the right size connecting point. Okay. Spectra, you can, yeah. 

[00:40:29] Emma Pickett: So if you're an NHS member of staff, you can go to Amazon. I don't know how purchasing works. That's not straightforward, presumably. No. So 

[00:40:37] Amber Clark: I essentially, this was a part of the project is going through procurement and getting the distributor brought onto our system so that we could then start offering different size flanges.

Okay. 

[00:40:48] Emma Pickett: Okay. So, so may mom is providing you a solution at the moment. Mm. But. Hopefully the more this research becomes widely, more widely known, it's going to be in the actual pump company's interests to, to, to get these smaller flange sizes happening. And it's, as I said before, I think it's my understanding that Ardo have had a little bit of an epiphany around this and, and Ardo are starting to manufacture the silicon inserts that can go into the, you know, the original shape.

Yeah. Does using an insert create problems, is it less effective than the actual original flange size being a different size? 

[00:41:23] Amber Clark: Yeah. We do find that when it's not that firm. Uh, plastic of the, the hard shelf flange that sometimes some people just don't respond as well to that silicone and that silicone changes shape.

It's more malleable where like the baby's mouth, like the hard palette, soft palette, hard palate. Like they're, they're pretty firm. And so we do notice that sometimes they don't get as optimum milk if they were using the hard shell flange. So, so silicone f flanges are my, they're not my go-to as a solution to shrink.

Downsize. Okay. My solution is that it would be hard shelf flange if that was possible. But some of these companies, they just don't have the option yet. 

[00:42:07] Emma Pickett: Yet. Okay. Okay. Yes. It's interesting what you're saying about soft silicon. I think we all assume that soft silicon must be better 'cause baby's mouths are soft and baby's tongues are soft.

And, you know, aren't we lucky to live in a modern world where we've got lovely soft silicon and no one, no one's gonna use a hard nipple shield when they're, when they're breastfeeding. So of course we want soft silicon. Yeah. So, and, and lots of the pump companies are going, Hey, look at our cool soft silicon flanges.

But it's so interesting to hear you say that actually the good old fashioned hard plastic flange that mimics a hard palette and maybe gets better results. Um, that's, that's interesting. 

[00:42:43] Amber Clark: Yeah. And that's, that's not just me. Um, I am, you know, I am in a group with Jeanette and, uh, other medical professionals and these conversations come up and that's something, you know, through her research and through her, uh, constant, uh, work around this.

Type of, uh, information that she has also found and other clinicians have found. And so it isn't just me saying it, it is a conglomeration of people who are collaboratively seeing that same kind of situation. 

[00:43:12] Emma Pickett: Okay, but despite that soft silicon may be possibly not being as effective. If, if the sizing on the hard flanges really way off, it may still be preferable to use the silicon insert and just experiment.

A hundred percent. Yeah. Yeah. 

[00:43:24] Amber Clark: Okay. A hundred percent. And I think something just to, to keep in mind, depending on, uh, the way it fits in, um, sometimes that silicone, because it is malleable, can be shrunk down slightly. So some people who need, let's just say a 13 for their hard shelf flange and they've been pumping in the hospital with that might have.

Need for a 15 silicone insert because as it's squeezed in, that can kind of shrink that silicone down and be a bit too tight. So sometimes we see a variability in the actual size you need with those silicone flange inserts. Okay. Does that make sense? 

[00:44:01] Emma Pickett: Yep. No, that that's helpful. Can I just ask you a practical question?

I'm just imagining a magic world where you've got your flange size clinic and you know the new mom who's having to pump maybe their babies in special care or NICU is coming to meet you in the flange size sizing session. You've got a room full of different sizes. This is a really DAF practical question, but if you're trying someone out, do you then have to discard that, that insert or that flange or what's, what are the rules in the NHS setting for, for trying lots of different ones?

[00:44:31] Amber Clark: Yeah. So this is, uh, an area that I'm currently working on. I've, uh, addressed it within my own system, um, and have spoken to infection control. And we have got a very specific way in which we can provide a pump, um, a flinch sizing toolkit that can be reused between people, but it must be sterilized in a particular way because we want to be decreasing wastage.

We don't want to be creating more issues with plastic. Um, and so essentially that has been something that I'm writing a. Uh, an SOP or standard operating procedure, uh, to go through cov governance on that Currently, uh, that has been approved by infection control, and that essentially is so that we can use different sizes because sometimes you'll measure somebody and it'll look like a 13 should fit, but then in reality they actually need a 10 whenever it starts to be brought into the flange.

They're like, oh, okay, well obviously the nipple tip fit differently or vice versa. You've measured at a 15 and maybe a 13 works better and, and it really is variable and you want to be able to try out those different sizes if you can. But as you said, infection control is really important, bodily fluids.

And so, uh, that is something that I have thought through and have gotten guidance on, and hopefully we'll be able to advise other hospital trusts or organizations on as well once we've gotten that all through our system. 

[00:45:57] Emma Pickett: Okay, great. So watch this space. So yeah, it's definitely possible to have, you know, not be throwing 15 millimeter.

Inserts and f flanges in the bin every five minutes. You should, as long as that sterilizing procedure is followed. And yeah. We'll, we'll watch this space to find out from you more about that. That's good news. Um, yeah. 'cause I know sometimes that you might be tempted therefore to go, oh, I don't wanna try another one 'cause then I'm wasting one That may not work.

And you wanna be able, you want the practitioner to be able to use all the options, really explore Yeah. You know, really have that parent leaving the room with the absolute right size for them. I, I know that the project's focus has been supporting babies in hospital settings, and you've been particularly looking at babies in NICU and premature babies.

What sort of results did you see when people were paying more attention to flange sizes? 

[00:46:40] Amber Clark: A lot of results to be honest. Uh, the thing that I think, uh, and I will say watch the space because I'm very keen on doing further research into this and, uh, having discussions with various. People at the moment. Uh, but, uh, one of the things that I have, uh, seen is when you are expressing from birth from day zero with a mom whose baby's in the neonatal units, say, uh, typically they're just obviously going to be getting colostrum.

And typically with those larger FLA sites is if we're just having them stimulate and hand express, you're, you're seeing really small volumes coming and almost like loads of wastage within that funnel. Um, and or it's dripping down and, and there's just like hardly any being collected. But actually what I have found that is just mind boggling to me is the volumes of colostrum.

Like. Becoming a, a lot more than you would anticipate in those early days, uh, when you had the right size flange. And so, um, you know, being able to express five, 10, or 1520 mils of colostrum on day zero, one or two is just incredible, especially for those preterm babies. And that wasn't something that I was expecting, and that's not something that's been looked into yet, um, with Jeanette and Lisa.

But that's something that we are discussing because it, the research is constantly evolving and it is something that I'm, I'm very interested in and hoping to do some work in. Um, I would say that specifically to the neonatal unit and the prem babies, uh, has been kind of the biggest, uh, wow to me. But then on a very, uh, specific level or, you know, seeing the volumes.

Let's say you've got a baby on TCU who's needing treatment for jaundice, and they're usually put on a topup plan for that. Being able to have those different sizes. Those parents, you're just literally going from a 24 down to a 15 and you're seeing their volume do double and so then they're not needing, and I can't say it's always happening in that way, but oftentimes you're literally just making this one change and you get almost twice as much milk.

And it's incredible because oftentimes you'll see these people pumping and expressing and they're just not getting enough, and they're still having to use either formula or donor breast milk to supplement on top of what they're getting, and then all of a sudden they're able to get it with the right size flange and they don't have to depend on that.

And for that parent, whether they're a neonatal parent or a baby, is unwell and you're pumping parent for them. You're seeing those volumes and, and the only thing you have control of as a parent in those moments is what you can do for your baby. And that at that time is usually provide your breast milk.

And so my main mantra really in this is that we want to empower those parents to feel like they're doing the best they can and know that they are, you know, and they're visibly seeing the fruits of their work, and it's not painful, it's not uncomfortable, and they're getting loads of volume that they need.

[00:49:38] Emma Pickett: Yeah, I mean that is, that is, I could talk all day long about it. Sorry. I'd be very happy to you talk all day long. It's just so important what you're talking about. You're talking about, you know, cost for hospitals and, and you're talking about the Absolutely. Transforming how parents' feeling in their most vulnerable time in their lives after having had such a difficult experience of, of seeing their baby born prematurely and, and to, to, you know, to double meal cap.

But what that does for someone's emotional state and mental today is so crucial. You know, historically when I, you know, when I first started as a lactation consultant, people were saying, oh, you know, don't ever use a breast pump in the first 24 hours. You know, that was, you're just gonna waste it. It's all gonna disappear.

You know, you must hand express when you're, when you're just producing colostrum. And now we're saying, no, no, no. You pump within the first six hours. If you give birth prematurely, you're aiming to pump really quite quickly if you can. Yeah. And as you say, with with the wrong size flange, that's just all trickling away and sitting in the wrong part of the pump and not being collected.

So just imagining with the more effective flange, the impact that has in those early days, and what that means for. Milk transitioning and, and the baby's health. And it's just amazing. Really, really crucial stuff. Thank you. 

[00:50:46] Amber Clark: But can, I'm gonna go back to something 'cause I, I think I've got this in one of the videos that I created.

But for people listening who may not have watched those, uh, in those early days, if you're supporting with colostrum, collecting and pumping, I have them turn it upside down. So that actually the bottle is, is, uh, sticking up and then the flange, uh, is here. And I know that sounds weird, but essentially that milk when it's just colostrum and that's, um, really hard to get.

You can actually open the back of the, uh, base connector and uh, I could send you a picture of this if you wanted to somehow put it on, but you can essentially open the back and syringe out of the funnel and it's not all just dripping down into the bottle. Oh, okay. 

[00:51:29] Emma Pickett: So the bottle is literally sticking up in the sky, the bottle up in 

[00:51:32] Amber Clark: the sky.

[00:51:32] Emma Pickett: So we're not expecting anything to go into the bottle. 

[00:51:35] Amber Clark: No. 

[00:51:35] Emma Pickett: And you are instead hacking the back of the, of the actual connected to get stuff straight out the connector that is, 

[00:51:40] Amber Clark: or pouring out of the flange, like the cone part. After you've done, you can, you know, pour out into a pot and then syringe out, or you know, those last little bits, you can open up the back of the.

You know, base connector and syringe out there and get those last drops too. Okay. 

[00:52:00] Emma Pickett: That is such a good tip. Just don't even try with a bottle. Yeah. Good tip. Yeah, please, please send a picture. Especially when you're just 

[00:52:05] Amber Clark: getting like five mils, that's really easy to just go down into this huge bottle and you lose loads of it around the edge.

And so this is really effective at trying to just keep every drop. 

[00:52:17] Emma Pickett: So you've still got the stimulation of the more effective pump, especially if you don't, you're not someone who gets on well with hand expression or you have a disability, maybe hand expression isn't an option for you. That that's, that's such a good tip.

Thank you Amber. Yeah, of course. Okay, so I'm gonna ask you a question that maybes not directly related to your project, but I'm just cu really curious to know what your thoughts are because you are spending so much time thinking about pumping. So wearable pumps, lots of parents now are just buying a wearable pump and Yep.

So one of them, for example, I. 21 millimeters, the absolute smallest it will go. There's no option for anything smaller. There's no one's talking about smaller sizes. For some of these wearable pumps, are you noticing wearable pumps having an impact? Is anyone talking about them or is that not really a conversation in NHS settings?

[00:53:03] Amber Clark: No, we definitely had those conversations all the time because we give support postnatally up until two weeks, uh, for just basic feeding issues and then up to six weeks that they're suspected tongue tie and complex feeding support. And so these there are coming back into us in community and we do get, in my particular hospital, we do have those discussions often.

Um, so yes, people are loving them. Not all are created equal. I can't really say which ones are better than others, but I wouldn't be spending hundreds of pounds on one when, uh. You, I let's the sign language to each other around. 

[00:53:41] Emma Pickett: But yeah, there's a very expensive one that is really well marketed. Everyone assumes it's the best one because it's expensive.

No. And it is not very different from ones that cost half the amount. Um, exactly. And it's in some ways people get better results with the cheaper ones. Okay. 

[00:53:55] Amber Clark: A hundred percent. We don't, 

[00:53:56] Emma Pickett: we don't even have to mention brand names. We know what we're talking about. Yeah. 

[00:53:59] Amber Clark: So going to that though, um, anytime. So this is, uh, so I have these conversations all the time, uh, with those people who are really wanting to use that kind of pump.

I, I tell them, look, if you're going to be pump dependent, this might not be your best option. So you might want to keep your options op open for having a larger, you know, double pump that, uh, could potentially help you if you're going to be doing it more frequently. If this is just an occasional thing and you're not wanting to pump exclusively, uh, fine, keep on using it.

But you might find you need to use two different types. That's also a possibility. Now, specifically with the flange sizing, our only options really are the silicone flange inserts to get down below that 21 that you're speaking about. And so what I have to tell them is don't listen to your pump company because they're gonna tell you if you measure a 17, 21 to 24 is fine for you.

I'm like, that's not the case based off of this new research. And so I measure them, I help them understand and essentially tell them to go onto Amazon, buy a variety pack that has 13, 17, 19, and 21 silicone flange insert for about eight or nine pounds. And that will go into your 24 millimeter flange and shrink it down to the size you need.

Okay. And I just give them some very basic information and, and that's essentially, you know, we are talking about Ardo a minute ago. That's your best option for that as well, because. We've already fed this back. The cost that they have put on their pair of silicone flange inserts is, is astronomical and, uh, not sustainable for anybody really.

Especially the NHS when you're talking about 10 pounds for one pair of a piece of plastic. And so really like knowing, uh, what options you have, they're pretty much providing the same service. Okay. It's just a piece of silicone that goes into 

[00:55:49] Emma Pickett: your pump. Okay. And your toolkit will have the, the information It does.

People need to be able to get to access this. It's a super, super useful resource. Let's, we've talked a lot, I think, to health professionals and we've talked a lot to kind of people who are in that support setting. Let's imagine someone's listening to this and they are a new mom, new parent. They're having a really difficult time pumping.

They're getting very little milk. I. They live in the, you know, a small town in the uk. They may not be able to come and see you or talk to you. What would you recommend they do to try and increase their pumping output and have a more positive pumping experience? 

[00:56:26] Amber Clark: I think that's a great question because ultimately it's the parent that we're wanting to support and, um, that toolkit that I've created really, uh, the premise of it was, okay, let's get this information out to as many people as possible, but then let's also hit the parent as well, because I want them to be empowered, like separately from, you know, they may not come in contact with someone like me who has experience, but their own knowledge is powerful.

And so within that toolkit, we won't talk about every aspect of aids, but there are different videos, one meant for staff or, um, lactation professionals or people who deal with that. And then there's a separate one and that I've created, and yes, it's within an NHS setting, but it's geared towards parents showing them how to measure themselves, showing them what proper, uh, expressing should look like, how that should fit into the flange.

I also show them how to kind of troubleshoot some common problems that can happen when you're trying to get it to fit correctly. And then I also give top tips for how to express, so I go into things like breast compressions and massaging. I go into things, um, you know, that. Talk about kind of managing engorgement, uh, stuff like that, that they may not have that information on.

And so it's not just about f financializing though. It is. I just love to add in my little TED bits to help optimize their output in general. So I think going to that, finding that ultimately also finding I-B-C-L-C who's done this training, being specific in what you're asking for and knowing that they've, uh, are up to date with current practice.

Because I think that's a, a key issue is you can't just go talk to anybody. You've got to know that they are current, um, which, you know, I appreciate we're having this conversation. Together, and this isn't my original work, and so I always send back to Jeanette's, uh, original work. 

[00:58:19] Emma Pickett: You're being very modest, Amber, because I know obviously Janet, Jeannette, and Lisa's research study was a trigger and it is incredibly crucial to, to get people thinking, but I don't think you can underestimate the influence of this, this piece of work you've done.

I mean, I really think, you know, there aren't many examples of something this practical that really could spread out across the UK really quite quickly. How are you getting the message across? You are, you are doing train, you're doing delivering training in different settings, aren't you? What sort of conversations have you been having?

[00:58:46] Amber Clark: Yeah, so, um, at the moment I've only been focusing in on, uh, trying to support those infant feeding teams within the NHS, uh, to bring this work into their neonatal units and maternity units and the children's hospitals as well in the pediatric, which I will say I have got this. Fully on board in my pediatric unit across the street.

Uh, and that it just is to me, the pediatric PICU side often is, is neglected. And that's a really important aspect that we don't forget them as well. Uh, but I do a lot of training, uh, for my region on supporting those other trusts to bring this on board. We are also going to be, uh, offering, uh, training and support for the wider group nationally because more and more people are inquiring about it from a national perspective, wanting to know how they can bring this onto their different trusts.

So, uh, I host those teams meetings with them and I really walk them through, uh, how to do that on a practical level, what things to talk about with their matrons or senior leadership teams. And so mostly my focus has been within NHS, but I personally don't think that this, everything within that toolkit could be really useful to people who are supporting privately as well.

And so I, I would love to do some work. Um, I'd love to do some, you know, teaching on this and sharing in, you know, conferences or things like that to help answer questions on a practical level, show some videos, all of that. I'm really happy to support in any way. But at the moment, I'm not doing, I'm not, I'm not doing much outside of the NHS, but I'm very happy to support with that and, and help.

Push that along. 'cause I think it's important. 

[01:00:26] Emma Pickett: Definitely, definitely. So, so people can get in touch with you. We'll put your email in the, in the show notes as well. I think you need to be in some national conferences. Amber, I think we need to get you at the UNICEF conference. I think what's tricky, and I'm gonna slightly kind of call a spade a spade here, is that people have, have a little bit of ick when it comes to talking about brands.

Like, so know even the fact in this conversation we've mentioned mam o and going and getting the, you know, multiple, you know, different products, you know, available from them and the different sizes available. Some people will be like, Ooh, no, no, no, you can't mention brands. That's not cool. You know, and I, I totally understand where that comes from, and that is absolutely well-meaning.

But at the end of the day, it's still about serving parents and serving families and the, and the difference this work can, can make. So we do actually have to have some, some icky conversations about brands. We do have to talk about where you buy the stuff from. We do have to talk about, you know, what shop are you gonna use?

I mean, it's not, it's not comfortable, but we can't stay up in the kind of, you know, clouds and pretend that we're super duper ethical practitioners if we don't talk about what actually helps, helps families. I mean, have you had anyone saying, oh no, you can't mention that brand. You can't tell people where to buy stuff.

Is that, has that been any, any kind of discomfort for people? 

[01:01:40] Amber Clark: I think the, probably the biggest issue is surrounding the pump companies and. What they want you to be using and don't want you to be using with their pumps. And so that my call to them then is listen and start making, if that's what you 

[01:01:56] Emma Pickett: want to do.

Yeah. Making and making it cheaper. Making it cheaper as well. Making, so we're while making the inserts, but if you're make the inserts and they cost a huge amount of money, it's not gonna happen, is it? So, 

[01:02:07] Amber Clark: no. And they said, oh, well, we'll try and drop those prices down when we've had enough buy-in for it.

And like, that's not how consumerism works. Like you, you, you have to make it sustainable initially. Uh, anyways, yeah, it, it, it's a tricky one, but I'm hoping through, through this research and ongoing research, I'm hoping that they, they would like, ultimately I believe that the pump companies want to help optimize.

The expression of breast milk for the parents. 

[01:02:36] Emma Pickett: They're not the bad guy. They are, they are. Ultimately, they, and there are men, you know, pump companies, and I know some of the people who work for Ardo, who are just the loveliest people who are so devoted to helping families and really, really, you know, want to get this right.

But maybe they don't necessarily come into contact with everyone who's had your sort of training. They don't necessarily fully believe, are you sure? How can people be using 10 millimeter? That can't be right. We've got people buying 30 and 24 stand and 26 and what? Yeah. Um, so I think it's, it's up to us and it's not all down to you.

It's up to everybody to communicate. You know, when we go to a conference and we see a pump brand, tell them what we want. Yeah. Talk to them. Um, you know, write an email and say, love your product. But by the way, we really could do with some more si, smaller sizes. We'd like it in the firm flange, please. You know, we need to, we, you know, even in a really busy role, we all have to be advocates for the parents that we work with.

Yeah. And you're doing such sterling work with that. Amber, I hope you feel really, thank you so much. Really proud of what you've been doing. Yeah. And so a call to anybody who runs a conference or runs some training. Amber's definitely the person you want to be talking to, your members of staff and, and we really just need to get this work out there because it makes such a difference to people.

So we'll put your project in the show notes. We'll put Jeanette and Lisa's research in the show notes. Yeah. Is there anything else in terms of resources that you want people to, to know? I mean, your project talk is so massive, it covers so much stuff. Um, but is there anything else you think we need to put in the show notes as well?

[01:04:01] Amber Clark: No, I mean, I am very happy for you to put, um, contact details for how people get in, get in contact with me. I'm very happy to support in any way possible, whether that's for private lactation consultants or, you know, peer supporters, whatever, or whether that's NHS. It doesn't matter to me. I, 'cause I wear those hats.

I could do, I could do it all. Um, and, and the toolkit is massive, as you said, and it, it's been created, I think, hopefully very thoughtfully in order to support people who don't even come in contact with me to be able to roll this out. 

[01:04:32] Emma Pickett: It's totally, it's totally usable. Well, I don't mean to sound like it's intimidating when I say it's massive.

It's very, very No, it practical. It's very practical. It can be used in lots of different ways and actually someone could read it and potentially deliver their own training if they, if they, you know, live in the outer heide and, and don't want to necessarily get you to come and talk to them. I mean, it is, it's very informative and it really helps people to get a sense of what's going on.

So, so brilliant job. Um, thank you so much for your time today, Amber. Is there anything we, is there anything we haven't covered that you want to make sure we talk about? 

[01:05:02] Amber Clark: Oh, not that I, I mean, I could talk about this all day long. This stuff is what makes me happy every single day to go to work. Uh, so no, I, but if you have any further thoughts or questions or you want to continue this conversation later, I'm more than happy to to 

[01:05:18] Emma Pickett: do it again.

Okay. That's very sweet. Well, yeah, well, hopefully we'll keep talking about it as, as more research comes out and so when, when this episode goes out, there might be some questions on Instagram. We'll, we'll tag you in and we can maybe carry on a conversation there too. Thank you so much your time today.

Absolutely. Massively appreciated. Thank you.

Thank you for joining me today. You can find me on Instagram at Emma Pickett Ibclc and on Twitter at Makes milk. 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.