Hannah's story - IGT and working with Imogen Unger IBCLC

This week, I’m joined by two special guests: Hannah Clapham, mum of two and a holistic sleep coach, and Imogen Unger, a seasoned lactation consultant with over 20 years of experience. Hannah has Insufficient Glandular Tissue (IGT) and struggled with her first breastfeeding experience.  She was better-prepared for her second experience, bolstered by Imogen's support, and continues to breastfeed her two-year- old son to this day. We discuss the complexities of diagnosing and managing low milk supply and how the right support can make the difference.

Find Imogen on her website https://www.imogenunger.com/ or on Instagram @‌imogenibclc.

Hannah is @‌littlenestsleep on Instagram.

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

Other resources mentioned - 

Caoimhe Whelan is an IBCLC with a particular knowledge of low milk supply: https://latch.ie/

Finding Sufficiency: Breastfeeding with insufficient glandular tissue https://www.lllgbbooks.co.uk/store/p230/FindingSufficiency.html

Breastfeeding Grief and Trauma https://professoramybrown.co.uk/breastfeeding-grief

Is Your Baby Getting Enough Milk - Video - https://globalhealthmedia.org/video/is-your-baby-getting-enough-milk/

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.

There are three of us today I am looking at the lovely Hannah Clapham, who you will find on Instagram as Little Nest Sleep. We could do a whole nother hour talking about sleep and little person's sleep, but we're not gonna do that today. We're gonna talk about Hannah's breastfeeding journey, which she has very kindly talked about on her Instagram page.

We're gonna talk about her journey with both of her children, but specifically her second baby who was born in September, 2023, and she shared a very honest and raw post, which encouraged me to get in touch with her and ask her to come onto the podcast. I'm also looking at the lovely Imogen unga, who is a very experienced and well-respected lactation consultant who's been working with families for more than 20 years in the UK and Australia, helping families, specifically neonatal and premature babies, but all babies with their breastfeeding journeys and feeding journeys.

She's based in South London and even though I'm in North London, I've never actually met her in real life. No, it's mad because that's the weird way that the lactation world works. Yeah. We all work in these teeny little circles. Um, yeah. But I very much hope I will get to meet you in real life. One day we've emailed and we've messaged and we've been doing that for years, but we've never actually met in real life.

So it's nice to see your face. Me too. Um, so the reason I've got image in here as well is because one of the things that Hannah talked about in her post was how Imogen supported her on her journey. So although this is Hannah's story, Imogen's very kindly agreed to join us as well. Thank you very much, both of you for joining me today.

My pleasure. Thank you. Very nice to see you. Um, so Hannah, tell us a little bit about your life. Tell us about your family. I know you work in the sort of sleep support world, but tell us a little bit about Hannah's world before we deep dive into your breastfeeding journeys. 

[00:02:25] Hannah Clapham: Yeah, so I, um, I had my first baby in 2019 and I guess we'll come onto breastfeeding how that worked a bit later.

But, um, yeah, it was just like lots of new moms just completely shocked at the intensity of having a little baby that needs you 24 7 and didn't get any sleep and became obsessed with sleep and long story, but ended up finding out about Lindsay Hook way and. Uh, I found myself with all of this knowledge about sleep and thinking the support available for parents is just a bit rubbish and I would like to be, uh, you know, offer some more support.

I felt really passionately about helping families through sleep, but also like supporting, like letting people understand like, what's normal, that you don't have to sleep, train if you don't want to. And I, yeah, I trained with Lindsay in 2020 and then set up my Instagram account and yeah, now I work with families all over the world, mostly toddlers and preschoolers with all kinds of sleep issues.

And that's me. And then I had my second baby in 2023, so four years later. And it was such a different experience knowing all I did about what was normal and no bad habits and no stress over sleep. It was a, a lovely experience to kind of go through that again. But I had, I did have a very tricky first year with my second baby in that I had a really hard time with breastfeeding again.

And also I became a single parent. So my marriage of nine years broke down in that time and now like, I can't believe he's nearly two, like he'll be two in a few months. And it's crazy to me Imogen, like I can't, yeah, I last saw you has happened and um, but I'm doing really well. Like, it, it was a really, really tough time, but I'm in a really good place now.

So yeah, I've got a nearly 2-year-old and a 6-year-old and a business I love and I'm based in London as well. And that's me. 

[00:04:36] Emma Pickett: Yeah, I mean, I have to say I don't do the YouTube thing for my podcast, but you glow in a kind of Korean skincare kind of way. Um, which suggests to me that you've, you've got to a good place.

I mean, it can't be easy to, to parent a 6-year-old and an nearly 2-year-old. And, but you, you do seem really positive in the way that you're kind of vibing, which I think is super lovely. Um, you could be faking it, you could be miserable 20 minutes later after you finish this conversation, but you, you've definitely got that positive vibe.

And I, and hearing you talk about discovering the work of Lindsay and holistic sleep coaching, that definitely makes sense to me. You're not battling against nature, which so many new parents are doing, and for anyone who doesn't know about, so Lindsay Hook way, we'll make sure we put her, um, account in the, in the show notes.

She's not the only person that talks about what's normal with babies. Um, but she's brilliant at communicating. Her books are fantastic. She has this course, the Holistic Sleep Coaching Course, and I recommend anyone who wants support with sleep finds a holistic sleep coach. As a starting point, how would you say holistic sleep coaching is different from maybe other kinds of sleep training slash coaches work?

[00:05:47] Hannah Clapham: Ultimately, it's about being responsive to the, to the child, um, and understanding though that it is a dyad as well and that you're trying to meet both the, the caregiver and the baby's needs or as the child's needs. It's about working within the parameters of what is normal and what is to be expected, and sometimes it's not about working on the sleep of the child, but actually supporting the caregiver and making things more sustainable for them.

I holistically, I suppose it means looking at that whole picture and trying to understand why a child's sleep is the way it is, so their issues with feeding, other issues with allergies, reflux discomfort. And obviously it's not my job to ever diagnose anything medical, but rather to signposts like red flags and, and signpost people towards medical professionals.

If I think that's, if there are signs of obstructive sleep apnea or something going on where a child's really unsettled to get them further help. Uh, and then looking at, I suppose sleep biology of sleep pressure and the circadian rhythm and their lifestyle, their diet, what's going on for the whole family, what their overall kind of natural rhythm, rhythm and routine is, and thinking, how can we optimize this?

So the goal isn't to ever say, right, we are going to get this baby sleeping through the night with zero feeds by this age, because that's what we want. It's more like, who is this baby? What is their personality? What is their temperament? What factors are influencing their sleep right now? How can we make it the best it can be?

And how can we make things as sustainable as possible? So it's about thinking like, what can we control? What can't we control? How do we as parents feel about the sleep and feel about ourselves and the choices we're making beautifully described. 

[00:07:34] Emma Pickett: We could clip that out. We could sell that to Lindsay and she could use that in a, in her course promotion.

You described that beautifully. And I mean, from my perspective, and I'm not a holistic sleep coach, I, what I see parents understanding is what's normal and as you say, what you control and what you can't control. Whereas there are some people out there in the sort of sleep training type professions. Who aren't being really honest with parents about what's truthful and what's really gonna happen, and then setting parents up to fail, or I have to say it occasionally, some local sleep trainers to me, making parents feel as though if their child's sleep hasn't been fixed inverter commas, it's because they've done something wrong.

So it's never the sleep trainer's fault because they set themselves up for false expectations. It's the parent didn't do X, y, Z in exactly the right way, and that's why it didn't work. Bye-bye. Give me your a thousand pounds please. Um, so I just love the honesty of a holistic sleep coaching. It's not pretending to be anything else, but it's also, as you say, if someone's coming to a holistic sleep coach, they, they're often super tired.

They need support, they need to sleep, so let's work out how to make that happen. And it's not always about controlling what the baby's doing. Sometimes it's about what we are doing as parents and how we can change our attitudes to things. And so often parents say to me, and I've seen them say it on Lindsay's account as well.

I felt I was failing. I felt I was in a battle. And when I actually learned what was truthful and normal, I relaxed. And then I found I could get more sleep because I wasn't feeling as though I was battling against nature. Okay. As I said, that could be a whole hour. So I'm gonna resist the temptation to talk more about sleep istic, sleep coaching.

Let's talk about you first image briefly before we deep dive into Hannah. Tell me a little bit about your, your practice and what you're doing day to day down in South London, miles away from me in South London, it does seem like 

[00:09:17] Imogen Unger: miles, doesn't it? I do come up around you though. I kind of like spread myself all throughout.

Oh, do you? I didn't realize you came this way all throughout London. Um, okay. So, I don't know. I've been supporting families, feeding their babies for a long time now. Mostly, um, just my, the start of my journey was in neonatal intensive care. And then I saw there was a lactation consultant where I worked in Australia and I was like, wow, what's that?

That's an amazing job. That seems like something that I'd really like to do. Be able to share information, like up to date information in a way that helps them get where they wanna get to. Then when I had my own babies, it became even more evident that the information that people were getting wasn't always right.

And it's, it's the same as sleep, isn't it? Hannah? Like so much. You've gotta do this. Like really black and white ideas around things. And that didn't sit very well with me. So then I did my training to become an I-B-C-L-C and then started working in private practice along, still working within the NHS as well.

And that's what I've been doing for the last like 13 years I think. 

[00:10:19] Emma Pickett: Okay, so you did the move, you did the move from Australia to the UK mid-career. How, how do you find the differences between Australia and the UK in terms of breastfeeding support and, and sort of the breastfeeding culture? 

[00:10:32] Imogen Unger: It's really hard, Emma, because I left so long ago now, like 20, 20 years ago this month.

So what I remember is, um, there's only snippets of the things that I remember. I remember that it was standard to have infant feeding specialists within maternity hospitals, which I don't necessarily see here. Maybe more so now, but not when I first started working within the NHS here. Um, and it was kind of down to people that were like super passionate about it and going maybe outside what their kind of like roles are within the hospital and the training that they'd done themselves outside to add more value to what they were doing and the support they were giving.

Just from my own, it's, my children are old now, so maybe like 16 and 14. So the provision that was available then is a bit different to now. I think like Hannah's noticed as well, like there's way more like drop in groups now, isn't there? With people that have um, got more specialist training. Um, I feel like that's more available in Australia.

I can't speak a hundred percent, but just from my sister's kind of, um, experience, she was able to go to the hospital and see a lactation consultant that was just part of her care if she needed any extra help. So I don't know where it is a hundred percent now, but maybe we are becoming more equal in the support that's available.

But. I don't really know. It's been so long, Emma. 

[00:11:51] Emma Pickett: Yeah, don't worry, I won't put you on the spot and ask you to, to quote statistics at me. I mean, my impression from Australia is that breastfeeding rates are higher than here. Yeah. And the drop off is, is not as significant. Yeah. So we have super high initiation rates in the uk, but the drop off is more significant.

It is, isn't it? But obviously Australia's a big place. It's gonna vary depending on where you live and that, and that's, that postcode lottery is definitely the case in Britain as well. I mean, there are some people that do have access to specialist clinics in hospitals and can meet lactation consultants.

And there are some people who have one a month peer support run group in the local church hall. It's so incredibly variable. 

[00:12:26] Imogen Unger: It's really difficult, isn't it, Emma? Like the message that we're, like, the public health message that we are being given and then the services available to, to bring those two together is it's this such a huge chasm between the two, isn't there?

[00:12:38] Emma Pickett: Oh, a hundred percent. And also, we're in a slightly weird place in the UK where um, volunteers do too much, I think. But also people who in private practice feel a bit weird and horribly guilty about being in private practice. 'cause it's almost a bit dirty to be in private practice. Yeah. So, so because we're an NHS run health system, people should be entitled to getting all the expert care they need within that health system.

Yeah. And sadly, because that's not happening, other things are coming in to, to bolster that. And, and it's, it's, it's not a perfect place at the moment. And even though there are improvements, a lot of the, that community support you're talking about is volunteer run, which, which shouldn't be the case. Or, or people who are in peer support jobs being paid very, very little on temporary contracts, I 

[00:13:23] Imogen Unger: think.

And then you create this big, um, you have to have a certain privilege to be able to volunteer as well, don't you? Yeah. So then the people that are providing the support are all looking the same, so mm-hmm. 

[00:13:34] Emma Pickett: Absolutely. Are we 

[00:13:35] Imogen Unger: representative of the people that are trying to access the services? So then those services may are not available to everybody and we have to really recognize that, don't we?

[00:13:45] Emma Pickett: Yeah. But, and even to be honest, not just the volunteer roles to afford to be a lactation consultant in private practice in the uk, you have to have had a big wa of cash. Yeah. To start to pay for the training in the first place, to be able to pay for the recertification and, and private practice. You know, the income is not guaranteed.

You, it's fluctuates quite a lot to have enough money to, to live, especially in London, you, you know, we're having to go absolutely flat out and not everyone will get that sort of income. Um, so quite often it's people who have partners who have better well paid jobs or, um, you know, it's not, it's not a great world at the moment.

And I thank you for highlighting that issue about inequality and underrepresentation because it's a huge problem in lactation support. Yeah, definitely. Um, yeah. Okay. Right, Hannah, let's talk a little bit about your breastfeeding journeys. Tell me about baby number one. Tell me about the birth, tell me about the bird breastfeeding experience.

[00:14:40] Hannah Clapham: So I was having a really straightforward, uncomplicated. Easy pregnancy. And then at about 36 weeks, I started itching. And I remembered like the week before I'd finished my NCT group and she said, watch out for itching. Like she, it can be a sign of this liver condition. And like, like five days later, my whole body was itching like crazy.

And she's like, it was extremely rare, but go and see your midwife. And I had obstetric cholestasis, um, very, very mildly. But being a first time mom, I was petrified and, um, started having lots of blood tests and regular checks on the baby and it was fine. But they, uh, the consultant I saw was of the opinion that I should have, um, an induction at 39 weeks, which I now actually, the guidance has changed on OC and wouldn't happen.

And I was like, okay, fine. I'll just go along with that. And then just before the induction began, it turned out my baby was breach, so we went for a scheduled C-section at 39 weeks. So I suppose that in itself didn't set me up for a great breastfeeding start because actually I always felt like my weeks were slightly off anyway.

I actually think he was born at more like 38 and I just felt like he was nowhere near neither of us were ready and I just felt like, okay, I had this plant C-section and then my milk didn't come in basically, and he latched fine. Um, and past his meconium and we were discharged from the hospital and feeding seemed to be going okay.

He wasn't, in hindsight, he wasn't quite weeing and pooing exactly as now I know he should have been doing. But for the first 24, 48 hours, I was like, great. He's latching on. It's comfortable like we're away. But by day four or. Five, it's a bit of a blur. He basically had spent the entire day feeding and very dis unsettled, not sleeping.

My milk still hadn't like come in, like I kept waiting for this big moment that everyone had talked about and I just, I didn't leak, I didn't feel full. I, my breast felt empty. Then this kind of scary moment where he sort of went a bit floppy and it was sort of like eight o'clock at night and I was, I called up one of the breastfeeding helplines actually, and I said, I think I should give him some formula.

And actually the person I spoke to was like, no, no, no, don't give him formula. Oh no. And started talking about the dangers of formula and like, oh, I'm so sorry. I was like, okay. Ah. Cried a lot. Like had him on the boob. I could just tell he was getting nothing. He had like a dry nappy and then I just, my. I think my instincts just kicked in and I just said like to my husband, like, grab a bag.

We're going to the hospital now. Went straight to a and e. And they were like, yeah, he's, he'd lost like, I don't know, 10% of his birth weight. He's dehydrated. I think at this point, I don't think I'd slept for about 24 hours. I'd been, and I'd just had a C-section and I just was absolutely exhausted. And I remember like basically passing out in a and e like once he'd been seen, I remember falling asleep on one of the, like the kids' beds in the ward on the, on the, on the bay because I was so exhausted.

Like now I think about it, I was like, God, you've just had surgery. You've not slept for about 24 hours. You've been breastfeeding, round the clock, um, in this high stress. And then like I just, I remember and then I felt so guilty 'cause I fell asleep. I was like, gosh, my baby was at a e and I slept for like two.

But that's, that's your 

[00:18:20] Emma Pickett: body going. We're we're finally in a safe place. Yeah. And you, you, you really, and, and three cheers for your, in instincts, your maternal instincts. Yeah, definitely. Es especially when you'd had that, that conversation on the helpline, which I, I'm so sorry to hear. And I'm involved with the national breastfeeding helpline.

I really, really hope It wasn't the national breastfeeding helpline. It wasn't, it wasn't. Look, I'm glad to hear that. Um, not that I want it to be any helpline, and I'm hoping six years later it wouldn't be No. 'cause that's, that conversation is, is not okay. But I would say that your instincts amazing.

Amazing. You knew despite having had surgery, something in your gut was telling you, this isn't right. This doesn't feel right. 

[00:18:55] Hannah Clapham: Now I think about it. I remember at the time, so I, the, he'd been born on a Thursday and then there was a shortage of midwives and nobody, so I was supposed to get, and I think we were discharged on a Saturday.

Someone's supposed to come on the Saturday, no one came, someone's supposed to come on Sunday. Nobody came. So it was the Monday and I had not seen anyone since we'd left the hospital. And so I was anxious about my C-section. I was anxious about the feeding and I, I had all, you know, I was given all these pieces of paper of signs to look for, but I didn't.

Such a crazy time. It's hard to take all this information in and that's obviously why midwife home visits are so important because they are not exhausted and sleep deprived and they're experts and can say no, he should be pooing. Like the fact that he hadn't pooed in two days I didn't know wasn't normal, you know?

Yeah. 

[00:19:45] Emma Pickett: Unfortunately there's still myths out there around pooing with newborns. Yes, that's true. You will still come across people who say, oh, sometimes babies just don't poo. Yeah. And newborn babies don't poo not the case. Yeah. Newborn babies, breastfeeding, any newborn baby will be pooing several times a day and, and you obviously, you dropped off some sort of list and you weren't getting them midwife care that you needed, so.

You were at hospital, you absolutely were allowed to sleep, which I know you, and now you know now. Um, what happened next? Presumably they were talking about supplementing pretty quickly. Yes. So I 

[00:20:16] Hannah Clapham: saw a pediatrician or the consultant on the, um, on the ward who put me on a very strange feeding plan. And I remember I actually, um, filmed it.

I've got the recording and it's 'cause I was like, let me just, I couldn't retain all the information and it was feeding 15 minutes on each side, but no longer than 15 minutes on each side. And then I had to give like 50 mils of formula. And this, you know, he was a week old and I had to do that every, I think it was two hours, but I couldn't feed in between the two.

Like, it was very rigid. It was like I wasn't allowed to feed in between, I wasn't allowed to feed longer. Luckily, as I was discharged, I had, I still hadn't been seen me by midwife and I was worried about my, my stitches and I'm, so I was, I popped up to the maternity ward as we left a and e and saw. The top midwife, I dunno what that's called, the The boss midwife.

The boss midwife, yeah. And she was like horrified that what had happened and took it very seriously and like brought in like I guess the infant feeding lead on the ward. And they were like, they all rallied around me. They looked at this plan I'd been given and they were like, okay, throw that out. This is what you're gonna do and this is, and so they really like very lovely.

And then like people came and saw me at home and it was really nice. And they were like, you're gonna go and see this. This is our feeding team. You're gonna go to this group on Thursday, you're gonna do this, you're gonna do that, blah, blah, blah. So luckily I didn't take, but I think my husband was a bit worried 'cause he was a bit like, but the doctor has said, this is how you should feed.

And we were so worried about a baby who was quite small anyway, like he was a little baby and he'd lost weight and he was like at the bottom of the centile charts. And I think, you know, his instinct was just like, I just wanna feed the baby. Like why is breastfeeding, he was supportive of breastfeeding, but ultimately when it's like.

The baby's sort of not doing well. You just want, he just wanted to feed the baby and he obviously didn't understand that sort of drive I had to breastfeed. Anyway, it turned out he had a tongue tie, which I didn't discover until he was about eight weeks old. And I was sort of going to all the breastfeeding groups and I was doing the triple feeding and I was seeing, I was, you know, I was getting the support, but I just felt like something wasn't clicking.

And I had lots of friends who were going through all their breastfeeding challenges. Like I knew it wasn't just me finding it hard, but I felt like one by one by like week six, week seven, I, I saw them sort of take off and saw, and they were doing the like, oh, I'm really glad I persevered. Like it's easy now and this is the best thing.

And oh, like I've come through and I was like, why am I still triple feeding at 12 weeks? Like I've had the tongue tie cut. I've been to the groups, like, they're probably sick of me by now. I'm going in every week. I've still never leaked. I still don't feel full. Like I'm. Pumping seven times a day. I'm supplementing he started to gain weight, but I, I just, you know, it really took over my life.

It really affected my mental health massively. I was so anxious and I just felt like I had failed so much. Like I just felt like there was something wrong with me. But I think I experienced a lot of well-intentioned gaslighting about my supply. Oh yeah. That sounds 

[00:23:21] Emma Pickett: familiar. Mm-hmm. So familiar. 

[00:23:23] Hannah Clapham: I'm, I'm so triggered whenever I hear anyone say, oh, it's very rare to have a low supply, or was it a genuine low supply?

And, you know, they're, they're just doing it because I know a lot of women do mistake low supply or there is a lot of misinformation about supply and a lot of people think they can't breastfeed when they can. And I should add as well, I forgot to say, I've gone on to become a, I've done the BFN peer supporter training, so I'm now a peer supporter.

So I do like, I do understand that that is a thing that people worry about their supply when they're fine. But if you've got genuine low supply, it can be really upsetting to be told, you're fine. You're fine. When like, the baby's still, like he took so long to gain weight. My supply was just not there. 

[00:24:04] Emma Pickett: You mentioned that your milk hadn't come in sort of day four, day five came Yeah.

That it never really came in in the sense that it was an ob obviously it. Did to some extent. 'cause you're expressing Yeah. But, but you didn't have that obvious single ament, that obvious transitional period. Not everybody does, but as well, you know, spoiler alert, something's going on for you here that probably people have picked up from the show notes as well.

Yeah. Um, I, I saw image and nod with this that, when you said that word gas lighting, because I know that sadly in the lactation world, because we are so focused on the perceived insufficiency of milk supply, which is a huge problem. Yeah. We've, as you just alluded to, we very easily forget the people for whom there is a genuine milk supply.

And you will even see posts on Instagram that say things like, everybody makes enough milk for their baby. Mm-hmm. And I saw someone the other day saying, I've been working in breastfeeding support for 20 years and I've never met anybody who had a genuine milk supply problem. I'm like, where are you?

Where are you working? 

[00:25:01] Hannah Clapham: Yeah. Like what blinkers have you got on? Like, I just, I think, um, I think for me as I like my mum. I'm one of four children and she breastfed us all for several years each. She's really like pro, like she's really passionate about breastfeeding. And then I've got two sisters who both exclusively breastfed their babies.

And I just felt like, well, I'll just do that. Like, you know, my mom, my and my mom, like, you know, she weathered lots of breastfeeding storms and was just like, no, you just, you just, it'll be fine. It'll be fine. So people really cheerleaded for me, but I just didn't feel like, I dunno. And I guess in my mind, I wrote this story that I was like, well, I had the C-section and then we had the tongue tie and maybe that was it.

Maybe that's why my body just never made enough milk and I just got onto the wrong start. So when I was pregnant with my second, oh sorry, I should say that I ended up breastfeeding for 10 months, but he was. Always supplemented with formula. And I would say from a, like as time went on it, the formula did continue.

So really I continued nursing for like comfort, for soothing around sleep. But he was not a particularly milk interested baby anyway. Okay. Like, you know, actually he wasn't that bothered about a bottle or boob, and by like 15 months he wasn't really ha he wasn't interested even in milk at all really. So he was, but anyway, so I kept going and actually it was the, it was the pandemic that really allowed me to stop because I didn't want to breastfeed.

I hated it. I resented it. I felt like it was this constant reminder of this thing that I wanted to do and that I couldn't do. 

[00:26:37] Emma Pickett: Can I just ask you a couple of quick questions about your first experience? Yeah. So, so while you're triple feeding, you're going to groups and you know, as we've just suggested, lots of these groups are run by peer supporters who don't necessarily have that more advanced level of training.

No one sat down with you and said, talk to me about your hormonal profile. No. Talk to me about retained placental tissue, which I think we've ruled out by 12 weeks, but, you know, talk to me about what might be happening with your body that no one's had conversations with you about primary milk supply issues at all.

[00:27:04] Hannah Clapham: I just got told about supply and demand, skin to skin, relaxing, trusting my body and like dropping my shoulders. 

[00:27:15] Emma Pickett: You know, wouldn't it be nice if dropping your shoulders is all you needed to make a film? So, so, I mean, this is, this is what happens in a world that doesn't have that proper signposting. You know, if we had a perfect system, yeah, you'd see the peer supporters.

The peer supporters would say, okay, you're plateauing. I can see that. Let me refer you to the specialist doctor slash lactation consultant who will talk to you properly about your history. Yeah. And you talked about not liking breastfeeding, which I think everybody could completely understand, but you kept going, you know, for 10 months.

That's pretty amazing. What's driving you at that point? 

[00:27:47] Hannah Clapham: It was just a really helpful parenting tool. Like, it just, it was just the, like, I think Emma, I think I've heard you refer to it as a Swiss army knife and I, that's what it felt like. He was a very sensitive little soul. He needed a lot of, like, he was a koala, you know?

And I just was like, well, what am I gonna do if I don't have my boobs? Because he cries a lot. He wants to be on me all the time. I dunno for sleep for, I guess maybe for my own stubbornness as well, a little bit. And I think part of it's maybe a bit of an identity thing. And also I'm maybe in, um, in an unusual situation where, not only around my family sort of breastfeeding, but I'd say like 90% of my friends around me were breastfeeding as well.

Like I've got in my, my kind of community, quite a high breastfeeding rate. And so I just felt like I wanted to be doing it. You know, I just, and I, I dunno, I felt like maybe I'd failed at birth and I felt like I was failing at sleep and I felt like I didn't want to fail at another part of mothering. Yeah.

And then it, like I say, it was the lockdown that was like, okay, no one's watching anymore. You're just in your home. What do you want to do? And I just had this conversation with myself. I was like, I don't wanna pump because I was still pumping. You've talked about pumping sort of seven times. Yeah. Pumping.

I pumped. So that's intense. I didn't need to, I dunno why I kept pumping and this is why I, I wanna talk about how great it was to have image in second round, second time round of just someone there saying, you don't need you. We've done the pumping now. Like you don't have to keep doing that anyway, so I pumped so much and I just was like, I'm just so tired of like cleaning bottles and cleaning pump parts and worrying about my supply and worrying if he's got enough.

And I just thought, there's no one judging you either way anymore. You're at home, just feed your baby how you wanna feed your baby now it doesn't matter. You've made it to 10 months. And I had this like thing, I was like, I want to do a year. And I was like, why? It's an arbitrary number, but. I'm okay with stopping now.

Actually, I should have stopped maybe a few months ago, but I'm gonna stop now. And it was, I was really pleased though that I got to stop when I wanted to. Mm-hmm. But I'm also sad for that version of myself as well that sort of pushed myself beyond it because, you know, I, I, maybe it's that thing, if you worry that you are not gonna have the bond with your child, you worry that you are not going to be able to meet their needs.

Maybe it was just this kind of worry that, what am I without breastfeeding? I think most mothers have that at some point when it comes to weaning. Right. It is like, well, will they still, how will I connect to them if I don't have that? And obviously, yeah. You learn as you, as your children grow, that there is, you know, that isn't, it's not just about your boobs, it's about you.

Yeah, yeah, 

[00:30:22] Emma Pickett: yeah. I can put all those feelings. When you, as you say, when you're surrounded by people for whom breastfeeding is a successful part of their parenting, it's very hard to close that door and say goodbye to that. That is a difficult thing to do, but I'm so glad that you, you had the freedom to do that.

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. When you were pregnant with number two, what were you thinking about breastfeeding? You knew you want, you wanted to breastfeed again. Yes. I'm guessing yes, because obviously you did. How were you, how were you feeling around that?

[00:32:08] Hannah Clapham: I felt so confident and excited and I felt like, you know, because of the job I was doing by then and I'd done some more training, so I did the ABMS Breastfeeding Foundation course, obviously to like support, even though I don't support families with breastfeeding, when you work with sleep, it's really important you have a, an understanding of, of how breastfeeding works and I just felt, I felt like, yeah, like I said, I felt, well last time it was the C-section and the tongue time.

This time I've got loads of friends that work in the lactation world. I've done my studying, I know about this. I'm excited, I know more. I'm ready to. To go for it. I didn't, I didn't feel any worries whatsoever, which now in hindsight, I feel quite naive about. And I had a bit of a plan like image. I don't think we'd ever spoken before, but I had a friend who'd worked or you'd worked, you'd supported her with her baby and or she'd always like, raved about you and I knew you were local.

So I kind of had you all like name in my head. I was like, okay, well I would, that's who I would go to if I was gonna have problems. And I knew like someone else who was, I assumed all of the children, our family seemed to have tongue ties, myself included. So I was like, well, i's gonna have a tongue tie?

Let's not, like who am I gonna get the tongue tie cut with? Who am I gonna, what, which osteopath am I gonna see? I had this whole plan to support the feeding and I also was very lucky that I had this spontaneous feedback that happened. Like, you know, I felt like I was ticking all the boxes for the so-called perfect breastfeeding journey.

We had the golden hour, the skin to skin he latched on. It was lovely. I was feeling left hospital feeling pretty good about it all except it did hurt this, that was the difference this time round. He immediately, I was like, ow, that's a very painful latch. Very painful. Oh, we didn't have that first time round.

Um, and even the midwife, I think when we were leaving hospital was saying like, obviously we can't confirm. But yes, there's probably a bit of a tongue tie there. 

[00:33:59] Emma Pickett: Can I just pause you for a second, hun? Did, did you have a C-section second time around? No, sorry. A vbac. Okay. Okay. And I'm gonna ask you a personal question.

Mm-hmm. And feel free to tell me to sort off if this doesn't feel comfortable. But you are single at this point. 

[00:34:11] Hannah Clapham: No, I was still with, I'm still with my partner. Okay. 

[00:34:14] Emma Pickett: Okay. Thank you for clarifying that. So, so you are in pain, probably a tongue tie, but you are feeling really confident about breastfeeding.

All the soldiers are lined up, you know what you're doing. 

[00:34:24] Hannah Clapham: Yeah. 

[00:34:25] Emma Pickett: So did you have the tongue tie cup? 

[00:34:27] Hannah Clapham: So it wasn't, so I made the mistake of giving birth on a Friday night, Emma, so don't recommend. Oh, Hannah, come on. Get organized with That was my first mistake. A big one because yeah, there was no infant feeding support at the hospital on a Saturday or a Sunday.

[00:34:40] Emma Pickett: Isn't it interesting that we live in a world where that's considered normal? 

[00:34:43] Hannah Clapham: Yeah. So 

[00:34:44] Emma Pickett: weird, isn't it? It's mad, isn't it? 

[00:34:46] Hannah Clapham: And like the, the midwives were lovely. Like I say, like, she was like looking at the feed and she was like, yeah, I can, yeah, I'm sure your instincts are right. Like, yes, like, you know, it's great that you're feeding, but, but yeah, we don't want that to hurt.

So, but she's like, but you know, what can I do? Like, there's no one here until Monday. Do you wanna stay until Monday? And I was like, not really. I've got a 4-year-old at home. And, you know, so because of the pain, I think, I, I think I'm, I think I messaged you Imogen, like, as I was on my way home from hospital on a Saturday.

I was a bit like, it's really, and it became really painful. Like, I'd like probably worse than birth. That's what I felt like at the time. Um, so I. Yeah. Imaging, I think was sat in my living room like 36 hours after giving birth on the Sunday morning. 

[00:35:30] Emma Pickett: Yep. So you are paying a little bit of attention to nappies at this point.

I mean, I'm guessing when you've had that previous experience of being readmitted to hospital Yeah. That trauma never quietly you Yeah. Were you worried that was gonna be happening again? You're looking for nappies, you're thinking about what's happening to your breasts. 

[00:35:45] Hannah Clapham: Definitely. Yeah. I was really worried about my supply.

Um, I, I mean, I, I actually, I wasn't like intensely worried about my supply, but I was worried that I was about ticking all those boxes, and he took a little bit longer. He, his first poo didn't happen actually until, yeah, it took a bit longer. Like he kept us waiting for it. But it did happen before we were discharged at hospital.

But then he didn't, I think by the time that Sunday morning, I don't think he'd pooed again. In fact, I think, if I recall now, Imogen, like, I don't even remember this, but he'd like barely pooed. Yeah, I remember at all. So I knew by the time that it was like 10:00 AM on the Sunday morning. Having given birth on Friday night that I knew that he'd only done one poo and he, I think maybe even had the urates in his nappies already by that point.

[00:36:27] Emma Pickett: Yeah. So urates are brick red orangy crystals that are very, very concentrated urine, basically in the nappy. And we might see that on day three for a baby that's doing okay. Mm-hmm. But ideally not beyond that. And certainly in, alongside a baby, not pooing daily. Yeah. Is, and that's, that's a flag that something needs extra attention and things aren't maybe going in the direction you might want them to.

This is one of the examples of when private practice can be a special thing. 'cause you can be in someone's home on a Sunday, um, right when they need you. Um, so you had Imogen's number, Hannah, you knew you wanted to, to get that extra help. She comes round. Um, what do you remember from that, that that first conversation?

[00:37:11] Hannah Clapham: I think mostly I wanted help because of the pain. Like, I just wanted her to like, confirm if that, well, you know, look for a tongue tie and, and help me feed so that I wasn't. Agony actually. But I've just, yeah, I remember her just asking lots of really good detailed questions and providing lots of like, encouragement.

And I know it's like a mixture of feeling really supported emotionally and having that, that kind of kindness and warmth that someone's really listening to you. And then also that very clear like professional ex expert experience of like asking questions that about my hormones, about my, my birth, about my feeding history, about my medical history, all those questions and feeling like, okay, like she knows, she knows what she's talking about.

And like that, that there's, that, there's those two levels of support, which I think are really important. But also, like, what I remember feeling was that she didn't make me feel panicked or like. Because there probably were some signs that I might potentially struggle with supply or like, I, I think we talked about low supply and I feel like, I think it was a very tender topic for me and I was, didn't want to hear that I might have a low supply, you know?

Um, and then, and by that point it was probably too early to know anyway, like it was only like day three. So, but I feel like you just gave me like signposted some information, things for me to be aware of in a way that I could kind of handle that wasn't too scary at that point. 

[00:38:40] Emma Pickett: Yeah, it's such a difficult balance getting that right Imogen, isn't it?

When you go and when you go and meet a mom and you can block your ears at this bit, Hannah who tells you her history and the first history suggests that maybe something is going on, something potentially was going on with primary milk supply and you obviously don't know. What the hormonal profile was first time around or what happened with the placenta or any, you know, blood loss, et cetera.

But there's a little, little voice in your head thinking, hmm, this mom may be a candidate for a primary market supply issue, but you don't wanna blurt that out on the Sunday. They just arrive home from hospital. Right. Um, you know, you want to be sensitive and you want to help 'em to feel supported, but you also can't mislead and pretend no and do the stuff we were talking about 10 minutes ago.

The kind gas light, everyone makes enough milk supply. So when you meet someone and you think you're thinking, oh, there might be a primary milk supply issue here. What kind of messages do you want to leave them with? What do you want them to be thinking about in the days that follow? 

[00:39:40] Imogen Unger: I think the biggest thing is, first of all, to do it, um, to be gentle and to listen, isn't it?

If they have had information given to them from other healthcare professionals that are maybe a bit gaslighting. Kind of acknowledging that that might not be factual in a gentle way as well without judging the other people that are supporting them. But I think the key thing is to let them know that this could be an unknown, isn't it?

'cause we, just because you've got this or this doesn't mean that this actual thing's gonna happen. But also I think it's really important to point out how to know if a baby's getting enough milk, isn't it Emma? So, so what are the signs that like that, the easy to see signs that will let you know? And like Hannah's talked about a lot of the time, nappies is a really good thing, isn't it?

Like you've mentioned already, like what does like breast fullness, does it feel like, do your breast feel softer afterwards and swallowing? I feel like swallowing is a really big thing as well. And lots of people will say to me, oh yeah, the baby feeds for ages, but it's nuanced what a suck and a swallow is, isn't it?

So helping them recognize that, which is tricky as well, isn't it? Am I like. 

[00:40:50] Emma Pickett: Yeah, it's really hard, isn't it? I mean, I've been doing this for, for a couple of decades and you have to look hard. Yeah. You have to sort of, you are looking for that tip of the chin that does that. Pause, pause it, it comes down a 

[00:41:00] Imogen Unger: dead point just for a split second, isn't it?

Yeah. It's that tiny pause. Yeah. And maybe, um, because it's a ratio ofs to swallow as well, isn't it? So, but then you don't wanna talk too much either within a session, do you? Because that's a lot of information for the person to be processing. 

[00:41:16] Emma Pickett: Yeah. And then also if you get obsessed on the swallow thing, yes.

You end up having a parent that dis spends their whole life staring, looking for swallows and oxytocin's not gonna happen. And they're just like, that was four swallows. Yeah. You know what's happening? You, they're already, you know, I mean, it is just, it's very difficult to engage the left and right brain at the same time, isn't it?

Percent. And get a parent to, to acknowledge what a swallow looks like. But, but don't focus on that too much. I literally said that this week. Yeah. Now we know what a swallow looks like. I want you to forget about that. Yeah. Forget about it. And, and try and focus on your baby. Yeah. That's the 

[00:41:47] Imogen Unger: thing, isn't it?

Try and focus on your baby. Try and focus on what your body feels like. There's a really good video on the global health media project as well of a baby swallowing and what sucking just looks like and what swallowing looks like. So sometimes sharing that with them, um, so they can circle back to that to have a look at as well.

[00:42:05] Emma Pickett: I'll put that video in the, in the, it's trying not to 

[00:42:07] Imogen Unger: overload, but I also feel like. You have a real responsibility, no matter if the information you're gonna share with them is maybe not what they wanna hear, that's their right to still hear it, isn't it? I don't wanna be the gatekeeper of any information, and I think that's what happens a lot, isn't it?

They're like, oh, just keep going. Everything's fine, everything's fine, everything's fine. But then if we don't share, oh, hang on a minute, no poos for a few days, it's not ideal. We need more than that. It could just be because of A, B, and C. So work on these things. But if we don't highlight things that are maybe off a little bit, then I really feel like we are doing that family a disservice and it's our right.

It can be really hard to share though, can't it? 

[00:42:51] Emma Pickett: Yeah. I 

[00:42:51] Imogen Unger: think and some, and I 

[00:42:52] Emma Pickett: struggle with that a lot. It's, it's, it's such a sophisticated practice getting that balance right? Yeah. Between encouragement and not giving the whole story because it's a bit scary. It's absolutely a fine line, isn't it, between those two things.

Um, but obviously you got it right on that day because Hannah felt supported and also she felt like she was getting the right information she needed. Um, were you able to get more comfortable? Do you remember with positioning? Yeah, 

[00:43:18] Hannah Clapham: it did. It did help. Um, I mean it was still very painful, but Imogen did help.

Yeah, we had a few like strategies, positions felt like I could keep 

[00:43:29] Emma Pickett: going. Do you remember what your favorite position was after that day? What were you doing? 

[00:43:33] Hannah Clapham: I think it was like a cradle hole, but. I think I have, I just have a few bad breastfeeding habits anyway, where I dunno, stick the baby in my armpit and hope it'll find the nipple and things like that.

So, I dunno, maybe, I dunno, I can't, I think it was 

[00:43:45] Emma Pickett: probably just like playing the baby, find the nipple sounds good to me. Yes. A bit of, bit of baby led attachment. Yeah. There's nothing wrong with that, I dunno. 

[00:43:51] Hannah Clapham: Yeah, but my nipples not in my armpit, so, um 

[00:43:54] Emma Pickett: Okay. Maybe that literal bit not, not so good. Yeah, 

[00:43:57] Hannah Clapham: maybe we did a bit of laid back feeding.

I feel like that's fine. Maybe we tried a few different 

[00:44:00] Imogen Unger: things, didn't we? And I think that's a really important thing to kind of, um, kind of touch on as well. Isn't it? Like you spend a lot of time seeing people sometimes chasing a perfect latch as well, don't you? And if that creates more problems as well sometimes, doesn't it?

So I don't find that there's one specific position that works for everybody is that it's about figuring out what works for that mom and that baby or that parent and that baby at that time as well. And that might change feed by feed as well, isn't it, Emma? I think. 

[00:44:29] Emma Pickett: Yeah. 

[00:44:30] Imogen Unger: And where you're 

[00:44:30] Emma Pickett: sitting 

[00:44:31] Imogen Unger: and a hundred percent time 

[00:44:32] Emma Pickett: of day and not exactly a hundred percent.

[00:44:34] Imogen Unger: Yeah. I think can we just circle back to like before when Hannah was talking about, um, a tongue tie, I think it's important to kind of highlight that, um, as A-I-B-C-L-C, I can't diagnose that's outside my, um, scope of practice. We can look at some of us that have done extra training, look at tongue function, you know, and can highlight when that function might be impaired and suboptimal.

Lining that up with what else is going on with that journey, then suggesting, you know, I really feel that this might be something that could be, um, impacting what's happening now. So it would be great if you could see a tongue tie specialist. So 

[00:45:12] Emma Pickett: yeah, thanks for highlighting that. I, I still get calls from people going, oh, you're an I-B-C-R-C, can you come and cut my baby's tongue?

I'm like, no, hang on. Let's just talk about the different roles. Obviously there are some lactation consultants who are also medical professionals and tongue tie specialists. Definitely. I've got, um, the lovely Sharon Silverstein, who's local to me, who's a tongue tie practitioner and an I-B-C-L-C, but lots of IB CLCs are not.

They are, and you just say they, and some of them may have had no training at all in tongue function. You can pass the I-B-C-L-C exam. Not even have training in tongue assessment, tongue tie assessment or tongue function assessment or any of that. So, um, yeah, I'm always a bit 

[00:45:47] Imogen Unger: hesitant to go in a baby's mouth as well because, you know, you don't want that to be a negative oral experience for them either, do you?

But I think you have to weigh up with like what's happening in their console and what you're seeing and history as well, don't you? And then just really highlighting that that's a snapshot of what's happening with that function then. And I'm not an expert and just because I say at this time that I don't think that there's any impaired function doesn't mean that there's not, you know, in the future things are still a bit tricky.

Definitely reach out to a, like a specialist and come back and look again, I think. 

[00:46:24] Emma Pickett: Yeah. Yeah. No, that's helpful. Thank you. So Hannah, you're coming to the end of Sunday, you're still in a little bit of pain. Yeah. What's happening in the next few days? 

[00:46:33] Hannah Clapham: So yeah, image, we talked about the tongue and also I think it was about understanding that.

It's might not just be the tongue. Like I, I knew then that sometimes people say, oh, it's, it's just the tongue tie. If you snip that, everything will be fine. Like, I knew there was more of a 

[00:46:46] Imogen Unger: mm-hmm. 

[00:46:47] Hannah Clapham: Holistic, like viewpoint on this. So poos were not, he wasn't pooing basically. Like I was not happy still with the, with the nappy output.

And I think it was on the Monday that I decided to, I think I might have messaged you Imogen. I knew which tongue type, um, practitioner that I was gonna see. And I talked to Imogen about that and she was like, yes, I think it's worth getting that, you know, let's look at that. So I booked that in, in a couple of days time.

'cause he was still really little. Like, you can't just go in with a, with some scissors on a four day old baby. Like, and the tongue type tech practitioner I saw actually was very like, we didn't cut it until he was a couple of weeks old anyway, because she's like, we need to stretch out his mouth. We need to give him a chance.

Like it's not just about cutting the frenulum and everything going right, like we. Actually, by the time we snipped the tongue tie, it didn't even hurt anymore. Like the pain was gone. It was more, and we really were like, should we, shouldn't we? Let's really assess this. Let's look at what is going on the whole picture here.

But anyway, I'm, I'm jumping ahead. But, um, I decided to give him some formula on day four because I could see that he was not getting milk and I had images, like confirmation that he was not getting milk. And by that point, again, my milk had not come in. Oh. And I think I began pumping. Oh no. I was hand expressing and just not getting, like, just not getting what I needed to basically.

And I felt good about the supplementing the formula because I felt like it, the first time around. It was this like disaster thing. I didn't wanna do that. I had to do that. They were telling me. And this time it was like, okay, I'm making an informed, educated decision. Like, it's fine. I need to feed my baby.

He's going to feed better. If he's got more energy, he's, you know, and I'm not gonna end up back in a and e. So, um, and I had images support on how much to give him, because that's like com comfy feeding is really hard when you're trying to develop a supply and not, and, but get the baby what they need. So I felt so supported having someone saying he only needs this much.

And I think perhaps we might have even done it via a syringe or finger feeding. It's a bit of a blur now. Cup feeding, I can't remember what we did because I was worried about the latch and all this stuff. So he was having really small amounts, but I felt really good that it was a way to Yeah. Give him the energy.

And, and I remember Imogen saying like, you know, first rulers feed the baby and think of it like, you know, yeah, we're giving him. Something he needs to help him keep breastfeeding. Like I saw it more as like a, a way to sustain my breastfeeding journey rather than a, an end of it, which is, I think the first time around I saw it as the end of breastfeeding with giving a bottle.

And this time I saw it as a way to facilitate that. But his poos, I mean, yeah, he just, he, he never really pooed a lot even with that. And so I guess, I think imaging, I think you must have come back. It's all such a blur, isn't it? I should have written this down before. It was like, don't 

[00:49:45] Emma Pickett: worry, you had other things on your mind, Hannah.

That's fair enough. 

[00:49:48] Hannah Clapham: Yeah, imaging came back a lot. I kept popping in and weighing him at home. That was really nice because I found the health center weigh weigh-ins kind of traumatic from the first time round. And I'm sad to say that my local midwife support with feeding was really bad. And I've made some complaints about that because there was on my like think day 10 appointments, I was clearly having major breastfeeding problems and he was not.

He just, he'd, he'd lost a little bit of weight, but not, but because I was supplementing not enough to meet the threshold for support and she said, you don't need any breastfeeding help. And I was like, I was like, I know he's tongue tied. One of my nipples is bleeding. He's still got urates. He's not pooing.

I'm paying for private support, but that's not like, you know, should I have to like, you know, it's, 

[00:50:39] Emma Pickett: that's not good, is it? That's not good. Anyway, I'm so sorry. 

[00:50:43] Hannah Clapham: And luckily my mom came with me and my mom's a social worker and so she kind of went into social worker mode and started like talking to the midwife and, um, yeah, to the point where the midwife kind of went to her, sorry, what do you do for a living?

You know, you sort of recognized that there was some kind of, uh, and then when my mom said, well, I'm a social worker, she started so being like, oh, okay. Um, right, yes. Okay. We can do more to help you. It was really. And that's a whole other conversation. But basically that whole, that first week was a bit of a blur, but I think having image and support and saying, no, this isn't in your head.

Your milk hasn't come in. You have a history of this. You're not feeling full. He is not producing the nappy output that we want him to in your gut is that he's not satisfied and happy after a feed. Just having someone say that's not in your head was such a blessing for me. It's what I really needed to hear, even though it was also what I didn't want to hear.

Mm-hmm. But, but it is that thing of like, um, and we had a really good, I suppose, like triple feeding plan so that it felt sustainable. And that was something that Imogen kept talking to me about was triple feeding is not a long, long-term strategy. This is not going to be sustainable for you. And I think I'm the sort of person that'd be like.

Yes it is. I'll just keep doing it. I'll just, I'll do it until I break myself. And, and Imogen was like, no, we're not gonna break you. Like, you know, it was, you were really, really like supportive. Imogen. I really appreciated that because I think before I felt like just so on my own with it all and taking 10,000 different bits of information and trying to make a plan for myself and said, it felt like having someone who's like, championing you, but also saying breastfeeding might not look how you thought it was going to look.

Let's, let's make it as it is. A bit like what I do with sleep, right? Mm-hmm. Like, you might not get your baby to sleep through the night, like, but let's make it as good as it can be. Let's make it feel good for you, let's make you feel confident about it, feel happy about it, and like that it's meeting your own goals.

[00:52:43] Imogen Unger: Yeah, and I, but I like triple feeding's a lot and I really hesitate to even talk about it. And I'm not sure how you feel about it. And like, especially as a long term thing, if you've kind of are doing it and then you're not noticing like, you haven't got this increase, then what's the point of going on and on and on.

So then you're thinking like, definitely there's something else. Or before you even do triple feeding, is there something else you can do? Because it's a lot of work, isn't it, Hannah? 

[00:53:06] Hannah Clapham: It really is. Yeah. And can you 

[00:53:07] Imogen Unger: do switch nursing and breast compressions and or can we, you know, like you said, breastfeeding doesn't have to be all or nothing, does it?

And No, I don't know. It's, it's a hot topic, isn't it? And something, 

[00:53:18] Emma Pickett: yeah, I, I mean I think one of the things that I do, and I'm sure you do as well, is what's someone's personal situation? Yeah. Is there someone else in the home? Is there another adult there? Two adults? Um, you know, how many pump parts are there?

Who's washing the pump? What kind of pump is it? A hundred percent? Um, there's, you've got to answer so many practical questions. Yeah. You know, if someone thinks they have to sterilize the pump between every use, for example, that's a very different day. Yeah. Than someone who understands that's not necessary.

Yeah. 

[00:53:42] Imogen Unger: Can you 

[00:53:42] Emma Pickett: have like 

[00:53:42] Imogen Unger: a little picnic bag with a freezer brick in it next to the bed overnight and just put everything in that. So like trying, if you're gonna do it, what are the shortcuts that you can do to make it a bit more sustainable? Five minutes is better than you're like no minutes. Like you know, if you wanna go out, but you don't wanna go out 'cause you're worried about missing a pump, just go out.

'cause that's so important as well, isn't it? Stuck 

[00:54:05] Emma Pickett: somewhere. Yeah. Yeah, a hundred percent. One of the things that's, that I can really hear Hannah, is that you were kind of feeling much more in control this time around. Yeah. And that was partly because you'd made that decision yourself to start supplementing and imaging, giving you information all along that process.

I'm kind of interested to hear that so far. You are not asking why, why, why am I not exclusively breastfeeding? Why is this happening to me? When did that start to kind of come in? I feel like we were having that conversation right from the beginning. 

[00:54:34] Hannah Clapham: Yeah, I think we did. I, I think it was there. I think I was blocking it out, like I think it was there hovering and I think I was so, like, I'm quite an optimistic person I think, and I think I just was like, not gonna focus on that.

I'm just gonna keep going and going. And I think it, but it was sort of hovering so it didn't feel like this sort of like, like there was no, like, Hannah, I've gotta sit you down and tell you now you don't make enough milk. Like it was there in the background. And I think it just was like a gradual realization for me.

And Imogen would sort of share different resources and I'd read them and I dunno, for me it felt like things were just starting to click and the more I read about like primary low supply, the, it was like this grief and relief is how I would explain it. I just didn't want it to be true. And yet I was like, Hmm, this is kind of explaining everything.

And yeah, it was just, it was really hard to accept because when I, like there was this grief of this experience that you want and you understand you are never going to have, unless I suppose I had like, maybe if I had five more babies, maybe my glandular tissue would eventually, you know, but I'm not going to.

So, um, you know, but it's this thing of like, well, with I'm not going to have this exclusive breastfeeding experience. And that was really, really upsetting. I found, I felt, I found that devastating, but then also this relief of like, God, it's not in my head. There is a physical reason why I'm not. It's not me.

Like I'm not letting myself down. I'm, because there is, I've encountered this attitude in this. I think we touched on it earlier about saying like. If you just try hard enough. And I've seen, I've had people actually say that to me like, well, yeah, breastfeeding was really hard for me. You've got to just, you've just got to like, don't give up.

Don't give up. And so the relief of being like, actually, there is a reason why you can't, and, and, you know, we did things like we, um, I got like, Imogen was amazing. She wrote a letter to my GP who was being a bit like, oh, you're fine, type thing. And I was like, no, no, I, I want to get my thyroid tested. So we had like some blood work done.

We trialed, um, donperidone, we, um, like I just wanted to throw everything at it. Yeah. 

[00:56:56] Emma Pickett: I quite often talk about future proofing. You want to look back and know you've ticked it, you did everything you possibly could. Yeah. So definitely, 

[00:57:02] Hannah Clapham: yeah. It was, it was this and, and we talked a lot about my hormones and my history and.

Uh, I just wanted to know. Basically I wanted to try everything. And I suppose a little bit when you're coming to terms with this is you're sort of hoping that there's going to be a, a magic fix as well. Like, you know, you're kind of hoping that they're gonna come back and say, oh, your thyroid isn't working and you're gonna have this medicine and it's gonna be like ta and there's few.

And, um, so it's, I feel like for me it was like a really gradual, it may be a couple of months of understanding that for whatever reason I do, and I, I, I do have primary low milk supply. 

[00:57:42] Emma Pickett: Would you describe that as, I think on your post, you use the term IGT. How, how do you, how do you define that? 

[00:57:49] Hannah Clapham: I do, I use IGT because I think it's just.

Easy to understand, but even part of me still feels like, do I do, I definitely have IGTI, I guess I haven't actually been seen by a medical 

[00:58:01] Emma Pickett: professional had that formal diagnosis. I think you're gonna struggle to find any medical professional that will be able to give that diagnosis. So IGT insufficient glandular tissue or hyperplasia of the breast Yeah.

Is about your body not making enough of those cells to be able to produce a full exclusively breastfeeding milk supply. Doesn't mean absolutely someone can't breastfeed. It just means that they may not produce the full volume, um, to help their baby to grow and they may always need to supplement. You mentioned before, imagine about, obviously with the inside the tongue Tai world, we, you are, we're not qualified to diagnose similarly with IGT.

Tell us a little bit about, about your training around that. So 

[00:58:38] Imogen Unger: mind training is just more what we learn during, um, when we are training to do, um, be an I-B-C-L-C and then just further reading that you do as well and like attending. Um. Workshops and, um, symposiums and reading books. Like I've read lots of books about it.

And then, um, Eva, um, whe she shares lots of information and runs a, um, a low supply group as well that you went to sometimes Hannah, isn't it? 

[00:59:03] Emma Pickett: Yeah. Yeah. Eva, I'm glad you mentioned her. Let's make sure we put her in the show notes. So Eva Whelan is in, is in Ireland. She's just actually written a book. She has, yeah.

She does a lot of work around low milk supply and primary milk supply issues. So you actually did, you were member of her group, were you Hannah? 

[00:59:18] Hannah Clapham: Yeah, I went to one of the, like the Zoom support groups and it was, it was amazing. Like just cried for like two hours basically with a bunch of other women. Um, and um, we like just talk, just hear, just told our stories and was just a space to like, feel sad about this, this, sorry, I'm getting a bit emotional now because I think, um No, it's good.

It's good because I think. My point is that it's okay to be upset about it. Yeah, a 

[00:59:45] Imogen Unger: hundred percent. 

[00:59:46] Hannah Clapham: And I think a lot of times it's, if it's not breastfeeding, it's something else. As mothers, we have this like, oh, but it's fine because I have a healthy baby. Or like, you know, it's, it's okay because, you know, it's like this guilt of feeling sad about it.

And I, I, you know, I've had lots of friends with terrible journey, you know, incredible. Been through awful things, lots of trauma and you know, you do sometimes feel this guilt of like, I'm here with this beautiful, healthy baby and we're all healthy and we're all fine. Why am I so upset that I can't breastfeed?

And I felt guilty for that. So going to a space where there are other women being like, this is really devastating for me was so like, was really like a turning point for me. Because I felt silly. Like even now I feel silly for getting upset about it. Oh, 

[01:00:34] Emma Pickett: oh, Hannah, you, Imogen and I are the last people in the world who would call you silly for getting upset about it, 

[01:00:41] Hannah Clapham: and that's why I wanted to talk about it.

I think lots of women go through this and feel really alone. Yeah. And feel really isolated. And they feel like they're not allowed to feel sad because Fed is best and you know, happy baby, happy mum. So yeah, like going to that support group, um, I think I read Amy Brown's book about and lots of like resources that Imogen shared with me and.

Things like that. I think just hearing that it's, you are allowed to feel really sad about that. You can be both, you can be really grateful that you have a, a healthy baby. You can be really grateful that you are still breastfeeding and at the same time you can be really sad. It doesn't look like how you want it to.

And I, you know, it's just such a very, for me, it was a very like, primal thing that I just wanted to do. And I've got friends who didn't breastfeed and they were completely happy about that. And I'm like so pleased for them. And I, for me it really mattered a lot. And yeah, just like allowing yourself to feel sad about it is really important, I think.

And you've got to, I dunno, my, my, my mantra is you've got to, you know, the only, the only way, oh God, I'm getting my words in mixed now. Um, the only way out is through it, you know, you've got to feel the sadness is you've got to have a cry. Like that's, um, it's okay to feel upset and, and grieve it because it is a, it is a loss and.

Yeah. So, yeah. 

[01:02:12] Emma Pickett: Yeah. Thank you you so much Hannah, for sharing that. You expressed that so beautifully and, and I know there'll be someone listening to this who will have really connected to that a hundred percent been and been really helped by you saying that the idea you're meant to fix yourself, you're not allowed to be sad.

Mm-hmm. Um, that that's a message. I think so often people are getting from somewhere, 

[01:02:32] Imogen Unger: just gonna say, 'cause there's also that book Finding Sufficiency as well with breastfeeding with the insufficient glandular tissue as well. Yeah. And Eva's got some images as well that she shares, doesn't she? 

[01:02:42] Emma Pickett: Mm-hmm. When you say images, you're talking about insufficient glandular tissue breast type hyperplasia.

Yeah. So shaping of the breast shaping. I'm, I'm gonna be super honest, I've, when I trained to be a lactation consultant, there's this set of four illustrations that we all look at, and I look at those and go. Honestly, they look frigging normal to me. I mean, what I, some of those pictures I, if I, I don't, they don't look like no insufficient glandular tissue pictures.

Someone's like, the, the quadrant is missing on the left. Looks like a, like that looks like a rounded breast to me. 

[01:03:14] Imogen Unger: Yeah. And 

[01:03:14] Emma Pickett: actually the, the hyperplasia, hyperplastic breasts I'm seeing are, I'm not saying this is you Hannah, by the way. Hannah's not naked. I dunno what her breasts look like. You know, significant asymmetry.

Very tubular, yes. Bulging areola. The breast tissue that is there falls into the areola. So you get this very large bulging areola. Yeah. You don't, you don't often see pictures of tubular breasts in these neat little illustrations. No. You see round little breasts where apparently some quadrant is missing.

Um, so during the lactation consultant training, you have to make an effort to actually find decent images. Yeah. And you have to go out there and really make an effort to get informed because you, the, the resources don't necessarily do it for you. 

[01:03:51] Imogen Unger: I think that goes back to being curious, doesn't it? Like you have to be curious and you have to keep putting yourself out there and reading books, and attending lectures and learning and speaking to other practitioners, because otherwise you stay really stagnant, don't you?

And quivas, um, images, they are, they're more, they show the differences a bit better. I think. Emma, I'm not sure if you've seen them. 

[01:04:13] Emma Pickett: Yeah, I, I need to, I'm gonna actually ask Eva to join me on the podcast. So if she never comes, you know, she said no. Yeah, but this, 

[01:04:20] Imogen Unger: here's the spoiler alert. I'm gonna ask her, but I find it really difficult as well, Emma.

I'm not sure. You know, when you're seeing a family maybe a little bit further down their journey. Because obviously we see their breasts, don't we? And it should be part of what we are doing. And they have some obvious signs of hyperplasia or IGT and no one's ever said that to them before. 

[01:04:39] Emma Pickett: Yeah, I've, I've had that conversation several times.

It's really difficult, isn't it? It's so hard, isn't it? And exactly what you just saying earlier, Hannah, about how there's that devastation, but also that relief at the same time. Yeah. And you know, as a lactation consultant, you hold that, I guess power is the word, and they're in your hands and you don't want to use that irresponsibly.

And there are some breasts that look like, yes, the hyperplasia breasts and are absolutely fine, but if someone is coming with, you know, very wide spacing, you know, pointy tubular nipples and ola, you know, not much breast tissue, and they're telling me they've always had to supplement, and the baby had a really difficult first few days and lost 13%.

Um, this year I've had that conversation with somebody for the first time, um, meeting them in month two. And they said something very similar to what you said, Hannah, that, that that was a relief. Um, and they came back the next week and we, we talked about it a bit more, but it shouldn't be like that. It shouldn't be because some flipping lactation consultant happened to go to some extra lecture.

Yeah, it should be blooming midwife on day three. It should be antenatally anally, a hundred percent. Let's, let's talk about your previous breastfeeding experience. Hannah. Let's talk about your breast. Let's talk about what might happen. Shouldn't be. You have to flip and pay wonderful imaging. It shouldn't be that.

You have to make these battles. Isn't it criminally awful that actually that is the situation that you're in. Yeah. 

[01:06:00] Imogen Unger: That's what just as blows my mind as well. Or you talk to someone who's experienced at themselves within a group and you're like, oh, hang on a minute. That's a bit like me. Maybe I'll look into that.

What was it called again? And then you go off and do your own research. 

[01:06:14] Emma Pickett: Yeah. People find it three years later, four years later. And when they've not breastfed for years, they go, oh, hang on. Yeah, what's that thing? And you've got a mid midwife saying, oh, you don't need breastfeeding help. Yeah. What the heck?

Mm-hmm. 

[01:06:24] Hannah Clapham: Or just the waiting lists are, the waiting list is so long, so there's no point in putting you on the waiting list. And it's like, um, okay. I, I dunno. So yeah, it's just, um, yeah. And that's why, I guess that's why I then went to go and do the peer supporter training. 'cause I was like, well, how can I.

How can I bring my experience? Obviously it's not about when you're supporting someone, it's not about saying this. That's a big part of the training is not, yeah. Making about you. But I did feel at least like, well, I can just be a voice here. You know, even if it's in the debrief sessions afterwards and we're talking to the other peer supporters just saying, Hey, I'm someone that doesn't make a full supply.

Like, you know, we exist. Like we're not, you know, we are real people. Like, and I like, and this is how I experienced that. You know, that's how I experienced that session when, when talking about my supply and this is, these are the sensitivities you might have if you have a low supply. And just bringing that to the, to the table was really important to me.

But yeah, I think it was just this kind of working with Imogen over several months, having her check in, having like, we kept up on the weight. For me it was like just having her just understand like what my goals were and helping us meet them because it's to, you know, for some women with IGT, obviously it's about stopping breastfeeding.

They've decided that's not going to. But that's not what they want. And for other women, and because I think it was my second and I made a bit more milk this time, I was really lucky that, and I had Imogen, that I could kind of have a plan that, that I felt so good about the supplementation that by the time that my son was seven or eight months old, I, I weaned off the bottles entirely once he was established on solids.

And now he won't, he won't even take a bottle like, you know, tried to go for a night hour, 10 months. And he was like, no way. So, um, we got there and now, you know, he, he's 21 months and we're still breastfeeding. And it's wild that I'm now at this point of like, God, how am I ever gonna stop? Well, I can help with that when the time.

Yeah, 

[01:08:26] Emma Pickett: I'll stick my 

[01:08:26] Hannah Clapham: hand. 

[01:08:26] Imogen Unger: You're in the right space for that turner. 

[01:08:28] Emma Pickett: Yeah, exactly. So exactly what you were saying before about how the supplementing helped your breastfeeding to happen. Yeah. That is exactly what happened, isn't it? So the fact that you'd supplemented from so early on. And kept baby healthy and, and kept feeding going.

That's the reason why you are now still breastfeeding. Yeah. And, and why you were able to, you know, stop the bottles at seven, eight months because you had done the supplementing. Yeah. Perfect example of the value of that. Yeah. 

[01:08:53] Hannah Clapham: Yeah. Like, and that's, I never had that first time. It was just give him more formula.

I don't, I just had no one explain. And yeah, there's lots of reasons why I didn't get that support, which we've kind of touched on, but it's just having someone who like understands you, your body, your baby, your goals. And it's, it's amazing because it gave me like confidence. It made me feel able to make other decisions.

It made me feel Yeah. Empowered with that, with that knowledge and like, I didn't feel like a failure. I felt, I felt good about feeding. Yeah. And I'm really lucky, like it is just, I just, it's so funny that, you know, almost two years ago I was like, how will I ever feed beyond another week? And now I'm like, oh God, how am I, I really wanna be done now.

Like, how am I ever gonna stop? It's, it's crazy. Like, I can't believe I'm in this position. 

[01:09:42] Emma Pickett: You mentioned first time around that you, you weren't enjoying breastfeeding, you didn't like it, you wanted it to stop. Does that feel different now, I'm guessing? 

[01:09:50] Hannah Clapham: Yeah, totally. I mean, don't get me wrong, obviously breastfeeding a toddler is something else.

Like I think everyone has a days where they're like, this is the worst thing ever. Um, because um, my youngest is a real like boob monster and, um, it's like, yeah, his favorite hobby in life. But it's funny because even now, actually, I still have to have sort, I've be quite strict with myself and not let these kind of old narratives creep in because there are days when I know he's just bored at home and he's just like feeding lots because he's a toddler.

And that's what a lot of toddlers do. I still have to fight this narrative of like, oh, it's because you don't make enough milk. Oh, you're like, he's fine. Do you know what I mean? Like he's like eating snacks off the floor and like he's not like he's just connecting with me or whatever. But I still sometimes get a little bit triggered and think, oh, is this because I don't make enough milk?

Or if he's sick and it's just me, and I think, oh, like am I giving him enough that he needs? And so I think it's still a, it's not all plain sailing. I still have these voices of like self-doubt and maybe like the grief and comparing myself to others, creep in occasionally. But I enjoy nursing. I'm happy to do it.

It allowed me to co-sleep and get more rest. And I think as a single parent, it was really helpful. Maybe that's a whole other conversation about single parenting and breastfeeding because the admin of the bottles like was insane. Like I, I, I know so many parents before they have their baby, so they want to combi feed and then when you actually start combi feeding, you're like, this is just the worst of both worlds in my opinion.

Like, it's like I hated, I hated it. So I would rather just either brittle feed or breastfeed and I didn't want to have to do them both. So. Yeah, no, I do, I do really like it. I'm really, I'm really happy that I, um, got to continue and I feel good about it and, uh, I'm not in a desperate rush to finish. I like that the end is hopefully in sight in the next, I dunno, I said it'd be nice to go to two years and I probably will probably be three years at this rate, but, um, 

[01:11:55] Emma Pickett: yeah, well you don't 

[01:11:56] Hannah Clapham: have to decide now.

That's not something I'm often saying. Take it week by week. In answer to your question, yes, I, I like nursing. I'm happy that we're doing it. Um, I feel good about it every now and then, these little voices of doubt still creep back in. But then I think as well, like you, obviously my supply has changed because he is 21 months old as well and goes to nursery.

And so that was actually quite difficult when my period, my periods didn't come back until, uh, he was 19 months, which is when I night weaned. And then it was like bam, periods came back with a bang and that dip in the supply with my, because with having a cycle again, that was quite like a bit re-traumatizing again actually.

And I knew there were days and I was like, oh, I'm really not making a lot of milk now. And then I was like, oh no, it's gone. You know? So it, every now and then it still comes back in that. Little, yeah. Little triggers I guess. 

[01:12:47] Emma Pickett: Yeah, that sounds very natural. Yeah. Gosh, time has gone on. I mean, I need to let you go and have a life.

'cause uh, this is, you've been very generous with your time, both of you, Hannah. I'm so honored that you've shared your story today and, and been really open and honest about that. And I know that will have helped people and, and I'm very grateful. Also, imagine to you to, for joining us to giving just a little bit of the insight.

I just wanted to make sure that, that you were celebrated in this story. I was really kind of you, um, because it wasn't me at all. I, I, well, I know you're gonna say that. I know you will, but it's really clear what a skilled practitioner you are and, and, and IBCLCs are out there supporting people emotionally as well as practically.

And, and you are a shining example of what a difference that has made. Thank you. And, and it's really clear to see what impact you've had on Hannah's life and on her breastfeeding experience. So I think 

[01:13:36] Imogen Unger: it's 

[01:13:36] Emma Pickett: just trying to change the message, isn't it? Like 

[01:13:39] Imogen Unger: trying to find it where a parent wants to be. It doesn't have to be all or nothing does it.

And you have to be gentle with yourself and give yourself permission to change your mind. Thank you for joining me today. 

[01:13:50] Emma Pickett: You can find me on Instagram at Emma picket, IB clc and on Twitter at Makes milk. It would be lovely if you should subscribe because that helps other people to know I exist, learn and leaving a review would be great as well.

Get in touch if you would like to join me to share your feeding or journey. You're amazing with imaging like you, your generosity of your time and your, 

[01:14:14] Hannah Clapham: your heart and your podcast is produced. It was aware and I just, you know, I'll never forget me like sitting on my so just sobbing at you, like blubbering away.

'cause I, I'm a crier obviously, and it's about so much more than just the expertise of the feeding, isn't it? I think that is what I'm, I'm grateful for both, but particularly the, um, the emotional support, it really meant a lot to me. So thank you. My pleasure. 

[01:14:40] Emma Pickett: Thank you. I'm glad I got to see that moment.

Yeah. Being an IBLC is a, is an honor group hug. Yep. Um, I, I dunno why I get to go getting the hug. I'm not really entitled. Uh, I'll watch you guys have a hug. Um, okay. Thank you so much both of you. I'm gonna let you go on with your day. So in the show notes I'm gonna put all the things that we've talked about, um, and, uh, and I'm just really hoping this, this episode will help some, some other people in, in this space as well.

Thanks guys. Thank you.