Low milk supply with Caoimhe Whelan IBCLC

This week, I’m talking to the wonderful Caoimhe Whelan IBCLC, an Irish lactation consultant and author, about her specialist subject, primary low milk supply. Caoimhe shares her research on insufficient glandular tissue and its impact on breastfeeding mothers and families. We talk about antenatal and postnatal support, the complexities of diagnosing low milk supply, and the role of technology and galactagogues. 

You can find out more about Caoimhe on her website https://latch.ie/ and find her research at https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-025-00699-4

You can find out more about her fabulous book here: Practical Breastfeeding | Book by Caoimhe Whelan, Lauren Rebbeck, Nicola O'Byrne | Official Publisher Page | Simon & Schuster UK

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 

Resources mentioned - 

https://www.lowmilksupply.org/about

https://professoramybrown.co.uk/breastfeeding-grief

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. I'm really honored to be joined by Caoimhe Wheelan. She's on Instagram as latch dot IE, which is a bit of a clue that she's from Ireland. Um, she's based in South Dublin. She's an author and an I-B-C-L-C in private practice and she's also a researcher and recently did her MSC, um, focus particularly on low milk supply, which is what we're gonna be talking a little bit about today.

Before I ask you about your specialist subject, Caoimhe, I'd love to talk about your wonderful book. Your fantastic book, which I just absolutely love. Oh, thank you Emma. So practical, breastfeeding and illustrated guide for parents. I'm really so impressed with it. It is just absolutely gorgeous. It's rocketed to the top of my charts as the book I recommend to your parents.

So I've got your book and, and Lucy Weber's book are my as my two favorites. And it's just so special. I dunno how you pulled it off, because it's what's, what I find amazing about it and you can feel free to block your ears if this is too uncomfortable, is you've got some really detailed specialist stuff in there.

It's not namby pam b basics. Mm-hmm. There, you know, if someone's got a specialist issue, they'll often come across it being discussed in this book, but yet it is also. A great introduction and, and it's also the basics. I dunno how you've managed to do the basics and also detailed stuff at the same time.

And also what's so special about it is just the way you've organized it in the presentation and the use of bullet points and, and inserts and images, and it's the most beautiful book. 

[00:02:14] Caoimhe Whelan: Oh, thank you so much Emma. Uh, that, that means a lot coming from you. I'm, uh, 

[00:02:20] Emma Pickett: I'm speechless. I dunno what to say. That's, you're very sweet.

But, uh, it's just, I mean, how did you, I mean, what did, when you set out, did you think right, I, I want something that's gonna look amazing. Was that kind of, must have been an early priority 'cause it's just so amazing. 

[00:02:34] Caoimhe Whelan: Yeah, definitely. Sort of to tell you the story of the book, I have to sort of backtrack a little bit and tell you about how I met Lauren.

Lauren Rebeck, she's the illustrator. 

[00:02:45] Emma Pickett: Okay. 

[00:02:46] Caoimhe Whelan: When I was at UCD doing my research, it was a, a master's by research on my, as you say, my specialist subject was women's experiences of breastfeeding with primary low milk supply. And about a year into my masters, it got to the point where I was thinking about presenting my research and, and findings.

And one of the things I noticed from some of the research seminars that I did in UCD with other masters and PhD students was that very often you would see people who had really interesting topics to present on, but their slides were often really dull and they were just graphs and words and not as, as an engaging as they could have been.

So it really got me thinking about how I would present my findings because it was a topic. I was just really passionate about, and it was really important to me from the beginning that I communicate my findings. And that was, I suppose, when I first had the idea to do the research, it was really, it was about telling the stories and raising awareness of primary low milk supply and what it is like for the people who experience it.

So to me it was very important that I really think about how I communicate that information. And I had seen some of Lauren's work in the, um, practicing midwife journal. Yep. Or the, the student one as well. And, um, I, I just thought it was really beautiful and that she, she had a lovely way of communicating ideas.

So I had the idea to commission a set of images that would portray my findings and that I could use in presentations. So I contacted Lauren and I just said, Hey, I. Doing this research, um, I was wondering if you would be interested in doing some images for me. And she got back to me immediately and she said, oh my God, that's such a good idea.

I'd love to, thanks so much for contacting me. This sounds so exciting. And I, you know, I just, I, I just had this sort of palpable feeling of excitement and joy from Lauren and I thought, oh yeah, you know, we're, we're gonna, we're gonna be able to do this. This is gonna be great. So she did about 12 images for me, and they were just incredible.

And I, you know, I, I would tell her what I wanted in an image and she would just come back to me and it, it would just be so spot on. Like, I think she really got that kind of vulnerability. Yeah. 

[00:05:18] Emma Pickett: Yeah. 

[00:05:18] Caoimhe Whelan: That so many mothers experience, not just when they have low milk supply, but that kind of vulnerability in the postpartum period, but also the joy.

And the feeling of empowerment, of overcoming difficult experiences. So we worked on that project together, and I used those images when I presented for, I did eye lactation and, uh, gold and various other presentations. Um, and I, I think it really enhanced the presentations that people not only heard what I was saying and saw the words, but they got a sense of, you know, what it was really like to be a mother who experiences primary low milk supply.

And, and that was my research was, it's called phenomenological research. It's a fancy word for really delving deep into the lived experience really what it is to be that person. So, um, yeah, Lauren captured that really well. So. A year or two later, I, I think I was driving my kids to school and just a little light bulb moment.

I thought, oh, wouldn't it be really amazing to have a breastfeeding book with Lauren's images? And I, I suppose, yeah, I, I, I wanted something really beautiful, really engaging, and I also wanted to try and reach people who might not ordinarily pick up a book because I, I felt that a lot of the breastfeeding books that are out there, while they all are, there's so many really good books.

Not everybody, you know, reads or kind of will read book from cover to cover. Yeah. Yeah. They get their information from 

[00:06:57] Emma Pickett: TikTok and Instagram and yeah, this is who this book talks to. I mean, it talks to everybody. I'm a, you know, old white lady from England and it talks to me too, but I can definitely see how somebody who's like 21, 22, who has, you know, doesn't, maybe, doesn't go very much formal education, this book absolutely connects with them and it's so inclusive as well that that's what's just brilliant about it, is for everybody.

Yeah. 

[00:07:18] Caoimhe Whelan: I, I suppose it wa was sort of thinking of that Instagram generation and, um, yeah, I wanted it to be really inclusive and just have a very soft feeling and I, I, I think the images bring that soft feeling to it, to sort of convey that message that you could do this. Or you could do this, what do you feel?

Um, rather than being prescriptive about this is how you breastfeed and you must do it like this. But just to say on the, the inclusive part of it, um, I have to credit Lauren with being just so amazing when it came to being inclusive and there were things that weren't on my radar. Um, and I've learned from her.

And through that process of working on the book, chapter to chapter, she might say something like, oh, how about we have a mom who's wearing a hearing aid? And I'm like, oh God, you, you know, I just never even thought of that. So there were just all those little things we're trying to make people feel seen.

Yeah. Um, irrespective of gender identity or race, religion, um, abilities. 

[00:08:22] Emma Pickett: Well, you nailed it. I would definitely say that. And I'd also say, I mean, and the amount of color in there, the amount of illustrations, that's a lot of work. And also just the support of your publisher. The fact your publisher didn't come to you going really every page color.

Can we not kind of cut this back? I mean, lots of publishers would be like, my God, that's gonna be so expensive to make a book because it looks like colorful and as that many illustrations. So you've got, you know, you obviously had their support too, so what an effective team. Just amazing. Yeah. Everybody go and buy the book.

That's the entire podcast. We're done in nine minutes. Go and by, go and buy the book. Um, yeah, it, it's just fantastic. Oh, thanks 

[00:08:54] Caoimhe Whelan: Emma. Thanks. Yeah, I'm re really happy with it. It was a, you know, it was a labor of love, uh, uh, a really, um, we both put so much into it, so yeah, we're, we're, we're thrilled with the end result.

Good, good. You should be. It's fantastic. Thank you. And, and 

[00:09:08] Emma Pickett: yeah, I mean, the illustrations are obviously on file somewhere. I mean, you could get them out there and you could sell these illustrations. They could be generating income. There's so much, so much there. 

[00:09:19] Caoimhe Whelan: Yeah. Um, to the best of my knowledge, because they were created for the book, they can only be used in the book or I, I, I, I dunno, I haven't really sort of discussed it at length with our publisher, but yeah, I, I, I think it would be nice to make little cards or something, but, you know, maybe that's, maybe that's another project.

[00:09:41] Emma Pickett: Yep. I mean post. Okay. Yeah. Next project. I'll come back to you and see how you're getting on with Anna in a few months. So we could, we could talk about any aspect of lactation and breastfeeding support. 'cause you're obviously, you're a lactation consultant who supports families with all their stages and all their journeys.

But let's do a deep dive in your low milk production, um, space. Yeah. Um, I said it was your specialist subject, like you're a contestant or mastermind, but you know a lot more than the specialist subject people on mastermind. So you did the research for your masters and that lovely word femin. Logical, which I think I can say yes because I did my A level in sociology.

Um, tell us about the actual research you did. Tell us first of all about the projects and, and and how those went. 

[00:10:22] Caoimhe Whelan: I came into lactation and the breastfeeding world through breastfeeding. My first child, Rory, who's now 17 LL, like a lot of I, bbc, LC in private practice. I came up through the voluntary route, so I started going to my local breastfeeding group.

It was an, an invaluable support to me in a big part of my experience of being a mother. I went on to train as a qui you voluntary breastfeeding counselor, which is sort of the equivalent of the NCT. It was sort of modeled along those lines here in Ireland and I volunteered for years, maybe seven or eight years, and then went on to qualify as an I-B-C-L-C.

I took the pathway, one route towards I-B-C-L-C certification. And one of the things that really struck me when I went from providing voluntary support at voluntary breastfeeding support groups and phone support to working in private practice was that suddenly I was seeing a lot of very difficult cases, the ki kinds of cases that I hadn't seen as a voluntary breastfeeding supporter.

And when I was volunteering, I suppose I, I would've been of the opinion that yeah, most women can exclusively breastfeed and, you know, 98%, or, and certainly that's what I would have learned in my, my training, um, this kind of idea that, yeah, you know, nearly everybody can. And in Scandinavian countries, 98% of women breastfeed.

So I really didn't know a lot about primary low milk supply, but I had to learn pretty quickly. And I saw quite a lot of cases of insufficient glandular tissue and, and sometimes cases where you just couldn't put, put your finger on exactly what it was or why this mother seemed to be struggling to produce enough milk to exclusively breastfeed.

And what really struck me was how the experience affected the mothers, the grief, uh, sadness, uh, shock and shame, and a reluctance to go to breastfeeding support groups because they didn't want to see other mothers with lots of milk. And there was one morning I brought, I think I had four or five clients, and I invited 'em over for coffee and just got them to sit in my kitchen and chat about their experiences.

And it was, I think it was cathartic for them. They cried a lot. And it just struck me that these women didn't really have a space to. I know Hannah talked about just a space to be sad in in your previous podcast, and I learned a lot from just simply sitting and listening, and I was really astonished by how deeply they were impacted by having primary low milk supply and being unable to breastfeed exclusively in the way that they had hoped they would or imagined that they would.

So I just became more interested in primary low milk supply and started to read up a bit about it. And it struck me that there was very little research on it, and I suppose I, in research parlance, identified a gap in the research and thought, oh my God, we need more research on this because healthcare professionals need to know more about this.

They need to know how to provide more sensitive and individualized care to this cohort. So. I knew somebody who had done a Master's by Research and I contacted her and I said, oh, I have this idea and I, you know, what do you think? And she said, yeah, yeah, go for it. And she put me in touch with a professor in UCD and she said, email her.

So I emailed her and I said, I have this idea. I want to do a master's by research and this is what I want to research. So I then had to go through the sort of formalized process of submitting an application, putting together a research proposal. And long story short, I was accepted, um, to do my master's by research in UCD through the school of Nursing Midwifery and Health Systems.

And the title of my thesis, I think it was, um, the lived experiences of, oh God, I Dunno, mother is breastfeeding with primary low milk supply in an interpretative phenomenological analysis. So rather than looking at. Sort of the, the clinical aspects of it. It was really looking at the lived experience, what it was like for these women, um, on a, on a very sort of deep emotional level, psychological, how it impacted on relationships, their sense of who they were.

And you did, you 

[00:14:55] Emma Pickett: also pulled together some themes that, that are, you know, you, you found general themes, like the attention to detail and the, the, the focus on triple feeding and the, you know, the Yeah. Feelings around formula. So it's a, it's a, it's not just, you know, his Sade story and it goes on for a thousand words.

It's, you know, you, you, you looked at it with an overarching view as well, which I think makes it extra, extra valuable for people in, in, in management and policy. 

[00:15:20] Caoimhe Whelan: Yeah, looking at themes across the nine participants and there were common themes that came up with, with all of them. Um, so I tried to capture that as best I can.

You did a brilliant job. So I, so I'll put a link, 

[00:15:33] Emma Pickett: I'll put a link to, so one of the open papers. I'll put a link to that in the show notes so people can, can go and find it. Let's talk about some of the basics. 'cause there may be some people listening to this who are peer supporters who think, oh my God, no one's ever talked about primary milk supply issues in my, in my training.

And also we have this really odd, I dunno if it's the same in Ireland, but in the UK we're, we're a bit stuck 'cause we're very focused on remit as we should be. Mm. But that means that lots of peer supporters are kind of blinded, you know, wearing little things that horses wear. What are they called?

Blinkers. And they, they, they're almost not allowed to look past the blinkers. And that means that moms are not getting signposting and they're not getting the, the information that they need. And parents are not getting the support they need. So we're not gonna be able to fill all the gaps and when, this is not a training session, but let's just talk about some of the basics for somebody who may not understand.

So obviously there are loads of different reasons why a parent may not be able to exclusively breastfeed their baby, but let's talk about those primary reasons, like the primary low milk supply stuff. What are some of the reasons that somebody may not be able to exclusively breastfeed their baby, that aren't connected to what you're doing when you're breastfeeding or your birth perhaps?

[00:16:40] Caoimhe Whelan: So of course it's important to say most, you know, breastfeeding, um, parents can make enough milk to feed their babies. But there, there is a, you know, a not insignificant cohort that are unable to and for primary reasons. So primary meaning that the causes are intrinsic. So something to do with their body.

It could be their anatomy, their physiology, but it's not related to something that happened subsequent to their baby being born. Like say for example, suboptimal milk removal, which. Not enough breastfeeding, which could lead to secondary low milk supply. But primary there's the, there's a cause there, it, it could be even before the mother has become pregnant.

And the number one cause of primary low milk supply that I see in my practice is insufficient glandular tissue. Um, where there simply is not enough of the milk making cells in the mother's breasts to make sufficient milk to be able to exclusively breastfeed and I suppose mammary hyperplasia or, you know, this insufficient glandular tissue.

It can be identified antenatally because there are certain physical characteristics that mothers with these breasts tend to have, like wide spacing, tubular shape, sometimes the asymmetry or bulbus areola. Sometimes we see, uh, stretch marks as well. But having said that, there's no way to say with any certainty what a mother's milk production is going to be.

Until she actually has her baby. Yeah, that's absolutely the number one. I, I, I mean, sometimes you see, I would see cases where a mother has maybe what looks like possibly IGT because there is no definitive diagnosis, but she might also have polycystic ovary syndrome. Yeah. Or maybe, you know, she was quite overweight at one point in her life.

Or sometimes, um, mothers will report that their periods were always very heavy and painful or that they started their period quite late. So you can sort of different things. And when it comes to hormones as well, things get very complicated. And I'm not a medical person, I'm not a doctor. I can't diagnose.

So I, I, I, honestly, I don't always know. Exactly why a mother is unable to produce sufficient milk. Okay. So there's the, 

[00:19:08] Emma Pickett: the, the physical characteristics of Yeah. Insufficient glandular tissue. You know, those of us who have trained as lactation consultants, we've, you know, seen the pictures in the textbooks.

We talk about different quadrants of breasts being missing. Yeah. But as you, as you're say, as you say. It's possible for someone who looks like they fit those markers and actually they seem to be producing enough milk. And it's also possible for people who don't necessarily have breasts that appear to be different.

Yeah. And they also may have issues with milk supplies. So what you're saying about how you are not a doctor and you are not able to diagnose, I I, the reality is, I dunno if it's true in Ireland, it's certainly true in, in England. There isn't anybody who can diagnose. It's not like there's some magical doctor in Harley Street in London and this is the, you know, mammary hyperplasia bloke who can tell you you've got, you know, primary low milk supply.

There isn't. It's, there literally isn't a test. The, the only test is no there isn't test. You try and feed your baby with all the best practice surrounding you, all the best information. And it doesn't yet quite happen. And so you don't know sometimes until you try and feed your baby, which I guess is why it's so emotionally difficult and painful because.

There's that always that element of hope and unpredictability, um, that makes it extra difficult. You talked about PCOS and my understanding, having read the Making More Milk book is that some people with PCs actually have overproduction and oversupply, and then about a third have, you know, what we might call under underproduction.

Tell me a bit more about the, the business about people being overweight. Is that to do with, you know, pre-diabetes and insulin resistance? What's going on there? 

[00:20:40] Caoimhe Whelan: Possibly. I mean, it's, it's something that's being researched more at the moment. Um, you know, the links between obesity, insulin resistance, PCOS, uh, and look, I, I honestly can't tell you exactly why it is.

Um, there was a recent study from Rene Ka, I dunno if you've heard of her. She's a researcher in Australia and she's done some research on IGT and um, in one of her studies, she linked obesity during puberty. With IGT. 

[00:21:13] Emma Pickett: Okay. 

[00:21:14] Caoimhe Whelan: Okay. In later life, but exactly, you know what that connection is? I, I can't honestly say.

[00:21:22] Emma Pickett: Yeah. 

[00:21:22] Caoimhe Whelan: But it could be hormonal. Um, we know that, you know, if people have insulin resistance or diabetes, sometimes lactation can be, or full lactation can be a little bit of a struggle because, I mean, everything is connected. There are so many different hormones that impact on lactation. However, I have to say, most people that I see who have PCOS make enough milk.

[00:21:47] Emma Pickett: Yeah. 

[00:21:48] Caoimhe Whelan: Um, most people with, with ti sometimes, um, or I have seen thyroid issues being flagged as a risk factor for low milk supply. The vast majority of people I see with thyroid issues, hyperthyroid or um, hyperthyroid, they make enough milk. 

[00:22:06] Emma Pickett: Yeah. Um, and they should be flagged up already and be having treatment.

I guess it's that risk. Yeah. That, that it's that group who are experiencing postpartum thyroiditis who maybe did getting diagnosed for the first time. And I'm sure, I'm sure you've had this conversation in your area. And even I have as a general lactation consultant, we're actually, it was thyroid and it was undiagnosed.

Yeah. And once they, once they had testing and treatment, it was, um, you know, it happened. Yeah. Yeah. So, IGT hyperplasia, I mean, just, just to quickly, the, the phrase IGT is not a heartwarming phrase, using that phrase insufficient. Did anyone talk about that in there, in, in the groups that you've had? Or is, are they like this and I've got bigger issues than worrying about that word?

Do. How do moms feel about that language? Do parents have issues with it? 

[00:22:51] Caoimhe Whelan: I have seen lactation consultants take issue with the term insufficient angular tissue and say things like, we should not be using this phrase. Um, you know, the word insufficient is. Yeah, say it's, it's not heart heartwarming and nobody is insufficient, but, but I have to say in my research and in my dealings with mothers, I've never had anybody say that they have an issue with the term.

And more than anything, people are generally relieved to know that it's not something that we're doing. And to be able to say, this is a thing. I have this, this is what it is. 

[00:23:30] Emma Pickett: Yeah. 

[00:23:31] Caoimhe Whelan: Because it can be really validating, because very often, and I'm sure you see this in your practice, people blame themselves or they've, they've sort of absorbed this narrative that you just have to try harder.

You just have to do more skin to skin, that there's a breastfeeding solution for every breastfeeding problem. And if they're not able to make enough milk, it's something they were doing. But for somebody to say to them, you know what, it looks to me like it's, you know, IGT is a possibility. This is what this condition is.

What do you think? And. More often than not, mothers will say, oh my God, yes, thank you. Yeah. And feel a sense of relief and look, this is just my experience, but nobody has ever said, oh, I'm not insufficient or interprets it in that way. They are sad that they may, may have IGT but also feel kind of validated and empowered by that knowledge.

[00:24:29] Emma Pickett: Yeah, that is my experience as well. But obviously the first time I meet someone who feels otherwise, they, they have the right to, to tell us. Um, yeah, as you say, it's that, it's that joint experience of immense sadness, of giving up a hope and giving up a dream, and then also, also an enormous relief of realizing that, you know, this isn't something that you, you should be feeling blame and un shame for.

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. Okay, so quick question. We've talked a little bit about, you know, the 98% and the 95% and you, A question that I'm sure you get asked weekly is, well, what is the percentage?

I mean, we've already just said we can't actually find out who's got IGT, so I dunno how anyone can ever ask this question. People say things like it's 5%, 5% of the population will never be able to exclusively breastfeed. How do you answer the question when someone asks you for a percentage? 

[00:26:36] Caoimhe Whelan: Look, it's, we don't have enough research to say with any certainty how many people cannot exclusively breastfeed or make enough milk for their babies.

There was a 1958 study done in New Zealand, so this has come back a long time. It was in a maternity hospital there, and there were almost a thousand women in the study. And, um, this study found that approximately 6% of the participants had primary low milk supply. 4% in total were identified as having insufficient ular tissue.

So like it's not some new thing, um, that we've just started talking about in the last few years. This was flagged then in more recent times. I, I think it was sometime in the 1980s, was it? No, maybe it was 1990. There was a study done in the us there were about 330 mothers in the study, and it concluded that 15% of participants had, um, primary low milk supply, or I, I, they phrased it differently, severe lactation insufficiency or something along those lines.

But the primary author of the study was Marianne ert, and sometime later she retracted to that figure and said, no, it was more like 5%. Okay. So at this juncture, we can't say, okay, what we really need is, is, is a large scale study to look at this, but personally, I would say somewhere between five and 8% may have primary low milk supplies.

Okay? So it's a 

[00:28:14] Emma Pickett: thing. It's a, it's a big thing. I mean, if you think about how many babies have tongue ties, you know, tongue tie hovers at around the 10% mark. And how much time do you spend talking about tongue tie. I know. Yeah. And how much training is devoted to it. And you know, how often is a study day for peer supporters got someone talking about tongue tie and it's, it's, you know, it's comparable to, to that.

No, it is. 

[00:28:32] Caoimhe Whelan: Yeah. And also, I, I think previously mothers who had primary low milk supply would've just stopped breastfeeding. Um, whereas now people have so much more access to information and support. There are, you know, the various breastfeeding support organizations. There's a lot more information on social media.

Um, I know it's a double-edged sword Instagram, but I think these people are now getting support, trying to find out what's going on, looking for a deeper understanding of what's happening with their bodies. So we're seeing them more. I mean, that's, I, that, that's what I think. Yeah, that makes sense. 'cause I, I know that like a few decades ago, there were no lactation consultants in Ireland or the uk so we're in the process of learning more.

[00:29:22] Emma Pickett: Yeah. 

[00:29:22] Caoimhe Whelan: About this issue. Yeah. 

[00:29:23] Emma Pickett: Which is, which is a positive thing for sure. Yeah. So we've talked about the kind of primary low milk supply stuff that's to do with pre-birth bodies, whether that's, um, um, insufficiency of glandular tissue, whether that's to do with, um, insulin, whether that's to do with what happened in, in, in adolescents.

And, and there's, you know, I guess it's possible for someone to, to have insufficient glandular tissue and then look back and go, what happened when I was a teenager? You know, what happened with my parenting? What did I get? I've heard, you know, people having injuries to breasts and adolescents and, and childhood and, you know, there's all sorts of, of stories, but let's, let's leave the kind of, it could be 

[00:30:00] Caoimhe Whelan: genetic as well.

[00:30:01] Emma Pickett: Yeah, yeah. Obviously that's a, that's a huge component. Yeah. 

[00:30:04] Caoimhe Whelan: Three of the nine women in my study reported that their mothers had breastfed and weren't able to make sufficient milk Okay. For their babies. So, you know, that's, that's again, something we don't know an awful lot about. 

[00:30:19] Emma Pickett: Yeah. So, so in terms of the pre-birth stuff, let's pause that for a moment.

I know you've been focusing in your research on primary low milk supply, but I'm just thinking about the peer supporter listening to this. Yeah. What might happen in birth that might cause someone a barrier for, to exclusively breastfeed their baby? 

[00:30:35] Caoimhe Whelan: I suppose one of the things that has the potential to cause primary low milk supply is a, like a massive postpartum hemorrhage, like she hint syndrome.

We don't see that very often here in Ireland, uk in the developing world. Um, it's more likely to happen in developing countries 

[00:30:54] Emma Pickett: because people get, they get transfusions very quickly in the, in the, yeah. And 

[00:30:59] Caoimhe Whelan: al also where there's birth, there's the potential for a very difficult birth. The decision might be made to carry out a C-section.

[00:31:08] Emma Pickett: Okay. 

[00:31:08] Caoimhe Whelan: So that sometimes doesn't happen in. Developing countries, so, you know, we, we might see greater blood loss. 

[00:31:15] Emma Pickett: Yeah. So I do sometimes meet people who've lost kind of, you know, one and a half liters, two liters, and it seems to take a longer for their milk to come in. And that's just about the pituitary gland being, being damaged.

Yeah, 

[00:31:26] Caoimhe Whelan: definitely. Yeah. Um, I would sometimes see others who've lost two, two and a half liters and, and doing blood trans fusions doesn't seem to happen very often. I'm often quite surprised that transfusions weren't done when, not that I'm, you know, a medical professional, but, um, hospitals don't, certainly here in Ireland very often do blood transfusions.

And you, you could see like a massive blood loss, you know, hand in hand with birth, trauma, possibly separation of mother and baby. Baby goes to the NICU for a night. So it, it's often like a few different things that all contribute to maybe. The milk, milk being a lot slower to come in. You know, there might be high blood pressure, low iron edema, just not enough milk removal, so it can be a, a slow start.

And then if the milk is very slow to come in, infant formula is introduced and, you know, you could have about 10 different factors that contribute to a not optimal start and a much greater risk for secondary low milk supply and struggle with breastfeeding. 

[00:32:41] Emma Pickett: And tell us about retained placental tissue and what that does to milk production and how that works.

[00:32:47] Caoimhe Whelan: Yeah, that's, that, that can sometimes happen. I've seen a couple of cases of, um, well what, what I suspected were repla retained placental tissue. So when the placenta is delivered, um, there's a massive drop in the hormone progesterone that allows for prolactin evidence to rise and for the prolactin receptors to be turned on.

In other words, allows for big milk production to happen on, you know, day two and a half or three or whatever it is. But even if there's the tiniest little fragment of retained, um, placental tissue in the mother's body, this will inhibit full milk production. Um, it's more likely to happen with a vaginal birth than a C-section.

And in the cases I've seen what happened, and I mean it was only, it's only two or three on around day 13 or 14 maybe. The mom had been supplementing with infant formula, very little milk, wondering what was going on. Suddenly she has a really big bleed and sometimes there's infection there and maybe she doesn't feel well.

Goes back into the hospital, they do A DNC and within hours she has significant, um, a significant increase in milk production. Yep. Yeah, that's, so that's a pattern I've seen as well. But also what I found in my experience is that it's not really acknowledged in the hospitals. It's like, oh, well yeah, well, okay, then let's do d and c.

But there's, nobody will really talk to the mother about what actually happened, why there might have been a fragment there, how it might have impacted on milk production. It's not, and I, I, I understand that, you know, staff are under a lot of pressure, and I'm sure it's the same in the uk. There is somewhat of a staffing crisis in our maternity hospitals, but it's, um, yeah, lactation isn't really kind of discussed in 

[00:34:45] Emma Pickett: the mix.

Yeah. It's about infection risk and the mother's health. Yeah. And we know we don't wanna be leaving placenta behind, but no one's talking about the impact that has on lactation and equally wouldn't you were talking about transfusions earlier. People are like, oh, your iron levels are okay. You know, we don't think you need a transfusion.

Your iron's all right. As if that's all it's about, rather than, yeah, thinking about the impact on lactation, just because if health professionals aren't being trained in lactation, it's those, that bit of the puzzle is just not being acknowledged. So thinking about the support that these families get, we've touched earlier on that, that message of, you know, it's just about belief and you can do it and come on, let's just get pumping.

And I talked about this in my conversation with Hannah as well, just that, I mean, because perceived insufficiency of milk supply is a thing, it's just become the dominant message. Yeah. And, and it's just about everyone can do it and let's not be negative. And I've even seen who they would describe themselves as activists saying, you know, sorry, but primary milk supply is not a thing.

Primary milk supply issues are not, is not a thing. It's, it's, everyone can do it. So what are some of the things that you see breastfeeding support get wrong when they're having conversations with some of these families that you've been working with? 

[00:35:54] Caoimhe Whelan: First of all, antenatally. You know, I, I, I, I think, you know, anyone who is supporting parents antenatally or doing antenatal education needs to talk a little bit more about, you know, the possibility of breastfeeding difficulties to communicate the message that most people can make enough milk.

However, you know, a small cohort will not be able to, because, you know, inf information is power and it, it doesn't serve anybody well to say, yes, everybody can do it. It's gonna be all right and all you need to do is get the right support and everything is going to be okay. It's just really undermining.

And, um, the, the other thing I, I think we need to talk about more. Antenatally is what a big experience it is to lactate and to feed one's baby at the breast. It's not just about milk. Um, 'cause so many parents I see antenatally, they're like, yeah, well you know, you either breastfeed or you formula feed.

And if breastfeeding doesn't work out, then everything will be okay. But nobody talks to parents about, you know, how intertwined the feeding mode is with motherhood self-identity or how you might feel if you're unable to exclusively breastfeed. What a strong, embodied feelings you might have about breastfeeding and, and I'm sure you've seen this in your practice before, like mothers who are just astonished that they feel so strongly about breastfeeding, like not understanding how they can love it so much.

And also some parents who maybe are facing difficulties. Whether it's primary low milk supplier or whatever it is who almost feel guilty for wanting it so much. So if we have more honest conversations about, you know, how complex breastfeeding and lactation is and you know, what it can mean for you emotionally, psychologically, um, what it can mean for you being in the world.

Like, um, I go back to sort of that phenomenological aspect of it because how you feed your baby is a very public display of who you are. And this is, you know, something that a lot of moms can find quite shocking once they have their baby and they, they just don't understand and think it's just them.

Like, there's something wrong with me. Why do I feel like this so much broader conversations about lactation and then postnatally. Yeah, I mean, god, it's, it's nearly where to begin, but I suppose the number one thing is listening. Can I just ask 

[00:38:38] Emma Pickett: you about, on a really practical notion, just, um, again, it's really hard to know what is peer supporter remit, but what are some of the red flags in the first few days, first couple of weeks after the baby's been born?

So we've talked about the signs that you might see around breast shape that might suggest IGT. If somebody has IGT, what might you see postnatally, that's a red flag. 

[00:39:02] Caoimhe Whelan: Usually from, from the get go, lack of weight gain is been flagged. And quite often I find that mothers, they, they have an instinctive sense from the beginning that something's not quite right, you know, where we're not seeing really good nappy output, where, you know, the return to birth weight is very slow in, in some of these cases.

You know, it may not be IGT, it may be something else, but just to say, okay, so what's going on here? Um, and, and, and really to, to sit with the mother and listen and look at the big picture and, you know, ask about, well, you know, tell me about the pregnancy and did you notice breast changes? What do you feel is going on?

What's your sense of things? And I suppose very often with the mothers that I see, they've been advised to triple feed in the hospital. That's, you know, is the answer to a lot of problems is just triple feed. And these mothers are, you know, trying to breastfeed eight or nine times a day and pump after every single feed and bottle feed.

So that's not sustainable for anybody. So support has to be individualized and has to work for an individual mother. But I suppose for voluntary peer support, it's really listening and. Trying to get a sense of, you know, is this baby gaining enough weight? Are there enough wet and dirty nappies? Does this mother need more skilled support to help her?

Yeah. Keep going. 

[00:40:44] Emma Pickett: Can I just ask you about engorgement? 'cause not everyone feels engorgement. Yeah. And sometimes babies may be fitting frequently and it may not be obvious. So if a mother doesn't feel engorgement, you know, in day 2, 3, 4, postpartum, is that something you're worried about or do you think it's not necessarily a problem?

[00:41:02] Caoimhe Whelan: Well, if, if the mother is seeing really great nappy output and that baby is feeling a lot, she might not feel breast engorgement know if you have a really efficient feeder and some others they're just not, maybe not that sort of tuned into what's happening. They might not even be aware of what's happening with their breasts, whether they're full or soft and they're just feeding the baby and everything is fine.

But if we're seeing lack of breast fullness, um, lack of any kind of engorgement. In conjunction with the baby who is not having good nappy output, who's maybe not very happy and crying a lot and feeding really frequently, and, um, you know, hasn't started gaining by about day six or seven, well, then we say, well, what's, what's going on here?

But I, I suppose one of the, the really important messages to communicate to mothers who have primary low milk supply or IGT, is that they can breastfeed and there's a way to do it. And it's, it's trying to find what's going to work for that individual mother. And the other message that's important to communicate is that, you know, full milk production or optimal milk production for a person, it doesn't always sort of peak at week two or week three for most people, you know, by week two and a half three, they full milk production.

But for very, very often for people who, um, have IGT. It's a slower burn and they might keep gradually increasing right up until about week six or seven. And I've seen this quite a lot. So that can be a really good way to sort of gently encourage people because often I, I see with mothers, I think by week two that's it.

Or somebody might have told them that, well that's it. After week two you don't make more milk. And people can often have fixed IDs in their head Yeah. About these kinds of things. But like we know with lactation, there's so much nuance and gray area and this is why individualized support is so important.

Yeah. Yeah. Thank you for that. 

[00:43:09] Emma Pickett: Quick question about Galactic Gogs. Um, yeah. What's the situation with domperidone in Ireland? Is that something that your doctors are able to prescribe? Do you see it being used and, uh, using herbs, something that you come across a lot? 

[00:43:21] Caoimhe Whelan: Yeah. Most GPS in Ireland will prescribe domperidone off license for lactation.

Once they understand why the mother is, wants to take it, um, and have looked at maybe any other medications she's on and her health history, I, you know, I, I don't see that many mothers taking domperidone now. I think previously it was much more common and I think one of the reasons for that was maybe US based Facebook groups that people were in and they were hearing about domperidone and people on doses of like 160 milligrams a day, like crazy stuff like that.

And were sort of not consulting with gps and buying it themselves, but the two cohorts of people that I would see taken it are people who have a baby in the nicu. And it can help taken for, you know, approximately two weeks at a dose of 10 milligrams three times a day, or it can sometimes help. Where somebody has had a good milk supply and something has happened, um, and milk supply has dropped.

Maybe it was mother baby separation. Um, maybe baby was sick and wasn't feeding frequently. Whatever it is, um, supply has dropped and that mom wants to get her milk supply back up again. In that situation, I think it can be helpful in bringing prolactin levels back up again. But domperidone and look, as you know yourself, it's, it's not a fix, it's not a solution.

Yeah. To primary low milk supply. I was gonna 

[00:44:59] Emma Pickett: say, if, if the issue's primary low milk supply and someone's got IGT, I mean, tell me if this is a DAF question. Prolactin levels aren't necessarily your problem. Your prolactin levels can be completely normal. Your pituitary glands breathing away, working just fine.

So if Donperidone is just gonna raise your prolactin, that's not your issue anyway, so. 

[00:45:16] Caoimhe Whelan: Yeah, you know, AB absolutely. Um, some, some mothers want to take it anyway, just to know that they've ticked all the boxes and done absolutely everything. And if somebody says to me, look, I, I just, I, I'd like to take it.

Yeah. I say, fine. Absolutely. I will discuss risk factors. There's some really good fact sheets. There was one I saw recently, oh God. It was a UK pharmaceutical, oh God, pharmacy website that had really, really good fact sheet. Was it Wendy Jones? Maybe her, no, it wasn't actually, it was another one. I'll, I'll think of it.

It just really, really good evidence-based information on taking domperidone and it's, it's mainly based on new research that is coming out of Australia. There's a research that there, Luke Gki or something like that, I can't pronounce the second name. And that research recommends, you know, just two weeks, uh, 30 milligrams a day and that it can.

Bump up milk production, but that research has been done on mothers who have babies in the nicu. To the best of my knowledge, there hasn't been any research done with participants who actually have primary LOA milk supply. Okay. And that's a gap in the research? Yeah, it's a gap in the research. And the same goes for the galactic cogs as well.

Like in any case, there's very little research that galactic cogs are, you know, herbs, whether it's fea, Greek, or moringa, that they actually result in an increase in milk production. But any of the studies that have been done are generally on a cohort of mothers who are already making enough milk. Yeah.

And sometimes those studies are done in the first few days, and they might, you know, the results might say something like, oh, well this herb, you know, resulted in a 50% increase in milk production on day two or three, you know, and. That was gonna happen anyway. Yeah. 

[00:47:15] Emma Pickett: It's, it's, yeah. Yeah. It's, I mean, Feni Greek, when I first started in lactation support, everybody was taking pH Greek.

Yeah. And now hardly anybody does. And yeah. Yeah. We're understanding much more about how it interferes with thyroid and, and, and you know, the fish and it can actually reduce milk production for some people. What about, I, I appreciate you're not a doctor, but what about, um, metformin and, and go through, what about the stuff that claims to work on glandular tissue?

Is that, is there any value for that? If someone's got IGTI, 

[00:47:42] Caoimhe Whelan: you know, I try to read up as much as I can and stay up to date. And to the best of my knowledge, some breastfeeding medicine doctors in the US recommend that mothers who've been taking metformin during their pregnancy where there's a risk of low milk supply that they continue to take it, or that they take goats through.

Because, you know, it's, the, the idea is that it can help with the growth of glandular tissue. That it can be taken from, I think around. 35 of pregnancy. I, I'd have to double check that. Um, and that it can help with the growth of glandular tissue and that it may be recommended for people with IGT. So I would try and give people this information.

But having said that, there, there, there is no conclusive evidence that it's going to make any difference. I mean, ultimately it comes down to optimal and frequent milk removal. Sometimes taking a herb, it, it could help if we, we can't say with certainty, but it's not the 

[00:48:46] Emma Pickett: most important thing. 

[00:48:47] Caoimhe Whelan: It's absolutely not the most important thing.

And I'm also mindful of the cost. You know, sometimes when mothers find that milk production is, is an issue, they end up renting a hospital grade pump. They might buy their own pump. They're spending, you know, it's a big, it's big. Financial outlays. I'm also mindful of, you know, how the costs of all of these things add up.

And a, a lot of the mothers that I've, I see have just been told, oh, we'll buy this galactic org as well. And you know, some of them are 60 euros for, you know, one like one month supply. It all adds up. And, you know, we have to be mindful of that as, as supporters and IB CLCs. Um, but it's really about having a conversation with the mom and say, well, what, what have you read?

What have you heard? What do you think? Um, and she might say, oh, you know, my friend said really helped her. I said, well, yeah, absolutely, go for it. Um, you know, you'd have to drink a lot of fennel for, to make a difference, but you know, if it helps a mom feel that she's doing everything. In itself can be helpful.

Yeah, sure. And 

[00:50:02] Emma Pickett: actually we can't, every, everything is connected. You know, placebo is a powerful thing as well, although it's difficult to say that without sound dismissive. Um, yeah, I mean it's also, there's also that whole thing about false hope. If people are doing this in that, in this phase of, I still believe I should be getting a full milk supply and I just haven't found the right super expensive capsule and I just haven't spoken to the right lactation consultant, that's not healthy necessarily, is it?

So it's, it's about finding, finding that balance. 

[00:50:29] Caoimhe Whelan: Yeah, it is. And it, it, it can be a difficult thing sometimes as a lactation consultant, you know, you want to say to somebody, yeah, sure I can, I can fix everything, but sometimes you just can't. And it's, it's finding a way, helping that mother find a way to keep going, to make peace with.

Not being able to exclusively breastfeed. Um, and that can be a journey in itself, but, but to also try and optimize milk production and keep going. But, you know, one of the things I found from my research that, that that journey towards real healing and self-acceptance can take up to a year. It's not a quick fix to go, oh yeah, well, I'll just use an SNS, and that's just like breastfeeding.

It's not, yeah. 

[00:51:16] Emma Pickett: Te tell us about SNSs for anyone who doesn't know what, what, how do they work and do you think they're valuable? 

[00:51:21] Caoimhe Whelan: Yeah. The SNS the, the acronym stands for supplemental Nursing System and essentially it's a very small tube, like a, a pediatric feeding tube and some kind of container. Now, there are commercially available SNSs or supplemental nursing systems marketed by a few different companies where it's, it's custom designed, built, and manufactured.

Device, which will usually have a little vent in it and, um, valve that will help to control the flow of milk. But you can also make what's sort of called a homemade SNS, where it's just some kind of container. It could be a feeding bottle and a little tube that goes into the milk in the feeding bottle.

And while the baby is at the breast feeding, the mother can insert the tube into their mouth, just into the corner of their mouth about, I suppose an inch. So the baby sucks and they get milk from the breast, but they also get this supplemental milk from the tube. Some mothers find it can work really well and they prefer to give their baby the extra milk while they're feeding at the breast.

There's some research that this can help with milk production because there's more stimulation at the breast and. The baby may take more milk from the breast because once they start to get the extra milk in the tube, they, you know, they're, they start to feed more vigorously. So there's lots of benefits.

Um, some others will just continue to use a feeding bottle and a, a zero five French pediatric feeding tube. Others prefer some of the, you know, the commercially available systems like the mea SNS or the, there, there's a hacker one as well. Um, and it can work well for some people. But having said that, it doesn't work for everybody.

Not all babies will tolerate the tube when they're feeding. Not all mothers like the idea of it. Or sometimes I will, I mean, I'll always give. People, the information say, look, this is another way to do it, and present it as just an alternative option. It's not better, it's not worse. This is just another way to do it.

Sometimes mothers will say, no, absolutely not. I just, I, I don't want a tube near me. And it's the idea of it, they're just not into it. Um, so again, it comes down to individualized preference, individualized support for what's going to work best for that parent. And, and for some people it's going to be breastfeeding combined with bottle feeding.

For some people it'll be breastfeeding, SNS. For some it'll be breastfeeding. Using the s and s, sometimes using the bottle sometimes. And it can take time to sort of figure out what's going to work best for them. 

[00:54:05] Emma Pickett: Yeah. Yeah. And also the SNS can be a bit of a fiddle to clean as well. I mean, it, yeah. Can, it's hard to kind of wash it through and get, and also to get information about how often to clean it and how to clean it.

It's not, it's not always easy. The information about cleaning anything is quite hard. Yeah. If you're triple feeding, someone says, oh, you know, pop it in the fridge and someone else says, no, no, no, you gotta wash it every time. Um, I, I say to, I'd be interested what you say, I say to, to moms that are doing any triple feeding, you know, because of what we know about milk storage and how long milk can stay at room temperature, it really should be okay to not wash it.

Yeah. Not wash it every time. And, and to use, use the fridge as a storage and maybe just wash and sterilize once a day. Is that what you, is that what you say as well? 

[00:54:45] Caoimhe Whelan: Yeah, yeah. Absolutely. Yeah. Yeah. I would say the same. 

[00:54:49] Emma Pickett: Talking about other kinds of tech. I saw a nipple shield the other day, which has a loop external to the baby.

So you can see the milk going into the baby. And the idea of this shield, is it reassures moms, particularly those who might have low milk supply, that they can see the milk going into the baby. I dunno if you've come across this, what's your kinda gut, gut feeling about it? 

[00:55:10] Caoimhe Whelan: Yeah, I've seen an image of it. I mean, look, I try to keep an open mind with any new kind of tech.

There's always new gadgets and devices. I am not keen on this at all. I really don't like the idea of it. The idea that you have to see the milk in a tube, to know that your baby's getting milk from your breast is kind of bonkers. You know, we, we need to help mothers understand. Or know how to sort of figure it out for themselves.

Look at the baby feeding, is the baby swallowing? Um, how does their breast feel? All of these sort of more, you know, physical signs that baby is transferring milk. Um, and, and to come to trust their body and get to know their baby and, you know, understand breastfeeding and having a bodied sense of what's happening with their body.

And, and the other thing as well is, you know, not all babies are going to feed well with a, uh, nipple shield. Nipple shields have a place, but if you have a situation where a baby latches really well and feeds at the breast, you really don't want to interfere with that and put a nipple shield on that.

Like, it's just, it's throwing some extra thing into the mix that doesn't need to be there. Especially when you've an already complicated situation, you know, where if there's low milk supply and that in itself is a challenge. Throwing in some extra fancy product is, is just not going to help. No. Um, it's certainly not gonna help that mother make more milk, which 

[00:56:51] Emma Pickett: is precisely the thing she wants to do.

And that, and as you say, that could be a bear, especially if she's got the wrong size or, you know, it's just, it's just instinctively make, gives me the heebie-jeebies if, if you don't mind me saying Yeah, yeah. Using that professional term. Um, but, but, but there are so many tech companies that will be in this space because moms who are insecure about how much milk they're making.

Are the breadwinners of breastfeeding tech actually, because you get all these devices that scan breasts and devices that, you know, you put a little sensor on the baby's neck and it tells your phone how much the baby swallowed. I mean, there, as the generations go by and tech gets more and more advanced, this, this group of people are gonna be even more at risk from the tech people.

We just have to find the nice, lovely ethical tech people who talk, talk to you and listen and understand breastfeeding, and maybe we can get some positive tech happening as well. 

[00:57:40] Caoimhe Whelan: Yeah, it's really, it just makes me really angry. The way in which some of these companies want to monetize, essentially monetize parents' anxiety and, and they know how vulnerable parents are in the postpartum period, particularly first time mothers who are breastfeeding and they're really preying on their vulnerability and their anxiety.

Um, and I, I just find it so unethical, you know, whatever about marketing a product to. Some of these products have a place, and they may be helpful in certain clinical situations, but they're marketing them to all parents. Um, there was a, there's a product that was developed here in Ireland and it's, yeah, it's a nipple shield that apparently monitors that milk intake of the baby milk transfer.

And, you know, it may have a place in certain situations, but this, this is not a product that should be marketed to all parents. 

[00:58:39] Emma Pickett: Yeah. Here, here. Okay. Let's talk about good resources. So let's finish by talking about your, some of your favorite resources for, for breastfeeding supporters and parents. So let's get you to talk about what you provide as well.

So you've got a webinar on your website that anyone who's involved in breastfeeding support can access. 

[00:58:57] Caoimhe Whelan: I did a, a free webinar on low milk production recently. Um, maybe I put it on my website. I think you did. I can't even remember. Okay. Okay. So, okay. It's there. And I was really geared towards parents. So anybody is welcome to view that.

Um, I think it's just over an 

[00:59:12] Emma Pickett: hour. Okay. So not just supporters, that, that's for parents too. And you also have, you have a Zoom group, don't you, that you do for parents? 

[00:59:20] Caoimhe Whelan: Yeah, I run a Zoom group. Uh, it's, well, we, we aim to do it once a month. I do that with another lactation consultant, Kristin Laurin. And it's for anybody who has low milk supply.

And usually people come just once. And I think it can be very cathartic for them just to be in that space with, and realize more than anything else that they are not the only ones. Because often they will have been made to feel that it is. And it could be one little remark from a healthcare professional, like, oh, low milk supply is so rare.

And that can make people feel marginalized. And like, I remember one mom in my research used the word freak. She said, I felt like a freak. Sometimes people come to the group with that kind of feeling, and when they see that there are other people who have the same or similar feelings, it's really validating to know that, as I said, they are not on their own.

So the, the, the group is a, I suppose it's a space where we can't promise to fix anybody's low milk supply. Um, we can, some we'll have sort of q and a and we'll answer questions. And sometimes the discussion, there's discussion between the, the, the parents about, you know, what works for them or their experiences.

And sometimes it can be very intensely emotional and there are often a lot of tears and people cry really hard. It's, um, yeah, it, it, it can be quite heavy sometimes, but I, but I think being able to do that can result in people feeling a little bit lighter. They can let go of, so. 

[01:01:05] Emma Pickett: Yeah, 

[01:01:05] Caoimhe Whelan: but there's also a, a WhatsApp low milk supply support group, so we, we link people in with that.

I am not an admin on it. It's the, there's a few mothers who are admins in the group, and I, I just wanted it to be a space for mothers, um, to sort of step, step away from lactation consultants and, you know, voluntary supporters. This is just for the moms and, and the feedback I get from others is that they find it immensely helpful and supportive.

Then in my private practice, I, I work part-time in private practice. I see a few clients every week and it's, you know, it's just a mix of 

[01:01:44] Emma Pickett: all sorts. Yeah. And then what about some of your, some of your favorite reading resources? If someone says, I want to learn more about Perillo milk supply, where would you signpost them?

[01:01:53] Caoimhe Whelan: Uh, making more milk is, is a great one. Lisa Morasco book. Um, I would often signpost them towards Amy Brown's book. Why, why breastfeeding, grief and trauma matters. Yeah, that's it. I think that's the title. Um, and, and again, they find that very validating. I will sign, post them towards various resources on Instagram as well, various IBCLCs in their area to post good solid evidence-based information about breastfeeding.

We've lot, lots of books in the office. I, I share my office. I have an office-based practice. I share it with Nick Obert and we, we've lots of books there. Um, and it's not always strictly breastfeeding books that I will recommend. Sometimes, you know, you could have a mom who's struggling with breastfeeding, but also struggling with transition to motherhood.

Um, so I might recommend, do you know Marianne Levy's book? Don't Forget to Scream. Okay. It's a motherhood memoir. Um, and she talks about the challenges of new parenting. It, it depends on what I think somebody might benefit from. 

[01:03:08] Emma Pickett: Yeah. 

[01:03:09] Caoimhe Whelan: You know? Yeah. 

[01:03:10] Emma Pickett: We, we haven't even talked about surgery. And, and if someone's had previous breast surgery, would that be still described as a primary low milk dysplasia?

I guess, I guess it would be technically. 'cause it's pre pre babies. So that's also set a separate group of people who may go into lactation, understanding that there may be issues, but not always. I met a mother this month who, hadn hadn't been given the full information by her surgeon. Um, and so breastfeeding after reduction, that website, b fa.org or something, I be, oh gosh.

Yeah. 

[01:03:40] Caoimhe Whelan: I, I find that most people that I see who've had breast augmentation, they've no issues with milk production. I had 

[01:03:49] Emma Pickett: one mother that I interviewed for my book, the Breast book, who actually she was blind, which was another element to her breastfeeding story. Yeah. But she actually did have surgery. That masked her IGT.

Um, and the implants, you know, meant that nobody who ever looked at her breasts would've considered her to have had a history of IGT. So I guess, yeah, there will be rare cases when someone will have had an extreme asymmetry and, and you know, they would've had surgery because of IGT markers. But, but generally augmentation, not a barrier, but reduction more likely to be, yes.

Yeah. Yeah. Is that what you're finding? Yeah. 

[01:04:23] Caoimhe Whelan: I actually had somebody a couple of years ago who had had augmentation and, uh, was really struggling with supply, having a very, very difficult time. And when we sat down and talked about her whole history, you know, she, she talked to me about how her breasts never really fully developed and she ended up having augmentation.

But the upshot of the conversation was a decision to stop breastfeeding. And for her, she felt that was very freeing. She was able to accept that it wasn't her fault, she had been blaming herself. And, um, you know, she felt then, you know, this is, this is not because I had surgery. She was blaming herself for having the surgery in the first place because that's what she felt was the cause of her low milk supply.

But actually wasn't, it was the, the lack of breast development in, in her teenage years. Yeah. So it's, um, and I'm sure you see this in your work as well, like working with an I-B-C-L-C doesn't always mean that the decision is to keep going. Sometimes it's. A decision to stop. Yeah, 

[01:05:37] Emma Pickett: absolutely. And, and it's certainly a decision to let go of the dream of exclusive breastfeeding.

Yeah. That's a conversation I'm having relatively regularly. And yeah. And, and if anyone's thinking, oh, I don't wanna work with a lactation consultant 'cause they're not gonna support me to stop. That's, that's, well that's what I'm doing all day long. That's part of my, my mo at the moment. Um, any good lactation support involves helping you to come to a decision that's right for you.

Yeah. Whatever that looks like. Yeah. 

[01:06:01] Caoimhe Whelan: Yeah. Absolutely. 

[01:06:02] Emma Pickett: Yeah. Is there anything we haven't touched on that you wanted to make sure we covered? Um, you've been very generous with your time. Is there anything we've missed? Um. I, I, I, I dunno, you could talk about this all day, as was the answer to that. Yeah. And there's so many more things that we could talk about.

So, yeah. So when you do your next Vita research and when you do your PhD ki Oh God. Which is gonna happen, um, I, I will look, I will look forward to talking to you, you again. Gosh. If you've got another spare hour, 

[01:06:31] Caoimhe Whelan: I, yeah, I, I dunno, I, I, um, I would like to do more research at some time. I don't know if that'll happen.

I, I actually do, you know what? After doing the book, I feel a bit like I'm in a, a kind of fallow kind of place where I'm, I don't have a project, so I, I feel like I need something to do. But um, yeah, I'd love to do more qualitative breastfeeding research. I dunno what shape or form that might take. 

[01:06:59] Emma Pickett: Okay.

Well, we look forward to seeing the results of that. Yeah. Okay. We'll see. I'm gonna let you go. Thank you so much for your time today. You've been really generous, and thank you for all the work you're doing in this space and what a difference you're making to women who often, often have not felt heard.

And you know, and I know they will be saying this to you directly as well, but, but thank you for everything you're doing. 

[01:07:18] Caoimhe Whelan: Oh, thanks for having me, Emma. And for, for, I suppose given this, um, given this space and acknowledging this, this topic, I, I think it really helps people and it's just that acknowledgement, this is a thing, it's real.

And I know Imogen use the, the term gaslighting, you know, and that that's what a lot of people feel. Yeah. When they have primary low milk supply. But, um, yeah, this all helps to contribute to that sort of broader conversation around it and raise awareness among healthcare professionals and supporters. And parents themselves, so thank you.

Thank you.

[01:07:58] Emma Pickett: 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.