Emily's Story - OCD and breastfeeding as a midwife

This week, I’m joined by the lovely Emily, a Norfolk midwife and mother to Effie (8 months). We’re talking about breastfeeding alongside significant perinatal mental health challenges. Emily describes exclusively breastfeeding, co-sleeping safely, and introducing solids carefully due to anxiety, then shares how pregnancy and early postpartum intensified OCD, contamination fears, and intrusive thoughts, alongside existing anxiety, depression, PTSD and PMDD. She recounts a planned home birth complicated by a postpartum haemorrhage, theatre treatment and a blood transfusion, plus early breastfeeding pain despite an apparently good latch, temporary nipple shield use, and support including craniosacral therapy. Emily also experienced antenatal and postpartum DMER, severe oversupply, and an unsettled baby, eventually using block feeding until supply stabilised around 12 weeks. She explains how NHS talking therapies helped her reframe fears, and discusses plans for returning to work as a midwife and aiming for natural-term weaning.

My 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, by going to https://bit.ly/JKPbooks and 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.lucywebberfeedingsupport.com/workshops 

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

This transcript is AI generated.

[00:00:00] Emma Pickett: I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time because I was breastfeeding my own two children, and now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end, and I'm big on making sure parents get support at the end too.

Join me for conversations on how breastfeeding is amazing and also sometimes really, really hard. We'll look honestly and openly at that process of making milk, and of course, breastfeeding and chest feeding are a lot more than just making milk. Thank you very much for joining me for today's episode.

Today I'm gonna be speaking to Emily. That's Emily Berry from Norfolk, who is the mother of the lovely Effie, who's eight months old. Emily is a midwife, and as you'll have seen from the title of the episode, we're gonna be talking about some of the things that she's been struggling with during her lactation journey, including OCD.

We're gonna be touching on D-M-E-R or DMER, um, and PMDD. Lots of initials. Don't worry, we'll explain what they all mean. Thank you so much for joining me today, Emily. I really appreciate it. Tell me about Effie. Thank you. 

[00:01:18] Emily: So Effie, she's a little terror. Bless her. She is, um, just about eight months old now.

She's my first baby. She's fiery, she's feisty, she's 

[00:01:29] Emma Pickett: independent, but yeah, she's great. She's brilliant. Oh, fantastic. So we're gonna be sort of diving into what it's like to have your first baby as a midwife, which I think lots of people will be really curious to know how that experience feels. But before we do that, tell us about a typical 24 hours for Effie's breastfeeding at the moment.

What, what, does breastfeeding eight-month-old Effie look like? So, so she is still exclusively 

[00:01:53] Emily: breastfed. Um, she ... We very much go with the flow. Sometimes it's quite hard to keep track of a, a, a 24-hour day, to be honest, because you just kind of get into the rhythm of going, going with her and, and doing, doing what she's doing.

Um, she probably has, like, a good solid feed maybe every three hours or so, but she's very much a snacker. 

[00:02:15] Emma Pickett: Okay. 

[00:02:15] Emily: Um, and she's just about kind of to the point now that she notices when I leave a room. So often when I then return to the room, she'll want a little comfort, little comfort snack just to make sure that it's me Yeah

and I have returned, and I haven't abandoned her. 

[00:02:28] Emma Pickett: Yeah, eight months is often a, a good age for that, that kind of- Yeah ... noticing you're a person, and we're not- Yeah ... the same person anymore. We're not, you know, obviously at the beginning, as you well know, they literally think we are one being. We are connected.

Exactly. And, and that gradual realization that, hang on, she actually can leave, is something that kinda can hit them quite hard. So breastfeeding's a lovely way to reconnect. We were definitely going through that. 

[00:02:49] Emily: Um, and then we, um, we made the decision quite early on actually to, to co-sleep. It was just a way that sort of, it was probably the only way that I was gonna gonna cope with the sleep and things like that.

And w- with my background, I, I knew early on that, um, actually, the vast majority of people that co-sleep don't plan to co-sleep. So I was aware of that, and going into it, we kinda just planned it. I knew it was gonna happen for us at some point, so we just planned it. Um, and for us, that's been, um, a really nice journey actually.

Um, and it means that I, I cope- Yeah ... because it means that I can kind of just sleep and feed, and I just 

[00:03:26] Emma Pickett: do it in my sleep now. Yeah, yeah. I mean, that's the gr- if you're in that situation where you can have her latch on and not really wake up and continue sleeping- Yeah, we're really lucky- ... that is the dream scenario

from that respect. Yeah. Yeah. H- how has she been getting on with, with solids? 

[00:03:39] Emily: Getting there slowly. Um, we'll, we- we'll talk, I think, more about, about my mental health, but it was definitely anything new, any big changes like that can be a real trigger for me, and I knew that weaning was gonna be a bit, a real, a real trigger.

So we started a little bit on the later side just 'cause of my anxiety, but actually I'm quite enjoying it now that we're getting into it. I've got good support around me. Um, and I have to very constantly remind myself that this is just exploration at this point- Yeah ... that she doesn't need it, that she's getting everything she needs from me still.

Um, because she doesn't swallow much particularly. It's very much still lots of touching, lots of smearing it all over her face, lots of throwing it at the dogs. They're very much enjoying- Love it ... the weaning journey. 

[00:04:23] Emma Pickett: There's this, there's this little Instagram thing, I don't know if you've seen, I'm sure it's on TikTok too, where, you know how they put, like, v- human voices on dogs, and the dog says to the toddler, "Would you like to form an alliance?"

Yeah. And it's, it's that- That's 

[00:04:37] Emily: pretty much them. As soon as the highchair comes out, they appear out of nowhere. So she's very much enjoying it, but I'm having to keep reminding myself to keep the pressure off it, keep the pressure off intake- 

[00:04:48] Emma Pickett: Yeah ... 

[00:04:49] Emily: because she's very much not having much. We're doing quite baby led, so it's, it's just lots of exploration for her at the minute.

[00:04:54] Emma Pickett: Yeah, brilliant. Yeah, still early days. Before we move off the subject of c- co-sleeping, I'd love to hear, for anyone who only listens to the first 10 minutes of a podcast, and there are some of those people Tell us about safe co-sleeping. So when you're talking to a parent that you're supporting, what do you want them to know about safe sleeping, and what does your safe s- sleeping space look like?

[00:05:15] Emily: Yeah, so it's obviously really important that we're having those conversations. You know, when I was, was trained, we were told to tell people that safe sleeping, that sort of co-sleeping isn't safe, and they should have their own space. But actually, the advice, thankfully, is really shifting now, and nice guidance is recommending that we, we do have those conversations in pregnancy.

So there's a couple of key factors in there, making sure that, you know, neither me or my partner smoke, we don't drink alcohol, but it's essentially for us, a space where there's no pillows, no blankets, and I sleep kind of laying on my side with my arm outstretched and create sort of a C shape with my body that Effie sleeps in, and she sleeps in a sleeping bag, so there's no loose blankets or anything like that for her.

Yeah. 

[00:05:56] Emma Pickett: And your bedding is sort of tucked out the way and there's no gap- Yeah, it's all tucked and tight and- Where she can get stuck. So, so you're in a- Exactly ... double bed or bigger than a double bed. Is, is there anything behind her? 

[00:06:07] Emily: Um, so there ... We used to have the next to me cot that she spent all of 10 minutes of her life in.

Um, so I used to have that open, um, but she start- as she got bigger and started rolling more, we kind of have that as sort of a barrier. So it's mesh, so it means that even if she rolls onto that side- Okay ... she's not got anything occluding. So she's got that just as a barrier 'cause she kind of sleeps on my side, so my husband's behind me.

She's not in between us, and she kind of sleeps, sleeps on my side there. 

[00:06:34] Emma Pickett: Yeah. Thank you. And as you say, um, you know, when I first started in this game, you know, it was all kind of discouraging people from co-sleeping- Yeah, absolutely ... and there, and there are still some very well-respected sleep charities that want to encourage people to have babies in a separate space.

But we do know- Yeah ... and this is the Baby Sleep Information Service in the University of Durham, we do know, you know, something like 70 to 80% of families who breastfeed will be co-sleeping. So we need to make sure those conversations happen, and it's absolutely considered part of normal life. And as you say, if you don't have those conversations, people are gonna do it without planning, and they're just gonna do it- Exactly

anyway without knowing what's safe and ... or even worse, trying to stay awake, sitting in a, on the sofa and ending up falling asleep on the sofa, which is really- And it's 

[00:07:16] Emily: so, it's so easy. It's so easily done. Um, even as a midwife, even someone who knows this advice inside and out, I still, we know when she was born, got the Lullaby Trust website out and looked at the, the safe advice just to really remind myself because when you're that tired, your, your midwife brain kind of goes somewhere different.

[00:07:34] Emma Pickett: Yeah. Yeah, for sure Okay, let's talk about your life as a midwife. So were you community-based? Were you hospital-based? What was, what was your job like? 

[00:07:42] Emily: So I, I'm largely community-based. So, um, the trust where I work is quite small, so it does mean that we kind of cross all, all areas a little bit. But a- as a whole, I'm a, I'm a community midwife.

Um, but that also in our trust covers the home birth service and the low-risk, um, midwife-led birthing unit service. Okay. Um, so my role would be caring for women and case loading women through their pregnancy journey. Sometimes I'd see them for birth, which was always lovely, and then, um, continuing that care at home afterwards.

So breastfeeding support is, is a lot of my, my bread and butter of my work. Okay, 

[00:08:16] Emma Pickett: brilliant. And presumably in North Norfolk, you're driving around a lot. I mean, you must have quite a spread out caseload. We do . We 

[00:08:22] Emily: do. I mean, I trained in Leicester, and we might do eight visits and cover five miles, whereas where I am now, I might do two visits and cover over 100 miles.

[00:08:31] Emma Pickett: Wow. Wow. 

[00:08:31] Emily: So we have a big s- although it's a small caseload numbers-wise, we cover a bi- big patch. So yeah- Okay ... it's lovely though. I really, I really enjoy it. 

[00:08:39] Emma Pickett: And, and home births, q- quick nerdy question- Mm ... 'cause of where I am in London, obviously home births are all over the place, but no one's ever more than- Yeah

20 minutes from a hospital ma- maximum. So you're doing home births that have qui- quite a bigger journey time, which gives, gives you- Yeah ... a bit more responsibility, I'm guessing. And you, you know, you, um, you're, you're obviously you're going to need to know l- everything to be a home birth midwife anyway, but you certainly aren't going to be blue lighting at the drop of a hat.

It's gonna be something that takes a bit more- It's 

[00:09:05] Emily: ju- it's just an extra consideration when you have that additional distance. I mean, one thing that is on our side is that y- you have to consider things like, because we're coastal, holiday traffic sometimes at different times of year, but actually on the whole, our roads are quite quiet, which is, which is beneficial But yeah, it's an, it's an extra consideration.

It's an extra thing that you have in the back of your head. But actually, we know through a lot of, a lot of research and a lot of re- recommendations that actually for a high number of women that are considered, you know, quote-unquote, "low risk", whether, uh, you know, you like the terminology or not, but home birth is safer- Yeah

than hospital birth for a lot of women. Yeah. So it's an extra consideration, that distance in your back of your head. But I mean, I, I had a home birth with Effie. So I think it's about wherever you feel safe. And for some people, they feel safer in hospital. That's where they should be. For those who feel safer at home, that's where they should be.

[00:09:52] Emma Pickett: Yeah. Yeah, and I guess if you're making the journey, and it's a long journey anyway, g- doing that journey in labor is not much fun either, so you might as well stay at home and have someone come to you. Um- Yeah. 

[00:10:02] Emily: Yeah. Yeah, you get two midwives for a home birth as well, so you get, you get that extra bit of TLC and support.

And I mean, as a midwife, it's lovely because I've got no other buzzers, nothing else going on. I'm just in that space, just in that environment. There's no distractions outside the room. 

[00:10:17] Emma Pickett: Yeah, that's, that's really special. I love your daughter's name, by the way. I'm gonna share with you- Oh ... a very, very nerdy fact.

Brace yourself. Oh, I love that. My producer might edit this out. So, so my dad is a historical writer and historian- Mm ... and a, and a novelist, and he wrote a novel inspired by somebody called Effie because he found- I love that ... an old historical document. It was a l- a tear-stained letter of a maid leaving a house.

This is 18th century Scotland, and she had to leave because she, you know, her heart had been broken, and she had to ... And, and her name was Euphemia, um, E- Eff- Effie for short. So, so that letter then inspired him to do some more research, and then he wrote a novel based on the documents that he'd found. So there you go.

I'm gonna have to read this novel now. Completely, we've just lost all our listeners. I know. No one else gives a hoot about that. I love that. But I just thought I'd share. I love that. And then I probably shouldn't tell you the next bit, which is then he named a family dog Effie 'cause he was so inspired by the character.

So- I'm still here for it ... um, okay, good, good. I'm still- W- willing to still talk to me ... it's difficult 

[00:11:10] Emily: as a midwife because I work with obviously so many women and then so many babies, and every name it was like, "Oh, wait, no, I know a baby with that name. Oh, no, wait, no." It's, it's, it's a challenging sort of extra thing.

I, well, I've met some, like, primary school teachers as well since that find n- finding names really challenging because you always know a child with that 

[00:11:28] Emma Pickett: name. I was an ex-teacher. I feel your pain. Um, so is it- ... is it Euphemia officially, or is it Effie on the birth c- No, she 

[00:11:33] Emily: is Effie. Okay. But my, my grandmother was Greek, so it was loosely inspired by Euphemia, which was, is a Greek name.

Okay. But she is, she is Effie. 

[00:11:40] Emma Pickett: Okay. Thank you for indulging me on that one. Okay, so you're working as a midwife. Yes. You get pregnant. What's going through your mind? 

[00:11:48] Emily: Phew. It was ... It's very, very strange to say that it was a shock because it absolutely shouldn't have been because she was very much planned.

We'd been, been trying for some time. But I think no matter how long you're trying and how much you want this baby, when you see the two lines, it still feels like a surprise, and it still feels like a shock. Um, but very excited. Um- I told, again, because I'm a community midwife, you know, my, my closest friends are midwives and community midwives, so I had a really, really good, good support network around me.

Um, we had a sort of a ch- sort of challenges, I guess, in terms of, um, there was one particularly really challenging shift on delivery suite very early in the pregnancy when I was caring for a woman doing amazingly in labor. Um, but it was a very physical shift, very moving about. Um, I got knocked about a little bit.

Um, I didn't have a break all day, and at the end of the shift, I did have some, some bleeding, so that was- Oh, no. I'm so sorry. That's scary ... um, quite scary. But again, luckily, I was, I was already in the right place, um, and had really good care and support. And, and she was, she was fine, luckily, so. Okay. Okay.

But it can be quite a physical job at times, and that can present an extra challenge. Yeah, and actually 

[00:13:00] Emma Pickett: not getting a break, you mentioned, I think- Yeah ... not being able to go to the toilet, not being able to drink, not being able to eat. I mean, that's gotta hit you pretty hard. 

[00:13:07] Emily: Yeah, and it is, you know, it's, it's not, it's not the plan, but sometimes it is the reality.

When, when you're in that position and someone needs you, you're not gonna be like, "So sorry. I know you're just about to have a baby, but I could, um, do with a wee break." So i- 

[00:13:17] Emma Pickett: it's the frustrating reality. Yeah, I've been reading on Instagram, L- Leah Hazard's been talking about some of the workload- Mm ... stuff that midwives are dealing with at the moment, and the reality of you think you've finished your shift and your boss says, "Actually, we need you to go and cover this home birth."

Yeah. Um, um, whoa. I mean, it's- Absolutely ... it's just incredible what people are g- being, are being pushed to do and, and, and what's, how overstretched everybody is. I just can't imagine what it's like to work, you know, a really intense job for a full shift and then not be able to go home. Um- 

[00:13:47] Emily: Yeah. It, it is, it is intense.

It's emotionally very intense. Um, there's definitely shifts where you come home and kinda just feel like a shell of yourself because you've given, given a chunk of your soul to the person that you're caring for. I wouldn't change it. I love that, that kind of escapism in terms of I give everything to the person that's in front of me and give everything to the, to the family that I'm caring for, but it doesn't mean it's any less, um, intense.

And I had hyperemesis during my pregnancy as well. Oh. So there was definitely times, I can very distinctly remember being in clinic, um, in my antenatal clinic and sort of doing an appointment, saying to the, to the, um, people in the room, "I'm just gonna nip out for one second", having to sneak, go be sick, sort myself out, and then- Oh, gosh

and then run back in. Um, so yeah, extra challenges. Yeah, extra challenges, 

[00:14:39] Emma Pickett: for sure. Um, and presumably, as you say, you've been working with breastfeeding support. Breastfeeding, you mentioned, is your kinda bread and butter, so I'm guessing you had positive vibes about breastfeeding. That was something you, you felt good about.

Yeah. I mean, 

[00:14:49] Emily: that's something that I think I was really lucky in terms of, obviously, I was aware of all the research and the education and the advice, um, but also I, I'd seen different experiences that I could pull and learn from. And in terms of a workforce as well, it's very much a supportive space. But also, it was very normal for us to have, um- Women coming back to work and midwives coming back to work who were still breastfeeding.

So it's a very sort of normal sound background in our office of a pump somewhere in the background because we've often got one or more members of staff who've returned to work breastfeeding. So I had that really supportive space of, so not just sort of the, the families that I was caring for, but also my colleagues around me, where it's just very much accepted that everybody has their own feeding journey, but if this is the journey that you wanna take, that we would be supported.

[00:15:39] Emma Pickett: Okay. That's lovely to hear. That's really good to hear. Now, obviously, we're gonna touch a little bit on some of your mental health challenges. Did you have in pregnancy any signs of anxiety or anything 

[00:15:47] Emily: that- Yeah. So I mean, historically, even before pregnancy, I've got, I've got a lot of, I've got a lot of initial diagnoses

Um, so in terms of sort of my background prior to pregnancy, I've already got a diagnosis of anxiety and depression, along with, um, PTSD and PMDD. Um, so post-traumatic stress disorder and premenstrual dysphoric disorder. 

[00:16:09] Emma Pickett: Yeah. So PMDD, I did a whole episode about with- Yes ... with the fantastic Lucy Webber, who's also somebody who struggles with that.

So if anyone doesn't know what PMDD is, please go and listen to that episode. But- Yes ... can you give them the little mini version now? 

[00:16:22] Emily: Yeah. So I mean, it's unique for everyone, but essentially for me, it's kind of the, um, my, the luteal phase of my cycle, that premenstrual phase, I really struggle with my mood.

Um, so for me personally, it can sometimes present as paranoia, sometimes borderline hallucinations, but really crushing low mood. Um, and then you come onto your period and you wake up and it's like the cloud has lifted and it's, "Oh my gosh, that's what it was". 

[00:16:47] Emma Pickett: Okay. 

[00:16:48] Emily: For a long time, I was on various different

I had various different gynecological problems, and so from the age of 14, I was on the pill, and then had the coil and things like that. So I didn't actually know I had it until quite late. It was sort of the year before, um, around a year before we got pregnant with Effie that I came off everything- Gosh, so that must have hit you-

and started to have cycles ... pretty hard. Yeah. So then the, the rollercoaster really hit very quickly and very intensely. And 

[00:17:12] Emma Pickett: working as a midwife with that rollercoaster- Yeah ... is, is really, really, really tough. It's something. And one of the things that we talked about in my episode with Lucy is that people who have PMDD are potentially more vulnerable To other hormonal shifts- Yes

and- Yeah ... and possibly more vulnerable to weaning blues and, and possibly more vulnerable to DMER, um- Mm-hmm ... which that dysphoric milk ejection reflex- Yeah ... experience of, of feeling that, that surge of low mood just as the letdown happens. Have you, uh, uh, obviously we'll talk a bit more about that in a second, but have you found any research that links PMDD to that condition?

[00:17:47] Emily: Unfortunately, like a lot of women's health issues, there is not much research. Um, but the sort of the physiology behind it lines up in terms of the, the big hormonal shifts and, and the specific hormones involved. It, it lines up- Yeah ... in terms of having those similar sensations, those similar experiences.

So it would be lovely if we could have some more research into it. Yeah, yeah. 

[00:18:08] Emma Pickett: If 

[00:18:08] Emily: anyone 

[00:18:08] Emma Pickett: fancies it, that'd be grand. Yeah. I also have another episode on DMER if anyone wants to listen a bit more about that. S- it's something about dopamine. It's something about brain- Mm-hmm ... releasing hormones at the c- moment when oxytocin is doing something.

Yeah, but as you say, so many mysteries when it comes to women's bodies and women's health. Um, okay, before we jump into all your initials a bit more- Yes ... let's talk a bit more about, I don't mean that to sound dismissive, by the way. Please share. No, no, not at all. Share as much as it does. I don't mind. Um, let's talk a little bit about your birth.

Yes. So home birth planned. Does that mean you had mates? Who were your midwives? People you knew- I did ... or was it special? I was really lucky, 

[00:18:43] Emily: and I've got to say, as much as there's, there's lots of challenges with being a midwife who's, who's pregnant and who's birthing, but actually I was cared for by the most incredible women who I love dearly and who really nurtured me and really held space for me.

My, my mental health definitely deteriorated when I was pregnant, and what I didn't know at the time, which I now know, is that, that I had OCD. Tell 

[00:19:07] Emma Pickett: me a little 

[00:19:07] Emily: bit more 

[00:19:08] Emma Pickett: about what that looks like, because I think OCD is one of those conditions where that term is misused all the time, as you absolutely know.

I mean, it's outrageous- Absolutely ... how, "Oh, I like lining my pencils up. I've got OCD." I mean, it's, it's horrifying how the, how misused it is. So can you help us understand? 

[00:19:24] Emily: Yeah. Being very honest, I completely misused it myself because I remember sort of fast-tracking forward when, when I finally got some help and spoke to the therapist, and she said, "Have you ever thought about OCD?"

Um, my response was, "If you saw my house, you wouldn't think I had OCD." And I very much had that connotation of, well, I'm, you know, my house is not tidy-tidy. I'm not a clean freak. Yeah. Yeah. Um, and so I can't have OCD, but actually looking back, I, I mean, I, it's, it's different for everybody. It's so different.

It's so unique. 

[00:19:52] Emma Pickett: So it started in your pregnancy. You hadn't had it before pregnancy? 

[00:19:55] Emily: So now I understand more. I think I've had it for a long time. Okay. Um, but it definitely accelerated in pregnancy. So in pregnancy, for me, that presented as, um, I was Utterly convinced that, um, the floor was dirty and nothing I could do, no amount of cleaning would make that floor clean.

And that then in turn meant that I forced my poor husband to rip up all the carpet because I couldn't- Mm ... cope with it. Mm-hmm. So I had little, um, sort of mats dotted around the house that I would leap pad across because they were considered safe zones for me. Oh, wow, Emily, that sounds really tough. I also had these little 

[00:20:28] Emma Pickett: sliders.

So was this connected to pregnancy safety and thinking about the home birth and wanting the h- house to be clean or not necessarily? Some, yes. 

[00:20:37] Emily: So a lot of it was con- it was contamination based. So I was convinced that if I touched the floor, I would get a disease that would pass to Effie and that, and that she would die.

Mm. Um, so it sounds a bit bonkers, but it felt very, very real. I also became obsessed with... And then I think this is where being a midwife and knowing too much can be a challenge. I became very obsessed with, um, taking, having dates later in pregnancy and drinking raspberry leaf tea, which is very like, you know, a reasonable thing to do, but I became very regimented with it.

Okay. Um, and even when the dates were making me sick, I was absolutely convinced that if I missed one date, I would have a really traumatic birth and Effie would die. Um- Oh, Emily ... so again, sounds cra- And even looking back, I'm like, "Come on, Em." Um- Hey, hey ... but at the time- Don't, don't ... it felt very- Yeah ... 

[00:21:23] Emma Pickett: very real.

Th- this is not about, you know, you used the word bonkers a moment ago. That's your word, not my word. Yeah, absolutely. It is, it is about- Absolutely ... it sounds like it's a lot about control, isn't it? And the, and, and wanting to- It really, really is ... control your environment, and it's protecting people you love, which is actually- Yes

such a lovely thought in a way, isn't it? I mean, it's- Yes ... it comes from this profound, profound want to, to be protective and- It does. It does ... and protect the people you love. But it, 

[00:21:46] Emily: it, it- And it is essentially this sort of your brain convincing you that you're, you're mad, you're bad, you're dangerous. Yeah.

Um, and I think what makes OCD kind of forceful and unique in that is that you, that it's driven by the desire to protect people, like you said, and that you absolutely don't want to do these things, but you're absolutely convinced that, that something you do or one of your actions is gonna hurt yourself or someone that you love, and that that's a really, really scary thought, so your, your actions and your behaviors shift and change to try and take back that control like you said.

[00:22:17] Emma Pickett: Yeah. And I, I guess your version of it had that, that sort of midwife knowledge- At its heart in a way. I mean, I've- It did ... I've known people in my life who've had OCD and it was things like, you know, I've got to touch something 10 times because if I don't touch something 10 times, someone I love will be hurt.

Yes. I've got to check something which I know is off, which I know is locked, because if I don't- Take clothes off the oven to make sure that I know it's off when I leave the house ... yeah, I'm sort of tempting, I'm tempting fate. Um- Yes ... um, and if I, you know, and, and it's ... So some of it's kind of this slightly mystical, there's the un- the universe is out to get me and I've got to do these, these things that are almost like spells- Absolutely.

Absolutely ... to stop the universe hurting the people I love. But yours, your version sounds like there's, there's a nubbin of science there somewhere, which I think- There is, and it's almost like- ... when, when your brain's not well, it's hard to argue against that because you've got something sciencey. Exactly.

[00:23:06] Emily: Exactly. And sort of the way my, my lovely therapist, um, Michelle, explained it to me was kind of the idea of this bully in my head. And the bully was telling me that I'm mad, I'm bad, I'm dangerous. Um, but my bully seems to kind of use those little bits of knowledge that I have against me, and, and that really I think accelerated it in my pregnancy for me, and that made, as well as the hormones and everything that comes with pregnancy, it made me quite vulnerable at the time.

[00:23:34] Emma Pickett: Okay, okay. So you'd mentioned Michelle. Was she somebody caring for you during pregnancy as well? 

[00:23:39] Emily: No, Michelle was not someone I met until, um ... So she, um, um, is a therapist through Just One Norfolk, which is our sort of local NHS mental health service. We're really lucky in this area, and most areas in fact, you know, when you're, you're pregnant or immediate postnatal, you get sort- sort of fast-tracked through that service.

So I ... Effie was three or so months old before I got help. Okay. Um, and- So that's quite a long time ... now I understand so much more thanks to Michelle. 

[00:24:04] Emma Pickett: Yeah, yeah. Okay, let's, let's go back in time a little bit then. So you're cutting up bits of carpet, you're sliding around, and presumably your partner's worried about you at, at this point.

Yes. What are they saying? 

[00:24:15] Emily: Um, so my lovely husband is so laid back that he's horizontal- ... which is probably why I married him, because someone needs to balance the chaos in my mind out. Um, I think obviously we didn't know that I had OCD at the time, and there's things that he would do differently now than he did at the time.

So at the time he very much just wanted to help me and just wanted to support me, so when I asked him to tear up the carpet, he just did it. And when I told him I needed this, he just did it. Whereas so now we understand more, we'd have that discussion of, okay, is this you thinking this or is that, is your OCD thinking this, and therefore maybe trying not to feed into it as much.

Okay. Okay. Um, now I understand that actually the more you kind of listen to that bully and the more you feed that bully, it, it grows and it evolves. Um, but yes, people around me were, were definitely worried, but I think didn't know how to support me. And I think again, being a midwife became a challenge for that because he knew that I, I had the knowledge, that I had the background So actually, I think it was probably really challenging for him to, to question those things- Yeah

because in his head he's thinking, "Well, she, she knows what she's doing. She's a midwife". 

[00:25:15] Emma Pickett: She knows about infection risk. She knows about, yeah, yeah, yeah. She knows about all of these things, 

[00:25:19] Emily: so I think that's been a, a, an extra layer of challenge for people around me as well, because how do they support me when in their heads I know, I know what I'm doing because I'm the midwife.

[00:25:27] Emma Pickett: Yeah, yeah. And you had your lovely home birth with the lovely people who supported you, which is great, and you were obviously able to get into that mental space at the time of birth and- Yes. My... 

[00:25:37] Emily: I mean, my birth was sort of a tale of, of two halves. Um, and a lot of, of those challenges I think were around the fact that even though as a midwife I know that everyone is so different and unique, but I also know of patterns and I know of research and I know of, of evidence base, and so I had kind of ridiculously expectations going into it of how things might happen, and when they didn't, that was challenging for me.

But I had quite a long early labor and then things sort of did progress in the end quite, quite quickly. But my, my actual birth, whilst intense and I saw everything that comes with birth, um, my actual birth was, was beautiful at home in the pool. Um, and I managed a couple of hours of skin-to-skin at home before I eventually relented and accepted that I did in fact need to go to hospital 'cause I had, um, a hemorrhage.

Okay. Um, so I wouldn't change my birth. I, I wouldn't change my decisions. Um, I, I loved my birth. But yeah, it did take a bit of a turn afterwards, which, which is still something that, that I battle with and have to think about, um- Okay ... sort of the trauma associated with that. 

[00:26:40] Emma Pickett: Is that... You mentioned PTSD. Is that what that's connected to?

So 

[00:26:44] Emily: my PTSD is, is longstanding as well. Okay. Um, I've got a... My, my amazing mum, um, has got a heart condition. Um, so my PTSD is largely connected to, to incidents related to her health, um, as well as a car accident that I was in when I was younger. So- Okay ... that's, that's already in the 

[00:27:02] Emma Pickett: background. Okay. Thank you for sh- for sharing that.

Um, so you're, you went to hospital and, uh- Yes ... obviously Effie came with you, and you're trundling through the Norfolk s- Norfolk roads, hopefully not too much in the way of coastal traffic, and you get to hospital and bleeding is managed. And- Yeah ... did you lose enough blood to possibly risk lactation success?

I mean, were we over that kind of threshold? Yes. 

[00:27:21] Emily: So I mean, i- going back in time again, so this is again sort of why I, I struggled with that kind of expectation versus reality. Um, I started leaking in my pregnancy when I was at about 16 weeks. Um, but then actually when I started hand expressing, um, I had a very high supply antenatally.

Um, so by about 37 weeks I was getting 30 mils- Just from hand expressing 

[00:27:48] Emma Pickett: every day Wowsers. Okay. Anyone listening to this, uh, that is not normal, and we d- and- At all. Who knows what's going on there 'cause that's, uh, you know, your prolactin levels are being suppressed by progesterone, so- Exactly ... who knows what's going on.

But it's, um, okay. And 

[00:28:02] Emily: all the advice I gave, which was even if you see a little glisten, that's fine. If you don't see anything, that's fine. Yeah. That's not what antenatal hand expression is about. I went into it with that, and then I got 30 mils and had to stop. It was still coming. I just had to stop. So I've still got an ice cube tray full of colostrum in my freezer.

But so I kind of went into it with that mindset of, "This is abnormal." Um, but then actually, so yeah, I ha- I did ... Me and Effie had to be separated, um, 'cause they wouldn't travel us in the same ambulance. Um, so w- I'm really glad that I, I had that protected two hours, and again, that's just a testament to the amazing midwives that I had really protecting me for that space.

But it did get to the point that it, it wasn't safe anymore. So we were separated for the ambulance, and then I had to go to theater to have a small piece of membrane removed that had- Okay ... had gotten lodged. 

[00:28:48] Emma Pickett: When you say membrane, we're talking about a bit of placenta. So the placenta was- Uh, so it 

[00:28:51] Emily: was just a bit of the bag, the- Okay

a bit, a bit of the sac, um, that, that got lodged when the uterus was coming out Which was stopping the uterus closing back up again. Yeah, exactly. So it was stopping my uterus contracting, and meant that, um, my uterus wasn't able to stop the bleeding. Um, so because I was, um, birthed in the pool, how much blood we lost in total w- we're not really sure, but, um, somewhere in the region of one and a half to two liters probably.

[00:29:13] Emma Pickett: Okay. 

[00:29:13] Emily: Based on the fact that my, my iron levels afterwards were about 69, so they got quite low, meaning I had to have a blood transfusion as well. Okay. 

[00:29:21] Emma Pickett: For anyone who's not an iron levels nerd, what's normal- Yes, sorry ... for iron levels? No, God, don't apologize So, um- Um, we, so it's, it's, uh, it's really great to have your midwife brain.

[00:29:30] Emily: Ideally, over 120 would be ideal. Um- Okay ... in pregnancy it can dip a little bit below that, and sort of, um, you really don't want it below, below the 100s really you're gonna start to get symptoms. And yeah, mine dropped to about 

[00:29:42] Emma Pickett: 69, so. Okay. And the, and we give a transfusion not just for iron levels but also because we want your pituitary gland to be able to function, and, and- Yes

and we need that, that- For 

[00:29:52] Emily: lots of things. Yeah. It was something that I definitely resisted, and again, this is where the OCD comes into play. But I was lucky that, you know, I, I, I trusted my colleagues. Um, and, and we had that back-and-forth discussion. It wasn't a, "You need this." It was a, a sort of a, a recommendation and then having that back and forth of is this what I want, is this what's best for me, et cetera.

[00:30:11] Emma Pickett: Okay. So Eff- Effie's in the hospital- Yeah ... in the arms of your husband. With me. Yes. Um, while you're in theater. And then- Yes ... and then you're back on a postnatal ward 

[00:30:22] Emily: I stayed on delivery suite because I was under what we'd call like HDU care. So because of the amount of blood I lost, and because of my symptoms, I needed a little bit more input.

So I was on, I was on hi- high dependency care rather than on the postnatal ward. 

[00:30:35] Emma Pickett: Okay. Okay. And what do you remember of those early breastfeeds? I'm guessing in those magic couple of hours you had a, a little bit- Pain ... bit of a go. Oh, okay. 

[00:30:42] Emily: Yeah. So, um, in those first couple of hours we did have a little go, and I, I wasn't too worried at the time because, again, Effie was born in the pool a- and it's quite sort of understood that actually babies born in the pool may take a little bit longer to have that first feed.

Um, she had a few sort of like licks and sucks, but I remember it burning and feeling really, really painful. But we managed like a little go at home, and then when I was in theater, um, my lovely colleague helped my husband to give Effie a syringe of expressed milk. So her first sort of ... Other than whether she, whether she got a tiny bit at home, I don't know, but her first sort of proper feed was likely from a syringe.

[00:31:22] Emma Pickett: Okay. And in the HDU, have, have you got people thinking about your lactation? I mean, do you start expressing? What happens? Y- 

[00:31:30] Emily: so, yes, absolutely. Our ... Because we're quite a small, um, hospital, our sort of HDU care, it, it was just a room on delivery suite. As we've kind of s- touched on already, staffing is a challenge at the minute.

Acuity was really, really high in terms of the workload was really high. So- What does acuity mean? I'm so sorry. So acuity is when- Don't apologize ... we kind of work how, um, sort of the number of staff we have versus the, the patients we have and what their needs are. So for example- So like logistics ... a woman in labor- Working out who goes where- Yeah, kind of.

A woman in labor- ... and stuff ... would need one midwife to her, and that midwife can't do anything else, whereas we might have a f- a few families on the ward that have less needs, and a midwife could look after a few of them. So it's kinda calculating, yeah, exactly, the logistics of the staff, the workload, and how we can balance those out.

So when I was in, it, it was very busy, and that presented a- an extra challenge in terms of, of support because I think as much as people would've wanted to, to offer that extra support, there just wasn't the resources- Okay ... at the time. 

[00:32:28] Emma Pickett: Okay. And you mentioned that burning sensation and being in pain. Yes.

Yes. How long was that carrying on for? 

[00:32:34] Emily: Um, that carried on for a long, long time. So when I was in hospital, I think, I think in honesty I'm lucky that I'm someone that, th- that I do, I can make myself heard, um, because I, I, I was struggling and I, and I did ask for that support and I did get that support. But sort of a challenge I had at the time was from the outside it looked like a good latch.

So it was very much that, you know, we, I, I knew the background. I was doing the, the nose to nipple and the chin in first and the more areola vili- visible at the top than the bottom. And, and from the outside it looked like a good latch, and even actually very early on her, her suck to swallow ratio was, was one to one, so she was going suck, swallow, suck, swallow, suck, swallow Which is, in my experience, quite unusual for, for those- Yeah

first couple of days, um, before the milk sort of fully come in. So from the outside it looked good, but it felt horrible. And nipple getting misshaping and anything? Definitely misshapen. Um, definitely that cl- sort of classic lipstick shape afterwards. Um, I didn't get any sort of, uh, bleeding really or cracking, but they bruised.

My nipples were sort of black and blue. Okay. So that was a challenge. And I, again, this was kind of where the, the exhaustion and the, the self-doubt came in because I knew that as much as it can look right, if it doesn't feel right, something's not quite- Yeah ... quite balanced there. But I, with everyone saying, "Well, it looks good from the outside," which it did, I started to convince myself I must be going crazy.

It must be something wrong with me, something wrong with my nipples. I just would keep going. And so I did. I just kept going. Despite the lipstick shape. Despite the lipstick shape, despite the pain. My brain was just telling me there's something wrong with you. I had a lovely support worker come and give me a lot of support overnight.

Um, and we got to the point actually that I was struggling so much that actually she was only 24 hours old, and we started using shields, which I have mixed feelings about looking back on. And as a midwife I have mixed feelings about. At the time it felt like I needed something. I needed something to change.

And with the resources available and everything else going on, we, we started using shields. So yeah, was that the right call? I don't know. Do you have a kind of specialist pathway 

[00:34:46] Emma Pickett: in your area? What happened? I mean- We 

[00:34:47] Emily: do. Um, our infant feeding team operate sort of on a Monday to Friday, nine till five, which is obviously when all feeding problems happen.

Of course. It's during strict office hours. You all power down like 

[00:34:58] Emma Pickett: little robots, so. 

[00:34:59] Emily: We do. Every- the babies are like, "It's cool that it's nighttime, so I won't cause ... You know, we won't cause any problems." And then the daytime comes, and then it all comes out. So I did the, the next morning, I've got a photo of me actually with, with my blood transfusion going through, trying to feed Effie, and the infant feeding team coming to give me some support.

And they had a good look. Um, and the only thing they could notice was that they said Effie's really, really tense. And she would kind of ... I had her in a, a rugby hold position, and she had her little fists up to her face, and little knuckles were white, and you could just see she looked really, really tense.

Um, so the recommendation at that point was to, to seek out some cranio and go down, go down that route. So for 

[00:35:39] Emma Pickett: anyone who doesn't know what cranio is, tell us what you mean. 

[00:35:42] Emily: Craniosacral therapy. So it's something that's not part of NHS care. It is, it's accessed privately in our area anyway. Um, but it's sort of an approach that looks at, um, sort of musculoskeletal alignment as much as other things, but sort of with the premise in breastfeeding that- Maybe from birth or from pregnancy, um, her neck was a bit sore or a bit tense or, um, something was a little bit misaligned that was meaning that it, it was hard for her to move her jaw freely, hard for her to be comfortable, and therefore affecting, affecting the feeding 

[00:36:12] Emma Pickett: So she was clamping down or there was sort of high tension and, and- Yes

yeah, yeah She was 

[00:36:17] Emily: very much one that she didn't, uh, that wide gape never really, really came initially. Um, she, she just looked tense and angry and unsettled all the time 

[00:36:28] Emma Pickett: Yeah. So the kind of work that a cranio- cranial osteopath does is similar to the work that a kind of cranial sacral therapist does. Um- Mm

um, I've had a, an episode with a, with a lovely, um, cranial osteopath to talk about some of the work that they do. So in your area, it's, it's a cranial sacral therapist that tends to be who's used 

[00:36:47] Emily: We've got a bit of a mix in our area. Again, this is where the midwife c- lucky midwife thing comes in because I, I knew the resources available in the area.

I didn't have to seek them out. So, um, this person that I actually got support from in the end, she came out and saw us at home when Effie was about four days old, um, is someone that I used to work with. She used to be our infant feeding lead, but she's a lactation consultant who does frenulotomies and cranio.

So she's kind of had that sort of package for us- Okay, okay ... which is, which was what I felt like I needed at the time 'cause I didn't think she had a tongue tie looking at her, but with everything I was feeling, it was something in the back of my mind of, is this something we need to look into as well? Um, so I was very lucky to have Jane 

[00:37:27] Emma Pickett: Okay.

And did, um... So, you know, cranial sacral therapy looks like massage, doesn't it, from the outside if someone's wa- watching it. It looks quite gentle 

[00:37:35] Emily: It's very, very gentle to look at. So at times Jane was sort of just kind of had her hands sort of gently resting on, on Effie's head, and it was sort of very gentle twists and turns and kind of going with her.

Um, Effie fell asleep during it, so it's very... It's not kind of how we see those sort of chiropractor videos online of- Yes ... sort of cracking- Not a chiropractor ... or anything like that. Absolutely not Definitely, definitely, definitely not that at all Um, Effie fell... Jane did it on the sofa sat next to me, and then Effie fell asleep during it.

Okay. So it's very gentle movements 

[00:38:03] Emma Pickett: But you did say at the beginning that you were in pain for a long time. Does that mean that this- I was ... this isn't gonna solve the problem? 

[00:38:08] Emily: It helped. It didn't s- so I was still using shields at that point. So what I kind of didn't understand at that point was the impact of that in terms of the feeding.

So- Effie on day three was only 1% off her birth weight, and by day five she was quite a bit over her birth weight. But up until day four, I, I used those shields, and I have distinct memories. My milk came in on day two, and I have distinct memories of putting a shield on and just watching as my nipple became invisible because the shield was just filled with milk.

Um, and what I now understand is actually Effie wasn't latching. She was just being able to drip feed because there was so much milk that it just dripped in. And so that meant that when, um, we did the cranio, I, I, I got that bit of extra support. Um, and I stopped using the shields. I, I haven't used a shield since then, but I almost had to kind of, we had to relearn because she hadn't been latching, so we had to really strip it back, start from scratch.

But, but no, it d- it definitely helped, but it didn't, didn't solve it completely. It, it wasn't a magic wand. 

[00:39:15] Emma Pickett: Okay. I'd love to tell you about my four most recent books. So we've got The Story of Jesse's Milkies, which is a picture book from two to six-year-olds that really tells the story of little Jesse and how his breastfeeding journey may come to an end in one of three different ways.

Maybe there'll be a new baby sister, maybe his mom will need to practice parent-led weaning, maybe he'll have a self-weaning ending. It's a book that helps your little people understand that there are lots of different ways breastfeeding journeys might end, that we're there to support them through all of them, and also, we sometimes have needs, too.

Also on endings, we have Supporting the Transition from Breastfeeding, which is a guide to weaning that really talks through how to bring breastfeeding to a close in a way that protects your emotional connection with your child. There are also chapters on different individual situations like weaning an older child when there's still a baby feeding, weaning in an emergency, weaning in a special needs situation.

Then we have Supporting Breastfeeding Past the First Six Months and Beyond that's really a companion to sit alongside you as you carry on breastfeeding through babyhood and beyond. What are the common challenges, and how can we overcome them? And let's hear some stories about other people who've had a natural term breastfeeding journey.

Then we have The Breast Book, which is a puberty guide for nine to 14-year-olds. It talks about how breasts grow. It answers common questions. It talks about what breastfeeding is. I talk about bras. I really want to leave a little person feeling confident and well-informed as breasts enter their lives.

So if you want to buy any of those books, I am eternally grateful. If you want to buy one of the supporting books, you can go to the Jessica Kingsley Press website. That's uk.jkp.com. Use the code MMPE10 to get 10% off. And if you have read one of those books and you can take a moment to do an online review, I would be incredibly grateful.

It really, really makes a difference. And as you can tell from the fact I'm making this advert, I have no publicity budget Thank you. Let's talk a little about, little bit about DMER. So D dash M-E-R. I used to call it DMER but apparently that's not what we're meant to call it. So Dysphoric Milk Ejection Reflex.

Yes. That usually doesn't hit from the very beginning when we're just colostrum feeding, but when, when did it start- Mm ... to affect you? 

[00:41:42] Emily: To be fair, I used to get it when I was hand expressing. 

[00:41:45] Emma Pickett: Even before birth? Yes. Wowzers. Okay. Gosh, I'm so sorry. Oh, 

[00:41:50] Emily: thank you. I think, you know, as women our hormones are all so unique, and a lot of the advice is really generalized, and that just doesn't work because we all function so differently, and our, our hormone systems function so differently.

I think with the background of PMDD, I, I have to wonder whether I've got some sort of sensitivity to it with the sort of the starting leaking so early, and then having that really high antenatal supply. But for me, it definitely intensified on that day two when my milk came in. And the only way I could describe it was sort of, you know, when you watch a cartoon and the little cloud is over the person, you can see the rain.

Yeah. And it would be this, when I felt a letdown in particular, this cloud would come over me, and it was just this really intense sadness for me, and this just feeling of sort of foreboding. And then it would sort of lift as soon as it came for me, and it would be like, "Oh, that was, that wasn't very pleasant."

So how long was it lasting 

[00:42:46] Emma Pickett: for, would you say? 

[00:42:47] Emily: Potentially for me, around sort of 20 to 30 seconds. 

[00:42:50] Emma Pickett: Okay. But that's a big wash of something, isn't it? I mean, someone once described it to me as b- like intense homesickness. The kind of homesicknessness that kinda- Yes ... you know, stops you in your tracks, and just absolutely f- you just feel overwhelmed.

[00:43:04] Emily: And, and it caused me a lot of sort of frustration and anxiety because I'm sort of thinking, "Well, I'm looking at my beautiful baby. Why am I, why am I feeling like this?" And there was definitely that thought of, again, you know, "What, what's, what's wrong with me because I'm meant to be happy?" Yeah, yeah. And it's, it's a very, you know, toxic way of thinking, but that I'm supposed to be thinking this and feeling this, but actually I'm feeling this.

[00:43:24] Emma Pickett: So I'm guessing from what you're saying, your midwife training hadn't really covered it, which is quite a common story. 

[00:43:30] Emily: No, it really hadn't. So there's definitely things that now, and, and I've spoken a bit to our infant feeding team about it, and actually how we can incorporate things more. But oversupply and DMER, you know, I, I've been, I'd been a midwife for nearly seven years and I, and I hadn't...

The only sort of support we had, or the only information I had for oversupply, and it's, and l- looking back, it's al- almost embarrassing, but actually I can only be the best midwife with the information I had at the time. Um, and we grow, and we learn, and we evolve. But all I knew about oversupply was lean back feeding.

[00:44:04] Emma Pickett: Right. Okay. So nothing about supply management, nothing about- No ... what might cause it? No. Nothing. Okay. 

[00:44:09] Emily: None of that. Um, and DMER I'd kind of loosely heard of, but it definitely wasn't something that- I'd been formally, formally- Yeah ... informed about. 

[00:44:19] Emma Pickett: So I, so oversupply and DM, I'm using an M for milk. A D-M-E-R.

Yes. Yes. I think do often go together. I think when someone's letdown is more forceful, I think it would make sense that- Yes ... they're, they're more likely to experience that. It 

[00:44:32] Emily: seems to track, it like logically it seems to fit with those, those hormonal shifts, and, and that, yeah, like you said, that big forceful letdown.

Yeah. And it, and that would be when I felt it, was when I had the letdown. 

[00:44:41] Emma Pickett: Yeah. And obviously her weight gain would suggest that you were overproducing from the, from the- Yeah ... very early, very early stages. 

[00:44:46] Emily: And I, and again, it sounds, sounds silly, but I didn't click really that I was oversupplying until day 10.

I had an amazing, the, one of the most beautiful, kind, amazing people I know, um, the lovely Daisy was supporting me, who's part of our infant feeding team with our health visitors. And she came out and weighed Effie, and Effie was 19% over her birth weight on day 10. Okay. Wow. Wow. And she kinda looked at me and went, "Em, I think this is oversupply".

And I still didn't really believe it. Now looking back, obviously it was. But sort of again, a, a challenge that came with that, and I, I wish, I really wish I, we'd had more training and I had more understanding because I then understood Effie was always a very unsettled baby. Very, very unsettled. And our days would consist of feeding, feeding, feeding till she vomits, and then feeding, feeding, feeding.

So a- a- as, as well as the pain, she would feed largely around 20 times in 24 hours. Okay. And what I didn't understand at the time, which Daisy sort of helped support me through, was that actually because of the high supply, that extra sort of foremilk and the high levels of sort of lactose in there, were meaning that sort of our experience was different, and Effie was, was probably quite uncomfortable.

[00:46:00] Emma Pickett: Yeah. So some of the undigested lactose, if babies don't have enough lactase enzyme to digest all the lactose in an oversupply situation, so some of the undigested lactose is gonna pass into the gut and, and, and c- potentially cause discomfort, and- Yeah ... you get faster gut transit, and you might get green stools, you might get mucusy stools.

Sometimes babies will even d- develop a sort of secondary lactose intolerance, um, if they're- Yeah ... dealing with a lot of lactose. And then obviously with fast flow, you've got babies struggling to coordinate their suck, swallow, breathe pattern, and ingesting air, and taking air at odd times. So you've got the kinda double whammy of both of those things.

Yeah. And then you also get babies filling up. I know you know this stuff, but just for anyone who's listening, you also get babies filling up on the lower fat milk. I hate the word foremilk, so don't- Yes ... don't shoot me- No ... but I'm not gonna say foremilk, but- No, I completely agree ... the, the lower fat milk, they will fill up on that lower fat milk, and then the, their weight gain might be great.

They're getting lots of lactose, they're getting energy, nappies are fine, but they may need to feed a bit more frequently, ironically, in an oversupply situation 'cause they're not getting that very slow fatty milk that's kind of hanging around. 

[00:47:00] Emily: And that's exactly what we experienced. And- I think one of the sort of the challenges with that of was when I tell people, you know, "She's, she's 19% over the birth weight," what I was often met with is, "Wow, that's amazing."

But w- I wasn't feeling amazing. I was feeling miserable because I wasn't sleeping and because I just had this really unhappy baby. And again, sort of the OCD rears its head because when ... And it wasn't at all the way it was communicated. I was so lucky with the caregivers that I had. But when I was sort of informed, 'cause I didn't, I didn't know it, but when I was informed by Daisy about that kind of the impact of, of the lower fat milk and the, the high levels of lactose, what she said was essentially kind of what you just said in laying it out.

What I heard was, "You're poisoning your baby." So that's kind of the, the OCD interacting with that, um, was, was an extra challenge because the sort of, yeah, my ... Although my logical understanding was sort of the physiology of what was going on, but actually my, my feelings around it was- by feeding her I'm hurting her- 

[00:48:05] Emma Pickett: Okay

[00:48:05] Emily: and I'm causing her pain. So that was a, a really, really difficult time. 

[00:48:10] Emma Pickett: Yeah. Gosh, I can imagine so. Yeah, I mean, that's a very literal interpretation of what's happening. Yeah. And obviously you're not necessarily getting support to, to manage your supply or, or thinking about block feeding- No. Yeah ... or moving into that space.

[00:48:24] Emily: So again, I'm really lucky that actually at the time Daisy was doing her lactation consultant training, so I kind of got that extra support, and we started doing, um, block feeding. So, um, I would do, I think I did, mm, I can't remember if it was two or three hours, but essentially I would only feed on one side for three hours, and then only feed on the other side for three hours to try and help manage it.

But my supply didn't really become stable as such until Effie was about 12 weeks old. Wow, okay. Up until that point, it was just 

[00:48:54] Emma Pickett: big boobs and milk everywhere. Some people say, "Oh, hold off on block feeding for a few weeks. Wait for your prolactin levels to drop." But there are some people who cannot wait.

Overproduction- Yeah ... is so extreme. And 

[00:49:03] Emily: I was one of those people. I think it just wasn't an option. And 

[00:49:06] Emma Pickett: even s- what you just described as kind of single-sided feeding, I mean, we need to sometimes in some cases go significantly beyond that. And, uh, you know, I've even worked with people who are doing six or even nine hours of- Mm

um, on one breast. Yeah. And to, to make ... Then we're doing that, so the engorged full breast is getting signals- Yes ... to reduce supply. And then when you swap sides, we need to be a bit careful 'cause that full breast is gonna be very overwhelming. So you might actually remove a little bit of milk before you bring that baby's onto that breast.

There's a, there's a, there's a concept of, um, full drainage block feeding, and people can read a bit more about that. There's an article, um, in one of the journals about potentially even fully pumping, draining the breasts as much as possible before starting block feeding in a very extreme situation. Um, and obviously some people are even managing oversupply with, with herbs and in some cases even medication when it's very extreme.

Um- Yeah ... gosh, that's a lot of ... You've got a lot going on there, Emily. I mean, with the- Lots of little things ... with the DMER and the overproduction and the clamping and the tension, there's so many things that you're challenging, that are challenging. Um, can we talk a little bit more about the OCD? So you talked about how it focused on your milk.

Mm-hmm. Was, was there anything else at the same time going on? 

[00:50:15] Emily: So one thing that I ... OCD evolves, and it moves, and as soon as you kind of get to grasp with one element, it kind of throws another one, one in the background. And my OCD at the time was very feeding focused. It was very about the feeding. But something that I didn't understand, um, and that I still kind of battle with sometimes is actually that my OCD told me that, um, the blood transfusion meant that my milk was contaminated.

[00:50:44] Emma Pickett: Oh. Um, 

[00:50:45] Emily: so the only way I can describe it, and the way I described it to the wonderful Michelle, was imagining sort of a bowl of clear water, and then you put a drop of dye in it, and that's, water's contaminated now. And in my head, by having somebody else's blood- By having that transfusion, it wasn't my milk anymore.

My milk was contaminated. So again, it compounded that idea that not only am I giving her all of this extra lactose and, and hurting her, but this was a very strong idea at the time for me, was my milk was poisoning her. And I also experienced what can be really, really common aside from OCD, um, and is a really, really normal thing to happen, um, is, is a lot of intrusive thoughts.

So I mean, roughly 50% of women experience intrusive thoughts outside of pregnancy anyway, and that was something that was became very prevalent for me. So for example, for a long time, I couldn't walk near stairs while holding Effie because I was absolutely convinced I was going to throw her down the stairs.

And then it kind of grew, so I couldn't near a wa- go near a wall because I was absolutely convinced I was gonna hit her into this wall. Um, so my brain was fully convincing me that I was going to hurt my baby that I loved so much, and it wasn't a, it wasn't a question of, of how much I loved her. It was that I loved her so much that I was terrified that I was going to hurt her.

So that became then very limiting for me because there was only a certain n- number of spaces that I deemed safe as such in the house. And, and again, through lots of support, I now understand that actually I was, I was never going to hurt her. I never will hurt her. But like we kinda said earlier, it's that absolute fear and that seeking some way of gaining control to, to take that control back and, and the only way I could do that was through controlling where I carried her.

So not being near walls, not being near stairs. Um, and yeah, controlling contamination and things like that. So things I touched, things she went near. 

[00:52:41] Emma Pickett: Emmie, I'm so sorry. It just sounds, it really, really tough- ... for sure. Just understatement of the century. Um, just a quick question before I ask you about meeting Michelle.

Um- Mm ... but you're still breastfeeding despite that feeling of contamination. I am. I am. Um- There was just, there was not a part of you that said, "I'm gonna fripping buy formula. I'm gonna..." I- is that because formula could be contaminated too? Yeah. What, what, what was happening? That, 

[00:53:02] Emily: that, I think that's the thing with OCD, is that it's a lose-lose scenario because your, the logical answer would be, "Okay, we'll do, we'll do this then."

But then, then my brain went, "Oh, but then I'm poisoning her with, with X and Y and Z." And so I think that's the, the ultimate answer to OCD. Y- y- you can't win with it. It will always find a way to convince you that you're, you're mad, you're bad, you're dangerous. Um, but yeah, so that was my experience, was, was that if, if I go formula, then I would risk various infections, um, that I would cause her pain, discomfort.

So yeah, I was convinced that, um, if I even expressing by bottle, I, I wouldn't pump and give her it by bottle. I, I only ever fed her off my breast. 

[00:53:43] Emma Pickett: Because the bottle might be contaminated But yeah, something might 

[00:53:46] Emily: be 

[00:53:46] Emma Pickett: contaminated Okay So it's very trapping Yeah, that's the, that is a word you can definitely see-

fits here. Um- Yeah ... so some of the things you're describing, and I obviously I'm not a mental health professional, but some of the things you're describing are probably under an umbrella for other kinds of postnatal- Yeah ... mental health stuff Yeah. 

[00:54:03] Emily: And absolutely, I think pregnancy and the postnatal period is something that w- with lots of conditions, you know, things like diabetes, high blood pressure, if you've got a slight vulnerability to it, pregnancy and having a baby will, will push you over that ledge.

So I already had sort of a vulnerability to various mental health problems, and it definitely pushed it, pushed it further 

[00:54:23] Emma Pickett: Okay. So are people around you are saying, "Come on, we need to get some help now"? Yeah Or did you think, "Hang on, this, I'm, I realize now I'm stepping over a line"? 

[00:54:32] Emily: It, um, I think I'm an advert for continuity of care because it was because the people around me providing care knew me that because I, I would lie.

I, I would tell them that I was fine. I would ... And as a midwife, I know how normal intrusive thoughts are, and I know that they don't mean that you're gonna hurt your baby. And, and that's something I'd, I'd say to, and I'd say it now to everyone, if you're having thoughts of, of, of hurting your baby, talk to someone.

Get help because you'll convince yourself that you're this awful person. So, and I would lie. I would say, "No, no, I'm not having any thoughts like that." But they knew me, and they knew that I wasn't okay. And so yeah, it was, it was the, the people around me, the, the midwives and supports, like, around me that said, "No, you, you need to get some help now."

And I was very reluctant. And I, on my first ... So I eventually accepted a referral to the, to the perinatal mental health team who had a chat with me and then thought that sort of, um, NHS talking therapies was, was the best route for me. And I remember having my first appointment with Michelle and telling her, "I'm not that keen on doing this.

I've had talking therapies before. It didn't work." And I went in, and she, she held her own because I went in very determined that this was not gonna work. I was not gonna get better. This was, this was what I was. And she managed to kinda create that space for me of, "Okay, well, let's try. Let's see how it goes.

And, and if it, and if it's not helping, then we'll try something else, and then, then that's okay." So I'm very grateful for her persistence with me. 

[00:55:53] Emma Pickett: Yeah. So obviously talking to her and understanding this bully- Mm-hmm ... is part of that story. Massive Are there any other sort of day-to-day things that you have as strategies that, that help you?

[00:56:05] Emily: So when we went through, so I was under, um, therapy weekly for a good few months. Um, and sort of when we came to the end of it, we, we developed, um, what we called, like, a therapy blueprint that has some, some resources for me so that when I struggle I can kind of look to that and go, "Okay, what, what can I do?"

But a lot of it was reframing. Um, so things like the, um- The blood transfusion, we did a lot of work on reframing and actually thinking of it not as a poison coming into my body, but as like healing energy coming into my body. And, and that helped switch my mindset to, you know, actually, th- this blood transfusion has meant that I can care for my baby- Yeah

because I can, I can stand up 

[00:56:43] Emma Pickett: and I can function. Yeah. You may not have had a full milk supply. I mean, that's the other reality. I mean, your oversupply at the m- m- may not have c- you might not have got anywhere near an oversupply. If your- Yeah ... if your pituitary gland had failed and you developed some Sheehan syndrome or something- Yeah

I'm not gonna say that was the likelihood, but, uh, you know, you were, you were certainly in that risk zone. 

[00:56:59] Emily: Absolutely. And a lot of sort of looking at expectations re- uh, versus reality and kind of putting myself outside myself. So going, "Okay, well, if I was caring for someone, if I knew someone who was saying, 'I, I feel this awful sense of, of sadness whenever I feed my baby, and I'm convinced I'm gonna do something wrong,' what, what would I say to that person?"

And actually, what I would say to that person isn't, "You're an awful mother. You're going to hurt her." What I'd say to that person is, "God, that sounds really tough, and you're going through a really tough time, and it's okay to feel like that." And sort of a lot of that reframing. It sounds very simple on the surface, and there was a lot that kind of went into that and a lot of support that went into that.

Um, a lot of unlearning and a lot of relearning how to, how to be kind to myself. 

[00:57:44] Emma Pickett: Yeah, yeah. So you've got kind of midwife Emily on your shoulder kind of- Yes ... talking- Like a little devil ... talking down Or an angel. Um, talk, talk- Or, uh, she can be both. This, the same kind of language that you would use supporting another mother- Mm

is what you needed to say to yourself. What y- Yeah ... that compassion that you've had in your job for many years is the compassion you needed to have for yourself. 

[00:58:06] Emily: Yeah. In the same way, I think, I think a lot of us do for friends, you know. If, if one of our friends was going through something, w- what would we say to them?

And I think it's that same kind of thing, is that actually the compassion that I give to, to women in my care, I, I can try and learn to give to myself as well, which i- is gonna be a lifelong journey, but we- we're getting there. 

[00:58:26] Emma Pickett: Yeah. So you s- you're saying that you've stopped working with Michelle now. How, how are you feeling now?

What's happening now for you? 

[00:58:32] Emily: I have ups and downs. Um, but I think actually the biggest hurdle for me was understanding it. Um, so it still catches me out. I'll still be driving along sometimes and have a sudden thought of, uh, you know, "I'm going to crash the car, and I'm gonna hurt my baby". But I can now learn to catch it and go, "Oh, that, that was cheeky, bully", and kind of suppress it in that way.

So I will always have the intrusive thoughts and that, and that's hard. I will always have those images. Um, and I'm quite like a vivid imagery person, so sometimes I may as well be watching a film of, of harm coming to my baby, and I, I will always have that. But I now kind of have that better understanding that It's not because I'm a bad person, it's just my brain trying to protect me.

Yeah. And that, that is all it's doing. It's my, it's trying to take back control. Yeah. So for me, what's been key is identifying is this an OCD thought or is this an Emily thought? And involving my family a lot in that, so kind of like I said earlier, now, you know, if I say, "Oh, I need to clean this again," my husband will be able to go, "Is that you or is that OCD that needs to, to clean that again?"

Um, and we'll be able to have those sort of, sort of back and forth discussions. Uh, you know, I've had it with the weaning of, you know, being scared to introduce the next thing or introduce the next step, and it'll, you know, be that discussion of, okay, is this, is this you? Are you actually concerned about this or is this the OCD convincing you that, that something bad's gonna happen?

[00:59:57] Emma Pickett: Yeah. So you mentioned that solid food in- introduction had been a little bit of a wobble. Is that- Mm ... just the idea that food's coming now in from an outside world and you can't control what's on that and where- Yes. 

[01:00:08] Emily: Um, it, it came, it came from different sources, a- absolutely. It was the, uh, the control, um, big fear of choking, allergens, um, they're a big, big one for me because it's the, okay, well, you know, i- if this happens and if this happens, and, and my brain will kind of jump from A to Z very, very quickly.

So it'll go from giving her a tiny bit of peanut butter to an image of her very unwell in hospital. Um, and it will kind of skip the, the weird journey to how we got there. It'll just show me the, the scary end result. So weaning w- yeah, was a trigger, I think partly because of that, but also because I f- I, um, found it really hard actually.

I, because I'd been so fixated on the feeding, the idea of her getting, um, nutrition from somewhere else, for some reason I found that, like, a really hard thing to, to grasp of, um, her, her being able to get, get nutrition elsewhere because I became very convinced that she needed, you know, that the boob was the only thing that was gonna be okay for her.

And, and again, it's that OCD. It's saying, "Okay, well, you're trapped because that's gonna cause her harm, harm as well." 

[01:01:15] Emma Pickett: Yeah. 

[01:01:16] Emily: So any sort of change, any next stage always presents a little bit of a challenge for me. Yeah. And, and I have to kind of reassess, go back to my, my sort of therapy blueprint and go, "Okay, what, what resources do I need?

What can I do to help ground myself back, back to where we are?" 

[01:01:32] Emma Pickett: Yeah. Yeah. Sounds like that blueprint is very, very handy. Um, you're going back to work later in the summer. Yes. How do you feel about the idea of going back to work? 

[01:01:42] Emily: I am terrified. Um, but I attended actually a, a talk by, um, Lucy Webber, who I hadn't met until that point- Oh, she's fabulous.

Yes ... she's someone that I've always idolized. Her resources to women. Her return to work webinar. Did you, you did that session? Yes. So I did one of her return to work webinars, um, and found that really helpful. I'm still scared, but, um, I took notes while I was doing it, and again, have to make myself refer back to that, um, just to remind myself and, and sort of ground myself in, in that, because otherwise my brain will convince myself that something else was said, or an X, Y, and Z, and it'll take me on a different journey.

But, um, I'm very worried, but there's, there's a little part of me that goes, "You did love your job", and, and maybe a little bit of, of Emily, and a bit of identity can come back. So there's that bit of me that's going, "No, it'll be, it'll be okay because you, you get to do what you love again and be around amazing women and families and, and get to, you know, be with them through this amazing journey."

But it is largely the, the feeding. I haven't been away from Effie yet. Um, I've not left her to do anything yet. I think it's very hard, especially because she's my first, I think it's very hard to picture the next step- 

[01:02:53] Emma Pickett: Yeah ... 

[01:02:53] Emily: outside of the phase that you're in. So at the minute, I'm very aware that actually other than from the boob, she's not really getting much food.

Um, she'll take little sips of water, but the idea of, okay, I'm leaving her. How, how is she gonna, how is she gonna survive? But I'm ha- trying to remind myself that at the minute she's an eight-month-old baby- Yeah ... and I'm gonna be leaving- You've got a while ... an eight-month-old baby. I'm gonna be leaving a 

[01:03:12] Emma Pickett: 12-month-old baby.

Yeah, exactly. You, you've absolutely got a while, and she's gonna be very, very different at that point. And yeah. Yes. And as I'm sure Lucy told you, lots and lots of people go back to work at 12 months, and- Yeah ... and, and have a fantastic breastfeeding journey that continues alongside that. Yeah. With your history of oversupply, you may need to express in the way that maybe some other people may not need to.

Um- Yes ... but yeah, absolutely, absolutely can work. And, and who's gonna be looking after Effie when you're working? 

[01:03:39] Emily: So I'm really lucky that my amazing mum lives 10 minutes away, and she's going to have her. Oh, lovely. Um, so that's a, a big weight off, um, for me that... Yeah, and I'm gonna go back on, um, reduced hours.

So because we do shifts, um, I can work t- you know, two long, they're long days. We do sort of half seven till eight, um, plus, like we said earlier, you know, potentially staying late and things like that. But, um, my mum's gonna have her, um, while I'm at work. So I'm- Okay ... really, really lucky. That's, that's really special to have that.

[01:04:11] Emma Pickett: Yeah. Um, and what, what would you like to happen with your breastfeeding journey with Effie? What's your kind of plan? 

[01:04:16] Emily: My hope is sort of some nat- like natural term weaning with it, to be honest. Um, I'd like to hit at least two years if I can, and then just be, be very much led by her. I'm very grateful that I've had the support when I've had it, because I'm aware that, you know, with, down the line with, with weaning and things like that, my mood is likely to struggle.

Um- But kind of the, there's power in that sort of predictability with it, um, and that I have those resources that I can put in place. But I'd like to breastfeed until it's not, you know, until she doesn't w- need it anymore. Yeah. 

[01:04:55] Emma Pickett: And chances are your weaning, your weaning blues will be significantly reduced by that.

Yes. So if you do go slowly, um, and, and she p- she leads the pace- Yeah ... you may not find you have any issues at all. Um. Fingers crossed. Well, I will be here unless I'm run over by a bus, Emily. Oh, thank you. Um, a weaning, the weaning conversation is a conversation I have every, every day. So- Yeah ... if you do have any struggles in that department, please, please come back and- Oh, thank you

come back and talk to me. I will. Thank you so much for your time today. I'm, I'm really- Thank you ... really, um, honored to hear your story. Are there any kind of resources that you'd want people to know about if anyone struggled with some of the same sort of issues that you have? 

[01:05:31] Emily: Um, I would absolutely say, um, talk to your care provider, talk to your midwife because they'll know what resources are available, um, in the area.

But for me, um, just One Norfolk, which i- is our, um, sort of health visiting team in the area, I had loads of support from their infant feeding team. Um, but it was NHS talking therapies that, that really made the difference for my OCD. And like I said, you know, in our area, I'm not sure if it's national, but in our area it's until your little one's two years old, you get fast-tracked through.

Okay. So I would absolutely say, um, to talk to someone, but look, look, and you can self-refer. It, it's, so you don't, you know, if you don't feel comfortable with your care provider, you can self-refer, which can sort of take a barrier away for some people that don't feel as, as comfortable with their care providers.

[01:06:17] Emma Pickett: Yeah. Yeah. Thank you very much. Well, very best of luck with the rest of the summer. Thank you so much. And, um, yeah, and, um, yeah, good advert for Lucy's Return to Work webinars. Um. Absolutely, yes. Yeah. She's- That resource as well. Uh, that one. Yeah. She's, she's great. Thank you. Good luck with the rest of your breastfeeding journey.

Thank you.

Thank you for joining me today. You can find me on Instagram at EmmaPickettIBCLC and on Twitter at MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist, and leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast.

This podcast is produced by the lovely Emily Crosby 

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