Hi. 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. So join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly about that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk.
Emma Pickett 00:47
Thank you very much for joining me for today's episode focusing on positioning and attachment. And I'm very honoured to be joined today by Maddy McMahon, who is an author, and a breastfeeding counsellor, and a doula, and a doula trainer and a mentor and about 50 other things. Alongside that, I could ask you about tonnes of aspects of your work or we could talk about your books, we could talk about your work with your charity Maddie's Miracle. And I'm sort of aware that I'm slightly overwhelmed by how much influence you have in the world of early parenting, and you've certainly been an influence on me. So thank you, Maddie, for joining me today.
Maddie McMahon 01:23
Oh, you're so welcome, Emma, it's really great fun to be here. Always love having a natter with you.
Emma Pickett 01:29
Tell me about Maddie's Miracle before we get stuck into positioning and attachment because we're going to put a link to Maddie's Miracle's website on the on the show in the show notes as well as links to your your books, and your other work. But I just want to make sure if anyone's going to listen, just to the first five minutes of this tell me about Maddie's Miracle.
Maddie McMahon 01:46
Well, it's one of those accidental charities came about because I was teaching a doula course. And we were all having lunch together one of the days and I mentioned to some of them that I'd always had this ambition to have a boobie bus. Now just to be mobile, with breastfeeding support to be able to get into the places that have no breastfeeding support provision to go to places that maybe did have breastfeeding support groups. And then that funding was cut. And there are breastfeeding supporters who are campaigning to draw attention to that sorry, state of affairs for all kinds of reasons to have a really visible, crazy looking vehicle that would draw attention to
Emma Pickett 02:39
didn't have to have a boob on the roof was that the plan?
Maddie McMahon 02:42
Well, in my head it did...
Emma Pickett 02:45
But not necessarily in real life.
Maddie McMahon 02:49
And it was, you know, we were just having a chat over lunch and then maybe a year later. Sohar who was on that course just rang me up. And she said, Maddie, remember, you know that I told you that my job is charity fundraising. Well, I'm going to set up a charity and I'm going to call it muddies miracle, and you're going to get your baby bus. And I was just dumbfounded. absolutely dumbfounded,
Emma Pickett 03:19
So special. You know, and that's what you do to people matter. You do touch people like that. And they remember what you've said, I know you'll have touch many, many, many parents as well as doulas and, and breastfeeding counsellors over the years, but that's what happens. You touch people and they go away and they act and that's amazing. So what's what's happening right now with Maddie's Miracle. Do you have a bus?
Maddie McMahon 03:40
Well, we raised the money to buy a grubby old van before the pandemic, and then it sat with nothing happening all the way through the pandemic. But during the pandemic, we set up online zoom breastfeeding support with a group of breastfeeding counsellors. So we did that all the way through the pandemic. And then as soon as things got back to normal again. And we'd been busily you know, raising money to get the van converted. It's now an absolutely beautiful little breastfeeding support space. It's got a toilet, it's got a little kitchenette. It's got a rock and roll bed so that we can teach sidelining breastfeeding positions that we can divide it off into two little private spaces for to private consultations, it's got an awning. Wow. It's just gorgeous.
Emma Pickett 04:37
Oh, it sounds fabulous.
Maddie McMahon 04:39
So that's starting to wend its way around the country and will do so if there's anybody listening to this who maybe runs a breastfeeding support group and would like the the bus to come to their locality maybe to to help promote what they're doing to your local population or to backup The campaign or something that you're doing around breastfeeding support in your community, then please do get in touch with maddis Miracle. We also now now have three face to face breastfeeding support groups going on around the country, one in Scotland, one in Bournemouth, and one in North Cambridgeshire. So we're we're starting to push out our tendrils and, and working with registered breastfeeding counsellors and ibclcs, from all four of the organisation.
Emma Pickett 05:30
Yeah, that I think that's really special, that kind of inter organisational stuff. And in some areas where people have peer support, they may just need that extra level of experience and people get access to breastfeeding counsellors, and really experienced breastfeeding counsellor, somebody's miracle, which I think is one of the super special things about it. Not to say that peer support is can't solve tonnes of problems and be really valuable, but it's just nice for people to wherever they live, to be able to get access, and not to have that financial limitation, I know that we should have another conversation about, you know, private practice and, and how not everyone can access that. And we've got issues with, you know, inequality of access. But anyway, thank you for being the inspiration for Maddies miracle and being the brains behind it and embarrassing the name. But you know, I'm so glad that's how it worked out. Because I know you well enough to know, you would never dream of calling it that yourself. And, and that's exactly what it should be called. So I'm so glad that that's what happened. And so I thank you very much for having the brains to do that. That's that's exactly what how it should be called to. So thank you for that. Right. So let's force ourselves to come back onto the subject for today's episode, which is about positioning attachment. And I know you spent many years supporting breastfeeding. Tell me a little bit about your history of breastfeeding support. When did you first start supporting breastfeeding and chestfeeding families?
Maddie McMahon 06:48
I think I signed up to do the breastfeeding network training in 2004. Qualified end of 2005 and started running a breastfeeding group in Cambridge in 2007. And then then it's been a daily aspect of my work ever since. And I was trying to remember this morning when I swapped to become an association of breastfeeding mothers member but I can't remember
Emma Pickett 07:23
I have a feeling that you were already ABM when I came along, because I think when I joined the ABM, sort of around 2006 2007, I think you're already the doula mentor in the organisation. At that point, I think it must have been pretty soon after I was around. So yeah, so quite a long time. I've been maybe a long time. And not only do you support families, but you train other people to support families, which I think really helps with your communication skills. It just means that you've got that extra layer of being able to talk things through and explain things to help other people to explain things, which is why why you're super valuable.
Maddie McMahon 07:56
Well, I was a teacher before all of this birth, the booby stuff. So that sort of comes naturally to me, I hope. And I am passionate about there being doulas out there with good quality evidence based breastfeeding knowledge to be part of our team.
Emma Pickett 08:17
Yep, snap on the teacher thing. It's I think being a breastfeeding is a bit like being a teacher, isn't it? In a way you're, you're supporting someone and scaffolding someone to kind of come to a realisation themselves. And it's a mini version of teaching every day. Okay, let's talk about positioning attachment. Why do we preserve positioning and attachment breastfeeding counsellors talk about p and A. Let's talk let's have a session on P&A. Why do we use two words? Why don't we just say latching or latching the baby on? Why do we talk about positioning and attachment as two separate things?
Maddie McMahon 08:48
Well, I always talk to people about it being dominos, really, the latch to the baby actually attaching on to the breast is the last domino to fall. Everything else has got to be put into place. And actually, I think when we talk about P&A, that's our sort of jargon for something that's a little bit longer because I think there are two peas and two ways. I think there's the mother's posture that has to come first. That's the first domino finding her comfortable, sustainable posture. Then there's the baby's position, How is the baby going to be positioned on the mother's body in order to stimulate those neonatal reflexes that are going to end up with the baby approaching the breast. So that's the first day and then attaching to the breast which is, you know, our prize at the end. And I think that breastfeeding counsellors put such a big deal on being specific about that because when we just talk about latch, then all of the emphasis is on the latch, and I Actually, what that means is all the emphasis is on the baby's head, and none on the rest of the body. And what we know about a baby, is that actually what they want is all of the plains of the front of their body to be firmly velcroed. To that parents body, in order to set up that lovely domino effect of moving themselves towards the breast opening wide tipping their head back and latching on in the optimal way that is going to be effective for the baby in terms of getting milk and comfortable. For the nursing parent.
Emma Pickett 10:41
Yeah. Gosh, I do love that. Two P's and two A's. I hope you've copyrighted that somewhere. Because that's there's a valuable stuff approach.
Maddie McMahon 10:48
It's BSN, Emma, it's BSN!
Emma Pickett 10:50
Oh is it? I've never heard that we used before. Okay, yeah, that a of approach that is absolutely key, isn't it? And we all thought we was focused on what does it look like at the end? And people come in and look at you halfway through a feed and go, Oh, yeah, looks fine. And then didn't see the beginning. So. So you've mentioned a couple of things about head tipping back and plains of body. But give us the 30 second description of what, like the 20 seconds prior to a good attachment look like? What, what's those? If we would making a little video that we wanted to share with the world? What would it look like in those sort of 20 seconds?
Maddie McMahon 11:24
Um well, I think that that would really, really depend on the mother's posture, and the baby's position. And what the vision that most people have in their head still, and the vision that most parents are taught when their baby is first born, is across cradle hold. So they are sitting up straight, that posture is up sitting up straight on their sits bones with a straight back. And with the baby, transverse across their body, in their arms, we all have that Madonna and Child kind of vision in our mind of a cross cradle hold supporting the baby with the opposite hand to the breasts that you're going to be feeding from, or a cradle hold with a baby's head resting in the crook of your arm. And if we're going to be talking to parents about how that baby might approach the breast, that's going to be very parent lead in that posture with the baby in that position. And parent lead in a way that we're going to be teaching them some micro movements, is the baby coming to the breast chin first, from almost from your cleavage is the baby wrapped around your body. So all of the plains of that baby's body touching yours velcroed to you around on your curves? Are you supported so that you know your back feels that you're in a sustainable position? And is your baby well supported? At the level of your breast? Is your baby too high or too low? All of these little micro movements need to be really carefully adhered to because otherwise, things can go wrong. You know, I always say to people, there's nothing inherently wrong with these cradle holes, but there's lots that can go wrong with them, because everything has to be so perfect. And I suppose what I get quite passionate about is that it's like learning to dance or drive or something like it feels at first, like a lot has to be done simultaneously with various parts of your body. And we're trying to teach people how to do this when they've just had a baby. And that's a very interesting time in terms of cognitive ability to learn new skills, the neocortex, our lovely human brain is quite sleepy at that point. And the limbic system, which is the seat of all of our instinctive behaviours is is awake and on fire. And yet what we are doing to new mothers is making them use their neocortex waking that them up to try to to learn how to do this very parent led activity. So that is one reason as a birth doula, when I've seen how instinctive people are during childbirth, and what their brains are doing at that point, that is never made any sense to me that we are then setting them up on often what is their very sore tail end? Or if they've had a caesarean sitting up right so the fold of their belly is over that wound, therefore slowing healing. And why aren't we leaning them back? Back in the same way that often that baby latched on for the first time in the birth room. Yeah. And this, this is the irony. And the thing that really makes me very confused because what I see now at birth is midwives very beautifully facilitating what they call delivery self attachment. baby is born, babies put skin to skin with mother in a reclined position with the baby between her breasts, and then the midwife goes off to write her notes. And when she comes back, usually, the baby has gone Bob Bob Bob, and latched themselves on hunky dory. But then they go to the postnatal ward. And the midwife says to them, oh, no, we don't do it like that. And they sit them bolt up, right and put a pillow on their lap, and teach them cross cradle hold. And this is the first moment of breastfeeding cessation for me that time were suddenly when it's gone from something that felt beautiful and natural. And mother and baby had been feeling competent and happy to oh, I can't do this. This is too hard. Yeah, it's painful or the baby is refusing to latch on.
Emma Pickett 16:27
Yeah, of course, that's you just described that so beautifully. That's exactly right, isn't it? There's there's that room of oxytocin and instinct and then you're expected to go into another room and use a different side of your brain and and if you don't get it right, if you don't know the 10 little tiny things, you know, you're going to be in pain baby's going to struggle, baby's hands will get in the way. And so when cross cranial hold goes wrong, what does that look like? What are some of the pitfalls if if it's not all lined up properly?
Maddie McMahon 16:55
Well, pain for for the mother or parent, I think you know it, there's so many things that can happen can't there, the the baby can be too far across the parents body so that they are latching on nose first. And if you've ever tried to take a big bite of an apple coming down onto the apple with your nose first, you will know that it's very difficult to get a big mouthful. So the baby might end up with just the nipple in their mouth. And if you've ever put your finger in your mouth and felt the the roof of your mouth, the palate just behind your top teeth, you will know it's like an old Granny's washboard up there. So we really don't want a nipple being rubbed on that washboard by a little rough baby kitten tongue that's going to cause pain and damage most of the time, or the baby's coming on to centrally so a lot of times mothers taught or at least they used to be I haven't thankfully heard it for a while, tickle the baby's lips with your nipple. And that the result of that would be that the baby would just then open their mouth a little bit, taking the nipple, and we get what breastfeeding counsellors often call fish lips, then just lips just flange out around the nipple. And again that nipple is not way back in that kind of safe zone where the hard and soft palate meet.
Emma Pickett 18:27
Talking about fish lips. I still I see sometimes still see online people saying that, that fish lips are a good latch a sign of a good latch that that toilet flushed out, which is amazing that that message is still out there.
Maddie McMahon 18:40
Yeah, it's really common, isn't it? I get mother saying that to me all the time or something must be wrong because the baby's top lips not flushed out.
Emma Pickett 18:48
And what um, what would you want to look for in lips when you're when a baby's attached?
Maddie McMahon 18:52
Ideally, the top lip is neutral. And again, I'll go back to the to the apple, you know if anyone's listening to this and they really want to try and get a sense of it. Go and get an apple and try and take the biggest bite that you possibly can. And what you'll probably find hopefully, is that the your bottom lip is flange out. Your top lip is neutral. It's neither tucked under or flange and folded out.
Emma Pickett 19:17
Yeah, yeah. And sometimes I say to parents actually ideally, you can't see lips at all. If a baby's attached effectively and their cheeks are nice and tucked in and they're really close. You won't see lips at all you'll just see a cheek touching a breast. And as you just just one thing to flag up at this point that if a parent has a different body shape cross cradle hold may not be possible at all. I mean if you've got a wide body and perhaps your you know large breasts, your nipple maybe points outwards. You and your you have a short forearm you may never be able to do cross cradle hold so you're immediately been set up for a sense of failure from the very beginning and and someone says oh well why don't you pull your breast across pull your breast to try meet the baby because you can't get the baby to that natural position and we end up in all sorts of messes.
Maddie McMahon 20:03
Then what? So then she has to never have a cup of tea hand ever for her whole breastfeeding relationship that that's just torture to me.
Emma Pickett 20:14
Cup of tea hand! Yeah, I mean, there are obviously there are some parents who want to hold their breasts, I've actually been reading a proof of AJs new book about supporting fat birth. And there's a chapter there about breastfeeding and Phoenicia, Virgo contributes to that chapter. And she reminds me that some parents do actually want to hold their breasts, they do want to support their breasts, but it shouldn't be compulsory, you know, it shouldn't be an option, it should be a choice that should be, you know, things that you can have, you can explore all the options before you necessarily get stuck with one and I, I'm just a bit worried. And I sense that you'd agree with me that if we start with the default, of course cradle hold, people feel stuck.
Maddie McMahon 20:51
That's right, you know, if you've got quite low hanging fruit, so that your nipple is pointing down to your lap, then to do the cross cradle hold, you may well have to hike and manipulate your breast to make it look, the way that you might be seeing other women, you know, younger, slimmer, more beautiful, with this kind of idealised beauty myth of femininity, of nipples that point to the opposite wall. But you know, how many of us look like that. And so we, you know, we are kind of giving this false, idealised idea of what a breastfeeding person should look like. And not helping parents to understand that they are a unique jigsaw puzzle, this, this lactating parent, this mother and this baby have never been put together before in the history of humankind. So we may need to create the unique way of fitting them both together comfortably.
Emma Pickett 22:06
So cross cradle hold is often the default, but when moms or parents get home, they may look at some other positions. So I'm not gonna put you on the spot too much. But let's just do a little little run through of some of the other positions that people come up against. So in a minute, we'll talk about reclined feeding, because I'm a massive fan. And I know you are too but let's so cross cradle hold, is using your opposite arm. And but you can't really sustain like that the whole time. You can't use you know, you're gonna have awful wrist ache. And so most people will start cross cradle and then maybe move into cradle, is that something that you recognise?
Maddie McMahon 22:40
Absolutely. And that's really common. And, you know, once you've sort of got the hang of cross cradle, then yes, a lot of people will bring that other arm round and swap, to cradle hold. And I think, you know, if you, if it suits you and you getting on with that position, then again, nothing wrong with cradle hold, it's just usually quite important that you're ensuring that the baby's head is resting on your forearm and not in the crook of your elbow. Because that can restrict the baby's ability to tip their, their head back. And we you know, all human beings, lift our noses just a little bit when we're swallowing to open our throats. And babies are no exception to that. So we don't want to make we want to make sure that the back of their head is not restricted in any way.
Emma Pickett 23:35
Yeah, and rugby hold or football hold. What are your pointers if somebody says to you on the phone, or I want to try rugby hold? How do you describe going about that?
Maddie McMahon 23:43
Well, on one level, it's exactly the same as cross cradle hold, you know, we're supporting round the back of the baby's neck in that C shape with our fingers and thumb in exactly the same way. And it's just kind of working out how your you and your baby fit together. Some people will hold the baby under their arm, like a rugby ball, with the baby sort of more or less lying on their back and lying along your forearm. But other people find actually they fit together better with the baby on their side. But fundamentally, the general guidance of having as much of the baby's body stuck to you as possible, is going to still hold sway with these under arm hold. So you may need to sit forward a little on your sofa or your chair so you've got some space to wrap your baby's legs around your waist.
Emma Pickett 24:44
Yep. And the other thing about making sure you've got space behind you as if you lean back on a chair and the baby ends up having to kind of come in front of you. You're going to get that chin tucking into the chest and there's no breastfeeding position where the baby's chin tucks down on their chair St just, it's just not a chance they're gonna be able to swallow or get that lovely mouthful of breast and, you know, get the nipple back to where we want it to be. And I think when sometimes when people start off with rugby hold, it's all going well, and then baby gets bigger and longer. And very gradually, things aren't working out so well. And, and parents may not realise it's because babies are getting longer and bigger and they're starting to curl around the body. I think that's possibly true for cradle hold. And cross cradle hold too, when babies are very tiny, doesn't it's not so hard to hold the weight of them on your arms and hands. You've even got a tummy, that's probably you know, probably your your womb hasn't gone back to its original position for quite a while. You've got little baby a shelf there as well. It's all working out. And then, you know, week three, week four, why is baby slipping off? Why is breastfeeding starting to hurt again?
Maddie McMahon 25:44
And then they start going out and about as well and thinking, Oh, how can I do this without a cushion? It just all starts feeling a little bit more problematic.
Emma Pickett 25:55
Yeah. Tell me about lying down feeding feeding at night? Because I think that's that is ideally something every breastfeeding parent can do, what are your...
Maddie McMahon 26:02
Oh it's a game changer, isn't it? An absolute game changer. I can't tell you how many families and I'm sure you've had exactly the same situation, you kind of you walk into a scenario where you know, you can see these parents that are about to, you know, expire from exhaustion. Sometimes they're even doing things like you know, sleeping in shifts. Yeah, yeah, with one parent watching them while they sleep. It's just and then you you know, you get them into a sideline position for nighttime feeding. And talk to them about the evidence around bed sharing and giving them all of the information they need to make an informed decision about whether bed sharing might suit them or not.
Emma Pickett 26:49
Give them the basis online and link. Yep. Which we'll put in the show notes. Yeah.
Maddie McMahon 26:56
And yeah, absolutely. The next time you speak to them, you know, it's so often that everything has rotated on a sixpence as my grandma used to say, you know, it's just, everything's changed.
Emma Pickett 27:07
Yep. And lots of parents resist it, because they think it's safer to stay sitting up. Yeah. And they end up sitting up on sofas or in chairs and falling asleep holding babies and sitting up sitting in that position. So absolutely. So even if you don't want to co sleep, it is still worth learning how to feed lines. And you can always move babies into another position.
Maddie McMahon 27:29
The absolute torture, you know. It always makes me remember when I had my first baby, I couldn't work out how to sit up in bed. And I couldn't work out how to do it in the chair that I had in my bedroom. And literally the only place I could manage to latch him on was sort of crouched on the carpet leaning against the bed.
Emma Pickett 27:53
Oh, Maddie, that's such an image.
Emma Pickett 27:57
Such torture for about three weeks. And if someone had taught me lying down feeding, and told me that he was actually allowed in bed with me, it would have been an absolute revolution. Yeah, worked out by myself eventually. But you know, could have saved me a lot of pain and distress for a few weeks.
Emma Pickett 28:18
Yeah, gosh, yeah. I mean, so So in terms of basic principles, it's that same head tilt, isn't it used, you want them to be looking up at the breast again, it's not nipples to lips and tickling with lips. It's no ideally, they're doing that lovely head tilt. So when you tuck them a bit closer to your body, they're in that position already with the chin driving into the breast.
Maddie McMahon 28:37
Absolutely. And the same rules apply. Don't say that. You want all of the baby's body to be attached to you. So no, no air between you and low enough down the bed. So the most common issue I have when people come to me and say I can't manage to do it lying down. And when I say well show me what you're doing, the baby is all the way up the head, the baby's head is all the way up in the mother's armpit. So they're just too high up the bed. And as soon as we shimmy the baby down the mattress a little bit. So as you say the baby's got to tip their head up to reach the nipple. It all just fits into place.
Emma Pickett 29:18
And what's your answer when someone says how do I do the other breast? I don't want to put the baby between me and my partner in the middle of the mattress. What do I do about that?
Maddie McMahon 29:26
Well, again, that depends on their anatomy. Some people are able to kind of tip themselves over and offer the other breasts. It's not particularly comfortable. You couldn't sleep in that position. But you could you could actually do it. And then you know we talk about well, you know, if you want to turn over, then obviously you can feed that way but then you know, you need to bring the baby back the other side of you so that the the baby is not between the two parents. When you all settle back down to asleep again. And, you know, we talked about the fact that, you know, actually, parents sleeping in separate beds is not the sign of an unhappy marriage, and that there are times in your married life where separate beds may be a boon to all of you, that other parent is going to get an uninterrupted night's sleep so that they can be useful to you during the day. And actually, for a lot of families, that works out very nicely. Thank you very much.
Emma Pickett 30:30
Yeah, no, I definitely vote for that. And also the top to tail trick that it's possible to switch your pillow to the other end of the bed and feet go the other end. So your your the breast on the outside of the opposite breast that can that can work for some people as well. So when someone's feeding, how do you answer the question? What should it feel like? Should it hurt? What's what's normal in terms of how breastfeeding feels? Well, it's a big sigh.
Maddie McMahon 31:01
Well, it's because it is. It is such an enormous subject that is so emotional. out there.
Emma Pickett 31:13
Yeah, people get very angry if you don't give the answer that they feel is the answer.
Maddie McMahon 31:18
Yeah, that's right. And I just want to read you a little something that I wrote on Facebook a few years ago, because I got quite frustrated. And you know, as is my want, I had a little Facebook rant. And I wrote, The breastfeeding myth about pain being normal is a tough nut to crack. It's common because women haven't grown up learning how to latch your baby. And because skilled support is often lacking, but evolution didn't intend it. Please don't tell people that it's bound to hurt. It makes people who never have sore nipples feel like people think they are smug lawyers, and stops people in pain reaching out for help. There's always a reason for pain. And it can almost always be resolved. Please help us spread the word. And I got so many replies to that telling me that breastfeeding pain is normal. And that nipples have to toughen, toughen up and get used to breastfeeding. And that pain for a few minutes, a few hours, a few days, even a few months is a normal part of breastfeeding. And I got inundated with stories like they were just coming. You know, I had hundreds and hundreds of messages. And you know, from people who said, Well, you know, I just had toe curling pain for a few weeks. It was bleeding. There were cracks and blisters and mastitis, but then it just magically went away. So it must have been a normal part of breastfeeding because I didn't do anything to fix it. Yeah, yep.
Emma Pickett 32:56
When if I've ever said breastfeeding shouldn't hurt, I get absolutely jumped on by people who feel dismissed. And I can understand if so if someone's told them, breastfeeding should hurt water betrayal to discover that someone who's you know, breastfeeding support professional doesn't necessarily feel that's the case.
Maddie McMahon 33:13
That's why they what they what they hear from us, is a message that we're that they're doing it wrong.
Emma Pickett 33:19
Yeah. You did it wrong. And if only you'd been clever enough to find the right support in the early days, you'd have been pain free. Haha, we've got the magic you haven't. So I can I can understand why, you know, we perhaps in the smug ones, but then also if you do say pain is normal. I've also worked with moms who are worried when it doesn't hurt. They actually think that maybe the baby's not doing it right. Maybe the milk is not coming properly. Maybe it's too soft or gentle and the milk is not being transferred. And I've even worked with one mom, I remember who was in pain. We corrected things. We improved a lot. She was pain free, and she was very disconcerted about being pain free. Because she actually thought that this can't be right. You know, surely I meant to feel more than this. This can't be right. So that took a lot of unpicking. I talked about a stretching sensation being normal. What do you say in those first few days?
Maddie McMahon 34:11
Yeah, well, I do say that. Most of us are not used to our nipples being stretched and in somebody's mouth. I mean, many of us will have experienced that as part of sexual play in our life, but not for many, many minutes. And many hours of every day for work day after day, week after week. So there may be a sensation that we might need to get used to. And in the really early days, I think that some babies you know, as both of you were learning, you know, we always talk about mothers needing to learn to breastfeed but actually although the babies born on, you know, with a biological urge to latch on and is hardwired to cycle, they're still got to perfect their technique in the early days. And so I meet a lot of people where the baby is what I call spaghetti sucking them the nipple in, in the early days. So I think sometimes there's a kind of how cool oh, no, actually, that's okay. You know, as the baby really draws that nipple in over the hard palate, and into that safe zone at the back of the mouth, and the milk starts flowing and you get that lovely rythmics sucking, going, then the discomfort disappears. So transitory I think is a really good specific word. And crucially, it shouldn't lead to damage. So we're going to look at the nipple, when the baby comes off, what shape of it is it? Is it nice and round and plump, your normal nipple shape, it might be a little bit more erect, because there's been some negative pressures, a vacuum in the baby's mouth, but it's not going to be squished flat, or the shape of a new lipstick, and definitely not going to be covered in blisters, or even goodness, bleeding, that that's not what we want. And that is not an normal physiological response to lactation is not what Mother Nature intends for us. Yeah.
Emma Pickett 36:37
And transitory in terms of the beginning of a feed the first kind of few seconds before the baby starts transferring milk and, and transitory in terms of the first few days, I mean, how long would you say is not isn't common normal experience?
Maddie McMahon 36:49
Well, how, how long is a piece of string, but I think that if I always say that, mothers and parents, they know these things inside them, and when we put numbers and rules onto things, actually, then that can be it can make things even more difficult for people. Because if if we sat here as to, you know, breastfeeding experts in inverted commas, and saying, If you experience pain for longer than three days, then something is wrong. Well, then, there might be people who put up with pain for three days when actually they could have seen one of us on day two and got it sorted out. Yeah, good point. So how about saying, if this discomfort is causing you distress? Get some help.
Emma Pickett 37:38
Yeah. And that could be our one not not waiting for day five. Yeah. Yeah, that's a good point. Okay, let's talk about reclined feeding, reclined feeding, laying lying back. There's so many words for it. People talk about biological nurturing, natural breastfeeding, reclined feeding, what do you tend to say?
Maddie McMahon 37:58
I tend to talk about laid back. But I also talk a lot about snuggled down. By the look of you, that's exactly what you're doing now on the sofa.
Emma Pickett 38:12
Are you saying I'm slouching? I am? I'm slouching on my sofa. Yeah.
Maddie McMahon 38:15
Yeah. Well, you know, I, I mean, I don't know whether you find yourself having these conversations with pregnant women. But as a doula, no, there's a lot of conversations about forward leaning positions and upright positions to encourage the baby to be in a good position for birth. So I also have the luxury of being able to say to people, a lot of people, now you can slouch. Now you can get into that lovely reclined position on the sofa that that you would naturally get into if you were going to snuggle down and watch a movie, feet up and on your sacrum. So I think interestingly, there are some people that if you say lean back, or you know, kind of reclining yourself on the sofa, they will sit back just a little bit onto their tailbone. And if we sit on our tailbone for too long, we get a number that's very uncomfortable. So if people don't know what their sacrum is, the sacrum is that flat bit right at the bottom of your back or at the top of your, your bottom. And if you're leaning back on that, if you're sitting back on that, then you will feel very, very comfy and you won't get a number and you'll be leaning back at about a 45 degree angle.
Emma Pickett 39:32
Okay, so you're leaning back, and where is your baby going to arrive? How are you? How would you talk this through with a parent in terms of how to then bring the baby with all those A's and peas?
Maddie McMahon 39:44
Well, I tend to try not to be too directive, because actually, there are all of these wonderful parental instincts at play, aren't they? So you know, I might ask more questions rather than tell them what to do. What position would you put your baby in, if you're going to pick your baby up now to give them a cuddle? And when they do, they tend to put their babies on their chest, with their, you know, their baby's head, somewhere between their breasts, and their baby's feet pointing down to their thighs to their lap.
Emma Pickett 40:22
So it's kind of the opposite message to the kind of cross cradle hold stuff, isn't it? So. So the cross cradle hold is angles and millimetres and put your fingers here and not you've put don't put your hand here. And then recline. Breastfeeding is just like, hey, you know what? The back? What do you know what feels right? Just kind of have a go? I mean, do you want to do want to shake your breast a bit? But that might be okay. Did you want to, you know, what are you going to hold the baby's body do and put your hand under their bum and you want to hold the you know, it's just there is a sort of mutual working it out thing, you're tapping back into that, that first feed golden hour post birth stuff on you. And that's right, absolutely. And the baby's instincts. It's not just that the mom who's got the instincts, those positions tell me about how those positions helped the baby to tap into their natural instinct. Well,
Maddie McMahon 41:08
I mean, they apparently they were around 20 primitive neonatal reflexes that can be switched on with the baby in that what the boffins call ventral ventral contact. So, chest to chest, belly to belly, so the front of the parents body, all attached to the front of the baby's body. And, you know, I tend to talk to parents about there being some rules of thumb. So if you're leaning back enough, and you put the baby on your front of your body, in that kind of cuddle position, then gravity will be your friend. Whereas in the cross cradle hold gravity as your enemy, you're having to, to hold the weight of the baby up to the, to your breast with your arms most of the time. So in the laid back position, you could almost feel like you can take your hands off your baby, and your baby will just be attached to you with gravity. So it's that so we want the baby on top. And we don't want the baby kind of rolled to the side. We want all of that baby's chest and belly to be velcroed. To you, but whether the baby is straight up and down your body, or diagonally with, you know, head, sort of at breast level, and feet pointing to your opposite hip. That's okay, too. And actually, Suzanne Colson, who did all of the original academic work around this labour position, which she calls biological nurturing, she says that the baby doesn't actually have to be attached to the parents body, the baby could be lying on a pillow next to you. The point is, is that the baby is in contact the front of the baby's in contact with a firm surface so that those reflexes are switched on.
Emma Pickett 43:10
So if you're in a labour position, and you've got very large breasts and a nipple pointing down, or you don't feel you've got much lab space, are there any particular suggestions you might make in that situation?
Maddie McMahon 43:23
Well, it tends to find that the more you lean back, the more your nipple starts to face the ceiling. And so that worry of your nipple hanging down to your lap when you're sitting up straight, more often than not begins to disappear, the more you lean back. Yeah, and you've got more of them. And so that means that actually you are making more space for your baby to find the nipple and not having to kind of borrow around down there. To find the nipple and latching them or not being able to see over your breast what's going on, down there on your lap with your with your nipple and your baby.
Emma Pickett 44:07
Yeah, I think one of the things that I find when I do talk to a parent about lay back is, is if you've been so used to all that sort of directive control stuff, it can feel a bit scary sometimes to almost, especially if you've had pain in the past or any nipple damage in the past, you sort of let baby take the lead can actually feel quite scary. If you had that experience working with
Maddie McMahon 44:29
Yes, absolutely. Especially if them if there are damaged nipples in the equation right now. And I suppose that I talk very calmly and gently about them the theory of what's going on here. And what we're what we're hoping to achieve in terms of allowing the baby to use the skills that they've been born with, in order to achieve a latch that is going to be much more comfortable for them. We can Aren't promised pain free if there's damage on the nipple, but we can hope that it's going to be much more comfortable. And then those nipples are going to be able to heal if we achieve a good, optimal, comfortable latch. So there's lots of gentle talking, and maybe some suggestions in terms of helping her get into a comfortable, sustainable, leaning back position, cuddling the baby, talking about how lovely is that now that you're leaning back and your babies in this position on your body, you can see your baby's face, you can look into your baby's eyes. And that's going to help your oxytocin flow, which is that lovely love hormone that's going to squeeze out of your milk. So your baby's going to get more milk when they latch on. And we're going to talk about how clever your baby is, look, already, they're moving around on your body they can smell and see where this milk is going to come from. Look at this, what these wonderful movements that in the cross cradle hold seemed to be movements that were getting in the way of getting the baby latched on, now we can see what they are for these reflexes, these little movements of the hands and feet. And the bobbing of the head, little work woodpecker bumps across the body to find the nipple. So I think, yes, there's some tension. But we talk about dropping the shoulders, taking some lovely deep breaths, and allowing the baby to do their thing. And actually nine times out of 10, it's nowhere near as bad as they think it's going to be allowing the baby to kind of you know, rummage around by themselves on that damaged nipple. And then she might need a little bit of support for to work out how how this baby's head is going to be supported, as well. So most of the time in a laid back posture, the baby's head ends up being supported by the parents upper arm. And so that arm on the side that they're feeding from, may need to be a little straighter. If we have a bent elbow, then the baby can Bob across our body, and sometimes overshoot and fall down between the mother's side and this open elbow. So if we bring our arm in a little bit closer to the side of our body, straighten it a little, and maybe put a cushion under the elbow, then it's like in the bowling alley, you know when you really rubbish bowler like me.
Emma Pickett 47:53
Yeah, me too. I always talk about guardrails. I don't know if that's the right word. But yeah, that's about that. That is exactly what that arm is doing.
Maddie McMahon 48:00
Yeah. Yep. And then yeah, and then yeah, so we were just helping them come together in a comfortable way. And, you know, asking, asking that parent, you know, what feels most comfortable, the baby straight up and down you or diagonally across you. And that's going to depend on the parents anatomy and the size of the baby and personal preference. So we can do some little tweaking currently along the way.
Emma Pickett 48:31
scenario that happens quite a lot to me. And I wonder if you recognise it as somebody was doing cross cradle or rugby. They're not it hasn't been going well, we do a session we work on reclined lay back feeding. It's a fantastic positive, wonderful feed. And then just at the end of the feed, the mom says, Oh, my God, this is amazing. This is fantastic. But hang on, what would I do if I was outside the home? What would I do? If I was in a cafe? I can't I can't do this in a cafe. Well, how do you answer that question?
Maddie McMahon 48:58
Yeah. Well, it's interesting. I think that the answer to that question depends on where you are. If you're in a breastfeeding job in and you know, working with breastfeeding counsellor, peer support, or something, the likelihood is that you've just taught them how to do this laid back position in an upright chair, in the same kind of chair that they will encounter in a cafe or a restaurant. So the answer my answer in that situation is, well, you're already doing it. This is out and about. You're doing it.
Emma Pickett 49:34
If you stick your legs out in front of you, you can recline on the world's worst upright office chair.
Maddie McMahon 49:39
It might not be the most comfortable feed in you know in the history of your breastfeeding relationship. But you can optimise it you can shove your coat behind the small of your back to give your self a little bit more support back there, and putting your feet up can really take so much strain off your lower back So if you're in a cafe, often Cafe tables have a bar between the legs, which you can use as a little footstool, or the bottom of your buggy, or even, you know, I've had clients just throw their changing bag on the floor and use it as a footstool. And that that can really make you feel more secure. Like you're not getting your bottoms not gonna slip off the, the, the edge of the chair because to do laid back in a, in a kind of dining room chair style chair, you do really need your bottom right on the edge.
Emma Pickett 50:32
Yeah. And what about sort of concerns around modesty or previously, I guess that that laid back baby bobbing phase. And having that skin to skin for some parents does feel a little bit difficult to imagine doing that in public and your typical breastfeeding clothing with your little zip that exposes just isn't exactly super friendly in terms of reclined feeding any tips of someone who's worried about that?
Maddie McMahon 50:54
Well, I mean, I would say that, you know, I always say to people, that your baby's not going to be bobbing around for ages, you know, they're going to get really good at this, like, really good. And so it will be a split second. And, you know, you're you're in a much more hands free situation, if you're leaning back. So you've got the opportunity to use a hand to adjust, you know, a pashmina or something over your shoulder. Yeah. And of course, you know, that leads on to conversations about, there's personal modesty, and then there's the worry of what other people are going to think. And hey, how about, we introduce this idea that what other people think is not your problem?
Emma Pickett 51:45
Yeah. Yeah. Amen to that. And sometimes it's it's worries in pregnancy, about what to say, when actually get out there, and you've got your baby and a baby needs to feed. It's amazing how you can feel differently about in that situation. When you're having antenatal conversations, do you? Do you talk about that? Right, laid back positioning from the very beginning? What how do you sort of handle things? antenatally? And do when someone says, oh, well, you know, surely I have to sit up right now to have a breastfeeding pillow. And what breastfeeding pillow should I buy? How do you kind of have those conversations antenatally.
Maddie McMahon 52:15
So we always have a play with dollies. And just sort of talk about cross cradle and how they might be taught they're in the postnatal ward, and how that feels to them holding I have a weighted dolly. So how does that feel holding that in, you know, all six pounds of it in a cross cradle position? And how does it feel now that you're snuggled back down on the sofa, with the baby on your chest, that can really help to get a message across? When I also just I think it's useful for people to know a little bit about history, you know, always whether we're talking about birth or infant feeding, people being able to put themselves in their historical and geographical context can be really, really useful. Because we can think that something has been the way it is now forever. And that laid back positions over this newfangled thing. But actually, if you look back at old paintings, you can see that we've only actually been feeding babies in cradle holds since we've been wearing corsets. And if you think about it, if you're sitting bolt up, right with a corset, so that you can't slouch, then the space between your nipple and your lap is very small. So the only way that we could actually fit a baby into that space is by posting them in sideways. But as soon as we lean back, we open up the space between our nipple and our thighs. And then we have this enormous, I call it a table to put your baby on. And that is nature's feeding cushion. Yeah, yeah. After we've had a baby. It's soft and pliable. For a reason Mother Nature has a reason for everything. So there's nothing inherently wrong with breastfeeding cushions. Again, it's just that there's lots that can go wrong with them. And I'm sure that you see it all the time as well with babies slipping down between a cushion and the parents body. Or the cushion bringing the baby up way too high so that the mother's having to wake her breast up to reach the baby.
Emma Pickett 54:48
You know, or a tall parent with a long torso hunching forward to get to the breastfeeding cushion. And yeah, for sure.
Maddie McMahon 54:56
Yeah, absolutely. But it doesn't mean you know If you've bought a kitchen doesn't mean that you've wasted your money because it can make quite a good lumbar support. So, you know, swish it around and put it behind you. And often they'll come round and give you good elbow support, as well. So that can be really useful. And then, you know, when the baby is learning to set, you can put it behind them and you'll find uses for it.
Emma Pickett 55:21
Yeah, yeah. Yeah, big cushion. I think there's made us think that everyone has to use a breastfeeding pillow in the same way. But there's, there's so much variety about everything to do with with feeding babies, for sure. So when babies are getting older, and, and breastfeeding starting to hurt again, if someone's coming to sort of eight, nine months, and they're talking about breastfeeding being painful, is there anything that that's often behind that or conversations that you're regularly having?
Maddie McMahon 55:47
Yeah, and I think, obviously, all breastfeeding counsellors, when we start a conversation, we don't want to jump to conclusions or make assumptions, we want to take a full history. And so you know, one of my first questions will be well, how have you been feeding Heather to show me what's going on? And then we can look and see what what might need tweaking. And maybe you I think you mentioned it earlier, you know, babies growing longer. And we think we're holding the baby in exactly the same way. But actually, the baby's grown all the way across her body and is coming in, knows first now. But we also just talk about the developmental stage of the baby. And whilst newborns might have been very happy to have been cradled in arms in some kind of crossbody position, now maybe they're starting to feel like they want to explore the world and be a little bit more autonomous. So they might want to sit on our lap, or try out the laid back position for the first time. It's not just for newborns, it can be absolutely brilliant for bigger babies and toddlers to fit in in that position. So, yeah, I think it's just about working with both of them and even asking the baby, what do you want to do now? Let's, let's explore an experiment and see what you're going to prefer.
Emma Pickett 57:18
Yeah, I love that. We've got we've got two clients. Yeah, absolutely. always true. Thank you. And, okay, so, I know we're coming up for an hour and we could do another hour on this, but we really should gently come to a close at some point. Tell me about some of your favourite resources where where do you often find find yourself signposting? What are your tabs on your on your computer saying?
Maddie McMahon 57:38
I love breastfeeding.support. I think that's a brilliant website. And it's kind of like the modern Kelly mom. You know, it's encyclopaedic. Yeah. So that's a that's a go to, obviously the ABM website. There are some really great things about the ABM website. I love the grandmas leaflet, you know that something that no other breastfeeding an organisation had thought of doing. And is really important because the social pressures on breastfeeding initiation are, are enormous. And the impact that grandparents can make for good or ill is massive. And I'm going to do a little personal plug here. So my other charity is Cambridge Breastfeeding Alliance. And we have a really brilliant Resources page. But in particular, as we've been talking about laid back, nursing positions, we have some beautiful photos, that we've taken a whole gallery of photos all the way through the process from the baby, being put on the on the body, parents body all the way through to latching on and feeding well. So they're, they're a really great resource for parents and for breastfeeding supporters.
Emma Pickett 59:04
Brilliant. Thank you. I quite often mentioned Nancy Moore Bakker and her Natural Breastfeeding YouTube channel. I don't know if you find that helpful as well.
Maddie McMahon 59:13
Yeah, yeah. And that's one of the resources on our website.
Emma Pickett 59:17
I'm going to go and have a look at your website right now. Because photographs are gold dust of really good laid back positioning. And it's and parents don't often recognise themselves in the fancy charity pages, but I have every confidence that your pages are going to look real and and will help parents to feel engaged and recognise themselves in those. Thank you.
Maddie McMahon 59:36
She was a real recipient of Cambridge Breastfeeding Alliance support, and wanted to volunteer her services for a photoshoot so
Emma Pickett 59:46
brilliant. Thank you. Thank you very much for your time. Maddie, that is so appreciated. I have enormous admiration for all the work you do and I was just telling someone the other day to go and train with you on the developing dude was cool. So I know what an excellent training course that is and, and as you say, doulas do so much but if a doula gets the feeding support right, what a what an absolute gift that is to a family and and you know, just a fantastic start to their feeding journey. So thank you to you and and a shout out to all the doulas that new feeding support.
Maddie McMahon 1:00:19
Oh, thank you so much. Well, we have just changed somebody who is absolutely inspired to go on and be a doula because she had your support when she had her baby. So
Emma Pickett 1:00:29
Full circle. Thank you. That's really good, too. Right. I'm gonna let you go. And we'll put your details in the show notes so people can find you people can find Maddie's Miracle, people can find Cambridge Breastfeeding Alliance. People can find your books, Why Mothering Matters, Why Doulas Matter. And learn more about what your work is. Thank you so much, Maddie.
Maddie McMahon 1:00:48
You're so welcome. Thanks, Emma.
Emma Pickett 1:00:55
Thank you for joining me today. You can find me on Instagram @EmmaPickettIBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist, and leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media.