Apologie production.
Hi, my name's beck Woodbine and welcome to Tenderness for Nurses.
I'm grateful for the person that I have the opportunity to be, so I hit it and parked it for Nelly four years.
We always have free will, We always get to choose. We are autonomous. Afternoon, everyone, Welcome to Tendinness for Nurses. Today we have Becky Cavalaro with us who is a regted nurse, registered midwife. She is a lactation consultant but also a prescribing registered midwife. Becky runs her own business around maternity and lactation consultancy and a few other bits and bobs that we'll get into, and it's called Full Circle Midwife. It's based here in Brisbane. So welcome Becky,
thank you, thank you for having me. Oh my absolute pleasure. Now, how about you fill everyone in on you your journey to be where you are today, because looking at what you've achieved, there's a fabit of study that's gone into your nursing Korea in midw free career.
Gosh, I don't even know where to start. I think the journey started in primary school really, where I knew from the get go that I wanted to be a midwife. There was never another path. It was a genuine calling. So everything I did from my Bachelor of nursing, because direct entry midwif free wasn't available, everything I did career wise was directed towards becoming midwife. I became a nurse first, became a ni natal intensive care nurse to consolidate those skills.
I wanted really good foundations before I did my MIDW free and because I was straight out of high school at that stage for nursing, I couldn't do MIDW free directly. And then went into MIDW three and I loved it and wanted to have continuity of care and do the full scope of practice. So I actually went on to get my mid with free registration in the UK. Oh wow, okay, yeah, which wasn't straightforward at all, but there was a different
caliber of midwife in the UK. Back in you know, two thousand and six, early two thousands there to Australia, and actually my Australian training didn't quite make the cut, so I actually had to come back. I could either redo my MIDW three in the UK or come back to Australia.
So you came back and you did more, so you did your masters here?
Yeah, So I finished my mid with free training, went to the UK. I worked as an inatal intensive care nurse and then came back to Australia to complete further studies so I could get my UK midw free and then worked in the UK as a midwife. But it took me down a research path anyway. It's a long journey, but basically midwife by heart and the path weanded to
research and natal intensive care, nursing and now lactation. So lactation was where things evolved when I had children and I was a full time continuity of care private practice midwife.
What research did you do in the UK?
I was the manager of the Women's Health Research Center at Imperial College London. There was a site at Saint Mary's and Queen Charlotte's in London and supported heaps and heaps of different women's health studies. I guess the interesting thing about how I ended up in research was more of a personal story which I'm happy to share. I had a car accident. I was hit by a car and unable to physically work as a midwife for a while.
It brought me down that research path and yeah, I absolutely loved it, So I very much have I guess the mind, the curiosity for research. I think we really need to contribute to the to the evidence we work from. And yeah, my time in research in the UK was just fascinating, really cool, diverse stuff.
So you're on the International Board of Certified Lactation Consultants. Yeah, is there an Australian Lactation Group or that's who you all belong to.
Yeah, it's an exam. There's a whole lot of criteria to become an IBCLC International Board Certified Lactation Consultant and there's an exam one hundred and seventy five questions, really full on. But it's an international certification gold standard, highest level for lactation. I guess education and support. But that's there's no sort of governing body, that's just national.
What did you have to do to become a prescribing registered midwife?
Got the hoops? I've done through back?
God, isn't it when you become an advanced practice.
Yeah, there's a lot I had to I think it was at least five years experience in the full continuum of pregnancy, anti natal intrapartum, so through birth and post natal experience. I had to have evidence of that. I had to do a prescriber's course. I had to submit what was like I felt like my life to APRA. I actually went into labor the next day after I submitted that, so I'm sure that was a surprised. It was pretty intense. Gosh, declarations or statements of service, all
the evidence. I think that's it. Gosh, I can't even remember.
Was that through a university to do that or was it independent?
So the prescribing course was through Griffith University. Everything else was through APRA.
I tell you what I doing my NPS, my masters was one of the hardest things I have ever ever done.
Yeah, you know, I know a few nps and it sounds hectic. It is so.
Hectic, And then you would have been exactly the same. When we put out my application in to be an endorsed Nurse practitioner. I'm not joking. It was novel, a novel, yeah, and I had collected everything. Oh my god, it just was And you know, I was really blessed. I was accepted really quickly because I think I had so they probably looked at it and went, oh my god, let's just tick, She's got enough stuff. But it was a tome And I know so many nurses now that have done their
masters and haven't been endorsed. Yeah. Wow, just because you do your masters as a nurse practitioner doesn't mean you become an endorsed nurse practitioner.
It really was a gathering of evidence. Yeah, like right through to submitting a philosophy of Midway three, you know. And as much as it was time can assuming, I'm sure you probably feel the same like it's so time consuming, but it really helps. It really helped me reflect and know the why behind what I do, why I do it, where I was going. So yeah, it was great even though it took heaps of energy.
It does, it really does. I had to as part of my MPs because I was dermatology focused. I did a couple of subjects with the Masters of Medicine Skin Cancer course and it would have to have been the hardest subject I've ever done in my life and we had to pass by eighty percent, had to pass the exam by eighty percent. It was stressful. I was the only nurse in that cohort doing that sub or a couple of those subjects. There were twenty five of us
that started. Seventeen of us passed, and I was really poopooed, Like I was given a bit of a hard time online because I was a nurse doing the course, but I was one of the only ones that passed, and probably passing that, I had far more satisfaction than with
anything else. And it was because, you know, climbed mountain to get that, and you know, I had been there was a bit of online bullying towards me being ans and not being a doctor doing those courses, so it felt pretty good, too good on you to pass that at the level I passed it. So I do get the you know, it's a lot of work, a lot of hoops to jump through, and when you get to the end, it is really worth it totally.
And you know, it's so beneficial to me now because I wear two hats as a private practice midwife and lactation consultant, and because I have the ability to give Medicare rebates in the first six weeks as a post natal console that also involves lactation, I'm cost effective, so it's excellent for the women.
So with your Medicare rebate, how much is it like it is for us withness practitioners as a consult like the first one, it's forty plus minutes and we get fifty seven dollars.
Yeah, it's short or long post natally and anti natally. There's a different price for short and long. I think long is over forty minutes. All my consults are hours, and I think it's currently like seventy six okay, rebate for the long, so it's good.
Do you do charge a gap?
Definitely? Yeah, Like I couldn't run a business just bolt build. I have tried through COVID, I did, and thankfully the rebates have actually gone up for women. But I do set my prices with the rebate going back to the women so comparable for lactation consultants without Medicare rebates because there's no Medicare rebates for lactation consultancy at all, none, which is crazy. But you know, there's lots of crazy in the post natal world.
There's lots of crazy in health period, and it is getting it is getting crazier. I have to say, yeah, particularly since COVID. And it's interesting you say that because I did a lot of online consulting and it was all bol Build because I had to shut my clinic because it was you know, face to face as many dermatology. So I just was able to you know, pivot and you know everyone was having skin breakout, stress, that sort of thing. So that was great. It's able to do vaccinations.
It was what like you and I only bolk build.
Yeah, it was crazy time.
It was crazy times. Do you work in the hospital at all now as a midwife, I don't, so full time in your own business.
Oh I love hearing that. That's so awesome.
And the majority of your work now is lactation consultancy.
Yeah, I do see women anti anti natally. Most to the women who find me anti Natalie have a story around lactation. They're planning a head so they'll basically debrief like a birth debrief, like previous birth trauma, and then we plan ahead and we journey together. I know it sounds silly, but it's exactly what we do. And yeah,
most of the people see me most Natalie. So it could be a real acute sort of urgent consult we pretty much need an emergency department for breastfeeding, or it could be someone who's you know, are not in an urgent situation.
How many of the women you see, do you think have had some form of trauma with first Bobby.
I guess there's so many versions of trauma, But in terms of their journey and finding their own voice as a mum and knowing how to trust themselves, most would have some version of a tough time. Maybe not trauma, A lot of trauma a lot, but yeah, a lot of tough times because of how they're treated in the system,
how they have to navigate. I call it an obstacle course to get to the other side of just knowing what they think and feel and their version of it is really valid and almost always or I would go as far as saying always right. They're always right.
So they just didn't trust their art with that listened.
To a lot of the time, a lot of the time.
So why do you think that is.
I think we have a lot of subliminal messages around self sacrificing as mothers. I think we don't even realize that as women. I see it on such a basic level where it's like a woman will come to me with absolutely shredded nipples. She's in so much pain, but she's gritting her teeth through it. She's she's doing it for baby, and you know, good on her, amazing, but also that or latch is going to affect her milk supply eventually, and that's going to be a problem for baby.
Does that make sense? And if she knew that, that would be a catalyst for her to care about her experience, but she won't do it for herself. So getting the women I see to care about their own experience, because it inevitably ends up being important, is a massive part of my job.
How do you get the message out to women that it's not normal to have nipples falling off your chest when you're breastfeeding, or trust your guard if you think there's something wrong with your baby, yeah, when Bobby's in utro, or you know, it's okay to ask the questions or get a second opinion, Like do we how do you go about educating.
Women if I have an opportunity to see them antiinatally, we'll do a lot of talking about that. Certainly, you know, we will reflect on where they've been when they come to me and say, there's been a lot of people saying that looks like a good latch, and they're showing up, you know, in a lot of pain trying to latch. Then you know that is a conversation around why that matters beyond it just being for baby, It actually is
important for her irrespective of her supply. How we get that message out is we support them so they know what's normal and that normal isn't meant to be. It's not easy. No one would say motherhood, pregnancy, birth, breastfeeding, parenting, the whole shebang. It's not easy, but it shouldn't be a self sacrificing journey. And I guess I'd really love to say the women mothers partners valuing what the work
we do as mothers, because it is work. You know, it's a lot of hard work that goes into raising and providing and supporting and being present and doing the things that are required biologically even for our children. But yeah, having the space and the time and the value in the support network around it, whether it's the system or just the community, is essential.
Do you think social media has been a good or bad thing for women's health in some aspects or for breastfeeding or do you think.
It puts.
Pressure on mothers. I know I've had many moms come into the clinic, you know, in tears or going, oh my god, you know this so and so's posted this perfect lunch box on Instagram, you know, and you know, put a little note in it and da da da. Now, I know there were sometimes where my kids were lucky to have lunch, or I just threw five bucks at them as if for God say go get touch shop.
When I was working and starting a business and doing you know, all that sort of thing, and there was huge guilt around that, but there was no social media at that stage, so I didn't have to compare myself to anybody else. Yeah, do you think that impacts mothers? Now? Did they talk about that?
I think there's I think it's such a grief when they feel they should breastfeed and they feel social pressure too, and for whatever reason they can't. It's enormous and so much unnecessary shame. I see some women navigate all of that. I think social media is rble for it. World Breastfeeding Week. Ask anyone who's ever had breastfeeding challenges how triggering that week is. It's awful, but that's the world we live in as well. You know, there's no one size fits all.
I think social media is just a bit toxic in many ways, but hey, I'm on it and it's not you know, we've just got to go go into that just so carefully when we're vulnerable. But yeah, I think the messaging around motherhood and the shoulds and all of that really doesn't have good foundations of support. I think some of the information that's on there is misinformation, totally, totally. Yeah, absolutely,
the Pinterest version of motherhood just doesn't exist. It's awful, and I think, like I said, it's a bit of an obstacle course, it really is. Some women, I'd say they're almost set up to fail in the system because there's just no continuity of care post natally. You know, we kind of have this normalized system of continuity of care through pregnancy and birth if women choose it, which research would say it's gold standard, that's got all these
understood benefits. But post Natalie, you've got to six weeks with someone that you trust, that knows your journey, and then it's like good luck, and it's just begun.
Like, yeah, that's just because it's long.
It's a long road ahead, and yeah, some of the issues are just starting.
So when I had my son at the marta easy delivery two weeks in breastfed like a champion. Two weeks in he stopped feeding. We had a month in hospital the Marter Private Children's would he was nato gastrically fed. Then they took the tube out and he started nuzzling, so we got electation consultant in because I still had milk at the stage. Nuzzled for a bit and then stopped feeding again, so then was nose gastricly bed again. And this sort of went on and off for twelve months.
The kid didn't sleep for three years. And when I say that he didn't sleep, I'm actually I believe him. I'm not exaggerating. He did not sleep. It was easy for me to go to a night duty and it was for him. I remember one morning I just was at the end of my tether and I went down to the Maternal and Child Health Center at win Them even before it opened with this kid screaming and sat on the doorstep far out crying like I was a mess. I hadn't slept. I had a kid that just wouldn't eat,
didn't a drink. No one knew it was wrong with him. The numerous tests, one stage they thought he had neurological problems. They just no one knew it's a big deal. So back then losek could just come onto the market. That's all they could think. It was was this silent reflux. It was really bad, but they they couldn't see it. So I used to have to give my half a tablet low second and liquefiret in water and squirted down
the back of his threat. It was horrendous and look, that helped a bit, but not really, so I ended up. I begged to go into Riverton and I said to her, you gotta do something now, I'm a donkey on the edge. And I was. I was a donkey on the edge, and they put me in for a week. The first twenty four hours I just slept and they looked after Jacob. But even after a week there they could not get that kid. They were able to get him to sleep during the day, at least for a couple of hours.
So my whole day was around getting my two year old to sleep or eighteen months to sleep at the same time as Jacob, so I could lie down and have a rest in the middle of the day. And if that didn't happen, it was horrendous. But what was interesting during that time, so many people going, well, you doing this wrong, and you're doing that wrong, and you just need to let him cry it out and you just need to do this. And you know, it was
the most horrendous time. And I look back now and there's no doubt in my mind I've probably had postnatal depression.
Who wouldn't.
He's the most beautiful, beautiful young man now. But I tell you what, I could have thrown him in the rubbish bin. And I think about all those women who don't have support and who don't know where to turn. And I mean, are there places like Riverton still.
Yeah, there's support, but that fact that's horrendous.
It was horrendous.
What changed did he get?
I had to feed him solids literally from three months of age. We just started to introduce solids after he stopped being nooser gastrictly fed. Yeah. Wow, And that in itself was problematic, and that in itself paused huge comments from people that just should have minded their own business. But you know, I had to take medication to dry my milk up. It was just awful.
That's really full on.
It was awful. And I think about other women, and I just go, wow, you know, I had support.
Yeah, and look, it's to really diverse how complicated things can get. That's refect, But yeah, I see a lot of really complex cases and it's tough when you're you know, babies are born to breastfeed, right, so if there's an issue with that, it's like I like to put my detective glasses on and be figuring out the why behind it, you know, like your story, I'm just like, why, Jacob, what was going on there? You know? But unfortunately we're
not all singing from the same hymn sheet. So you can have support, but your caliber of understanding biological norms and breastfeeding so you know, it is completely different from
health care provider to health care provider. So a pediatrician, a midwi flactation consultant is going to all have completely different lenses on a tricky case of diad, a mother baby diad, And it's hard because it means you end up with conflicting advice and it's just a mind field for the poor mom that's trying to listen to her intuition while just desperately do whatever for their baby. The most vulnerable you'll ever be is then Oh my god, yes, it's full on.
It is so full on. And you know, the one thing I remember from that is this is why I say to people who are bored or don't know what to do, go, do you go and volunteer some time at a hospital or natal center or birthing center or somewhere. Because there used to be this lovely man that used to older gentlemen that used to come in and he would sit with Jacob so I could go and have a shower because Jason was working and he also had Chloe.
My parents were running a farm. Jason's parents were away like everyone had stuff on, you know, and he used to come in and sit with Jacob so I could have a shower, go grab a coffee of five minutes to myself, and then come back up. And he I don't know what it was. He just would come in. He just kept coming in and to this stay, I couldn't even tell you his name, but his kindness has stayed with me, and Jacob's what twenty four now, it
has stayed that gentlemen's actions have stayed with me. And it was just, you know, he was just feeling his day. But I used to look forward to him coming in special and he always you know, he showed up, and then when I was back in hospital, he came back again. To this day, I very grateful to that gentleman.
Yeah, look, I think we kind of understand the power of how we treat women in labor and that well hopefully we understand that. Certainly midwives do. We know that.
You know now that there's been an inquiry in birth trauma and women are reporting that it stays with them and they, you know, are reporting how awfully it feels when they're that vulnerable and not treated with respect and left in the driver's seat post Natalie, Hey show up for a vulnerable mum who's still you know, still birthing to some degree, You're still you're still birthing yourself as a mother. You're still you're still in it. You know.
It's like birth's the wedding day, but breastfeeding, all the post need, all the first two years is the marriage. It's a big deal how people treat moms and families and that's phase. So yeah, like, I agree, I agree.
I I make a point now if I see a mum that's a bit of a donkey on the edge herself and a screaming child, and everyone's looking at them like, go, oh gosh, I can I will go over now, and because say, hey, do you need a hand?
Yeah?
I promise I'm not the creepy person, But do you need a hand?
Yeah?
Absolutely, because they don't need someone to sit. We you know, we're embarrassed as enough as it is, and we you know, no people are judging us because Lord knows, there's no tolerance anymore in our society. Totally, you know, they just need to be of kindness and maybe just a little help totally.
And you know, it hasn't all been sunshine rainbows in my own journey. I've had my I've had significant lactation challenges. Yeah. So I you know, I feel like it's such a privilege to be able to support women in journeys that I have also been through, been on, And I really get it. You know, it doesn't really matter how much
you know or how many books you read. Sometimes there's just an experience that the cards you get dealt can be tough, and how you get supported to deal with the cards you dealt is the game changer.
So did you have feeding issues with one or all of.
You all of them, all of them and really different, and really it's just interesting. I'd say, I'm still on the journey of learning as as I go as a practitioner. It's just such a rabbit hole oral function what shows up in breastfeeding and how that is connected to suck swallow bris than moral function, as.
In, we're talking down the track down the speech, yes, like that speech palette teeth and god, I'm not a dentist, but like the influence of how functional and how well.
A baby breastfeeds or uses their tongue, whether they breastfeed or not is a big deal, is a really big deal.
Interesting. I well, I didn't know that, But now that you say that, it actually makes complete con sense.
Like, yeah, and I didn't even know that. I didn't know that. As a midwife early years as a lactation consultant, I guess the goalposts were a healthy baby that's growing well. You know, someone coming to me for lactation support, it's like exclusively breastfeeding if that's what they want, A mum that's comfortable, a baby that's growing well, and you know, that's obviously great goals to have. But now I know more,
I can see more and do more. And it's actually oral function, and it's such a great lens to see things from because you know, mouth breathing and hear those throat issues can show up via breastfeeding dysfunction because it's oral dysfunction. Not that I know all the answers, but I can certainly recognize when there's a problem better now that I know it. But anyway, going back to my
own journeys, yeah, they're all very, very different. My son, my nine year old, has a tongue tie that was never treated and he grew beautifully, but you know, laid down the track, different sort of issues around his mouth. Do you wish you had a pad for him? I do only but can you do it now? Yeah, totally. We'll need to expand his palette first to fit the tongue in his palette, but yeah, we can absolutely do that.
But the reason why I wish I did it is not because like he's fine, there's no major issues going on for him. It's that I worked really hard to breastfeed him. I normalized the abnormal and self sacrificed.
Okay, so you're speaking from experience when you're talking very much just you know, just got on with it, and you know, we got there, but it was hard. And how long did you feed him for?
It was hard to win? Two and a half years? Yeah. Yeah. And then my daughter, she breast refused at three four months. We managed to somehow continue and then she continued breastfeeding until she was like three, but there was lots of
gut issues there. She had cow's milk, protein intolerance, blood and her who full blown refusal, like your milk is poison kind of behavior, so full on, And I really my heart goes out to every mother I've ever looked after with breast refusal because I can just I know it. I know, and it actually hurt soul of it so much because it just really highlights the primal hormones behind
breastfeeding the whole and just that part of life. Like you hear baby crying, you're just in your body is telling you to do something and you're in battle with your baby. It's just such a nervous system explosion.
So did you develop anxiety? Did you feel yourself getting anxious?
I was absolutely anxious, but I helped, you know, I held too much in. I think I've learned the hard way that it's really important to seek support. I wasn't very kind to myself. I did get support, but I expected so much of yourself. Yeah, I thought I had friends, well meaning friends say if anyone can figure it out, it's you, which was a compliment but also just not what I needed. I needed someone to say, you're a mom,
You're not a lactation consultant right now, like you need support. So, you know, three am kind of phone call to a friend saying, if my baby won't feed. Who was breastfeeding at the time, You're my girl. I kind of knew I was in deep water with the situation, but we got there, and yeah, it was. It was just such a lesson in so many things, but also a lesson in like you can go through hard stuff and it's
a very dynamic journey. It doesn't last forever these incredibly challenging times, whether it's breast refusal or not sleeping for two years, which one hundred percent trumps are that's insane. So yeah, that is my daughter, and then my youngest is really my wild card. He has really given me just like endless humble pie, and we're still on a journey. He still breastfeeds. Actually he's healthy, well but has significant allergies like he's anaphylactic to dairy Oh my goodness. Yeah,
and was just like covered an exma as a baby. Yeah, just a really complex gut situation. He had a tongue tie. I didn't treat it. He was growing beautifully. He had that done it three and a half. So you know, lots of lessons santis hereditary. Are they all familiaral Yeah, so there is a level of genetics behind it. Yeah.
Yeah, And midwives can study to do tongue tie procedures.
They can. There's not many that do, but it's generally a pediatric dentist. It's one hundred specialty within a specialty. Incredibly controversial topic. It is incredibly as we talk about.
I think we leave that one alone. Yeah, you know, you pick your battles, even in podcasting, and you know what, I don't want to go down that at all.
But yeah, lots of eyes wide open in terms of like to treat or not to treat. And there's no perfect answer. And I've had my own journey with that and very different experiences with each child. So same person, different baby, and it's completely different journey.
Can I ask I suppose a bit of a controversial question to you, did you ever consider just going, Okay, this is all too hard, I'm going to bottle feed?
Yeah, yeah, yeah. I had a very memorable moment with my sister who I was telling her how my daughter was rest refusing and she could see it was like time to talk about lines in the sand, and she said, would you think about just expressing and bottle feeding her? And at that point in time where I was, wasn't an option. And I have learned from that like that wasn't very nice to myself. It was really expecting so
much of myself to get through that. And I absolutely take that into how I care for women that there is no like sprint at things. We can tap out and have a little bit of grayness to honor your own journey and get through it. But yeah, I thought it, but I didn't do it.
And how did you respond to your sister in that moment?
I said, stop, Yeah, I wasn't. She knew, she was just kind of she was worried about you. She was very worried about me, and I don't think I received help very well.
So do you think that's a nursing and midwife thing? I truly think it is.
It's kind of sad to say it out loud, really, because that's what I offer, you know, So it's like, come on me.
Yeah, I'm sorry when you said that, I'm just just like, yes, I've said that to myself so many times.
Yeah, come on, bickie, Yeah yeah, yeah, yes, I do think it's a nurse midwife things. My favorite families will look after healthcare professionals. We are.
We beat ourselves up terribly.
We have some really cruel expectations of ourselves and midwives. My god, we're out of OSCO practice past six weeks. Like, stop expecting to know everything about children. It's just really important we put mum hats on.
I'd really love your advice on how mums and showed some tenderness to themselves. You know, new mums, you're about to have a baby, your post bubba and you know you're trying to breastfeed. What is the number one thing you tell your beautiful patients to come and see you or mums that see you.
I like to tell them anti natally, you know, and who knows their journey to get to that point. Sometimes just to get pregnants. Yeah, full on. So there's all of that, but they're usually sitting there fairly heavily pregnant, wondering what lays ahead. And I will say, you know, you're probably popping an eyelash right now. Babies growing a tone out and we're not even thinking about it. You're just doing it. And there's a miracle inside your body
and we're just taking that for granted. But then once that person becomes two people and we have to support that grow that baby on the app side, suddenly there's this loss of trust often for their body being able to do it. So I'd like to try and tell them to imagine that it goes from there to here, and it's just you know that they they're the source. So if they can look after themselves and bring the baby heart to heart and just take a few breaths,
they generally know what to do. But really just getting a mom to understand, like they she grew it, she made a human and it's incredible, absolutely, Like if that's not enough, what is.
Oh wow, I've never that just gave me use because it's so true, isn't it.
Yeah?
We put so much else on it, and yet what a miracle.
We make humans. We can do anything.
My God, I love that. Yeah, I couldn't agree with you more. Thank you so much, my pleasure,