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 am very excited to be joined by one of my favorite lactation consultants in the world, Joanna Sargent, who is based in Switzerland, originally from Australia. The last time we met Joanna, we were having dinner together in an Italian bistro. Uh, so they're not called bistros in Italy, are they? What are they called?
Trattoria in Bologna. Um, tell everybody why were we having dinner together in Italy.
[00:01:10] Johanna Sargeant: I know, and it was the first time, that weekend was the first time that I met you, and I was so thrilled to meet you. We were both traveling to speak at a IBCLC day in Rimini, and they hooked us up together. We were the only two speakers there, so I think it was lovely to actually have that really quality time together and to properly get to know each other and to see each other in work.
I think that we probably know a lot about each other's work and have never actually made real person-to-person contact. So we had a wonderful time.
[00:01:50] Emma Pickett: Yeah, it was a seaside hotel. It was all... Everyone else spoke Italian. Obviously, there were some people speaking English, but, um, we were the, the two main speakers, and we all did it, we all did it all through translation.
So all the sp- people we were talking to had their little headsets on. Felt like we were at the United Nations. Um- ... and one of the things you talked about was what we're gonna be talking about today, so that's why I pounced on you and said, "Can I get you to talk about SNSs?" But you could have talked about 100 other things, 'cause I know you've got a lot of expertise and, and you've talked at the Gold Conference and, and you talked about several things on the weekend f- for all the Italian folks.
But it was, it was really lovely to get to meet you in person and then talk to you. Tell us a bit more about who you are. So I basically said, you know, you're in Switzerland, you came from Australia. What's your story? How long have you been doing lactation consultant support, and what's kind of a typical week for you?
[00:02:35] Johanna Sargeant: I've been living in Switzerland for 15 years, and I've been doing this work, um, for about 11 years now. I have a private practice here working alongside a gynecologist and a postnatal psych as well, which is a pretty dream setup, I think.
[00:02:53] Emma Pickett: Yeah, that's, that's a special combo.
[00:02:55] Johanna Sargeant: Very, very nice. Yeah. I, um, I'm working, I would say 75-ish percent, and the other 25% I am a writer as well, so I'm, like, creative writer, do my, working on my novel at the moment, and-
[00:03:09] Emma Pickett: I got to hear about your novel when we had dinner, but I don't wanna spoil anything 'cause when it comes out, we can talk about it again.
Um- ... but it was very exciting hearing about your novel with a little bit of a breastfeeding subject. No, I mean, obviously about lots of other things as well, but-
[00:03:21] Johanna Sargeant: Yes ...
[00:03:22] Emma Pickett: um, I think, I think, uh, the breastfeeding world w- will love it, and I think everybody will love it.
[00:03:26] Johanna Sargeant: Oh, thanks very much. I'm excited about that, yes.
So that's my, that's my fun part. Um, not that this isn't fun, but this is intense work, right? And I think that we- Have to be careful in this job about pouring all of ourselves into it all the time, which is what I did for the first five years, and then really struggled and had to figure out kind of where my limits are to be able to do the work well and still function with my...
I'm a, I'm a mom. I've got two boys that are now, uh, tomorrow my eldest turns 14- Oh, happy birthday tomorrow ... which blows my brain. Yes. And my baby is 11
Yeah, so I mean, that's, that's my life. Anything else you wanna know?
[00:04:10] Emma Pickett: We'll, we'll get to it. We'll get to it. Um, I think what you just said then about self-care and boundaries is so important. I think that one of the dangers of Instagram and social media is that you can get pulled into forgetting your boundaries so easily.
You know, you put up a post and lots of people in the comments are obviously very desperate and having questions, and obviously there are even ethical questions around w- whether you even should reply to somebody as an IBCLC if you haven't taken them on as a client and you don't know their case. But it feels very difficult not to at least say something.
And, and then all the DMs are flying around and, and, you know, I do my very, very, very best to signpost people and, and, you know, obviously I will signpost someone to potentially become a client if that's a possibility. But my capacity at the moment is such that that's often not a possibility. So I'm doing really badly at the moment, Joanna, with the boundaries thing.
I had a little bit of a flurry on, on Instagram, and I've, and I've-- lots of new people are meeting me for the first time, and I'm doing really badly with the boundaries thing, so I've decided I'm not gonna take any new clients in August. I'm just gonna just focus on my current client list and, and start there.
Um, but sorry, this is, I've-- so this turned into a therapy session for Emma. That's how I roll anyway, so. Yeah, but it's, it-- uh, one thing I think is so important for anyone who's getting into this work is it's so easy to think, "I have a responsibility to every single person who contacts me, and if I do not help that person in their moment of crisis, they are going to fail, and that is my burden."
And, and you've got to learn to look after yourself because, as you say, you just won't last. And I've seen brilliant people who just disappear, and like, where's she gone? She was great. Yeah. And she's gone into teaching. She's given up being a lactation consultant. Um, you know, just doesn't, and, and gone into teaching, and it's not like teaching is a walk in the park.
I mean, you can tell how intense they must have been working.
[00:05:58] Johanna Sargeant: Yeah.
[00:05:59] Emma Pickett: Okay, let's move away from the Emma therapy session. Let's talk about the subject for today. So, as I said, we could have talked about 100 different things- Yeah ... 'cause I know you've talked about lots of different subjects in your training and teaching sessions.
But I wanted to really pick your mind today about SNSs. So SNS, supplemental nursing system, supplemental nutritional system, supply line. What do you like to call them? Let's start with the real basics, like kind of if you were talking to an alien type thing.
[00:06:27] Johanna Sargeant: Mm-hmm.
[00:06:27] Emma Pickett: If no one has ever seen one of these things- Yeah
what do they look like? How does it work?
[00:06:32] Johanna Sargeant: I call it an SNS, and in my brain that means a supplemental nursing system. But I feel like that is quite connected to a particular brand. That's how it was branded originally. Yes.
[00:06:43] Emma Pickett: Yes.
[00:06:44] Johanna Sargeant: So I have moved away from that and tend to call it either at-breast supplementation or a supply line feeding.
[00:06:52] Emma Pickett: Okay. supply la- I think, I think let's be honest, we probably will have to mention brands in this conversation. Mm-hmm. Mm-hmm. And I will just say that sometimes lactation consultants do need to talk about brands, and they are not necessarily WHO Code compliant companies, even what their future intentions will be, we don't know.
So if we do talk about a brand today, that is not to say that we are promoting that brand, or we get anything financial from mentioning them, or we think that's the only option. Um, but I think in the purposes of education, I think if you're comfortable, I think we probably will need to mention names of brands.
Do you remember the first time you ever met one, met, met an SNS, whether it was personal or professional?
[00:07:28] Johanna Sargeant: I do. Um, I, uh, so I mean, we just had your therapy session, so here's mine.
[00:07:34] Emma Pickett: Okay.
[00:07:34] Johanna Sargeant: Uh, I was unable to breastfeed my first boy, and by unable, I r- came to a point where I realized like, yes, I did, but it never really worked, and we had about four weeks of really intense struggle and falling apart.
With my second, it was such a vital part of motherhood for me that I-- it was really, I couldn't pull these two things apart. They were one and the same. And I know that that is, um, you know, that's fraught with a whole bunch of problems when people have got the concept of mothering connected to being able to breastfeed.
That's a whole thing that we need- Yeah ... to pull apart. Yeah. Um, but that was the fact for me at that point in time, and I did so much research during my pregnancy with my second to attempt to not have a repeat of the same situation with my first, and yet I still had not come across a, an SNS in all of that reading, months and months of, of immersion in it.
And there was a point where he had come out, and we're at 10 days postpartum, and things were not going well again, and I just, I just struggled with milk supply really badly. And my midwife at the time, she's the one that mentioned it to me, and she came to me with a printout of a picture of it from the website, and she said she's never worked with these before.
She doesn't know anyone that has used it. She can't kind of give me any kind of support, but I might be somebody who would be interested in looking into it and finding out about it.
[00:09:14] Emma Pickett: Okay.
[00:09:14] Johanna Sargeant: And as soon as I saw it, I thought, "Oh my God, I think that's the thing that I need to be able to do the thing I want."
[00:09:21] Emma Pickett: That's actually, I really respect her for doing that actually. Yeah. Because a lot of people would say, "Oh shit, I don't know about this. I, I can't help someone else with this. I can't, therefore I shouldn't talk about it." Yeah. But actually to be so open and humble and to say, "I can't help you, but look, I found this thing- Yeah
what do you think?" That's, I think that's fantastic. What did that picture look like? I've, we jumped in the last question and I forgot to ask you t- to say what, what does it physically- What is it? Yeah. Yes. What's it physically doing? What, what did you see in those images?
[00:09:48] Johanna Sargeant: Right. So what I saw was a woman that had a bottle hanging around her neck, and the bottle was kind of attached to a necklace really, so hanging around her neck.
And outside of the bottle, instead of having the bottle teat, there were like two very thin tubes that looked like little IV tubes really. And each of these were taped onto each of the woman's breasts, and there was a baby that was breastfeeding with the tube in the side of their mouth at the same time.
So the milk coming out of the bottle was also going into the baby's mouth while they were directly at the breast feeding simultaneously.
[00:10:34] Emma Pickett: Okay. I'm really sorry about your f- first breastfeeding experience. That must have been really tough, four weeks of struggling and not getting the right support. And when you look back at that time, I mean, obviously you, you are a very, a person with lots of EQ, and you've done loads and loads of reflection and thinking about this.
Do you still feel you've got some lingering trauma there, or do you feel like you've been able to kind of process that and have your second experience as a kind of repair and, and a healing?
[00:11:02] Johanna Sargeant: Oh, there is a lot of lingering trauma there, for sure. Uh, and when I say four weeks, it was kind of like four weeks of attempting to get him to latch, and then 12 weeks after that of burning myself out with pumping and a lot of pain and a lot of injury and no sleep and all, you know, you know, you know the story.
We come across these all the time.
[00:11:25] Emma Pickett: Yeah.
[00:11:25] Johanna Sargeant: The, a lot of the trauma, I think, comes from the things that people said to me at that point in time, and the, the deep misunderstanding and misconception about everything that was going on. And the things like, you know, the concept that breastfeeding is the key to good mothering that I had been told on repeat at that point in time, and I know that this is the kind of thing that, that very much then informed my decision the next time that, okay, if I have failed as a mother the first time around, this is my chance to try it again.
[00:12:00] Emma Pickett: Okay.
[00:12:00] Johanna Sargeant: And so there's, there's still a lot of that. And I know with the pumping situation that I had when I started this work even, um, I had gone into it saying, "I do not want a pump within 100 meters of me. I don't wanna see one. I don't wanna hear it. I, I cannot have anything to do with pumping at all." And I had to very much work through that process and, and now I'm fine with it.
Now I can support people with an oversupply. I wasn't able to do anything with oversupply for a long time as well. So there's a lot of stuff that is there, for sure. I know with my, with my second, I did very much get to a point of healing, but I still never Was able to make a full supply and to get to the root cause of why I was in that scenario.
[00:12:52] Emma Pickett: Okay.
[00:12:53] Johanna Sargeant: And that was very much the, like, the sticking point for me was the why. When I'm doing everything right, ticking all the boxes, things aren't kind of happening, and hence why I'm doing this work now, right? So.
[00:13:04] Emma Pickett: Yeah. And I bet it makes you a fantastic lactation consultant because you've got that empathy and, and also the, the skill in being able to take a step back and, and having processed some of your own trauma as well.
It, it only undoubtedly adds, adds amazing skill to your experience in working with families. So you've seen the picture of the SNS, the midwife's given you the photo- Mm-hmm ... and you think, "Okay, crikey, I'll order one of these." Um, it comes in the post, and you are literally on your own with this, or is she willing to sit with you and have a go?
[00:13:32] Johanna Sargeant: No, 100% on my own. And I think that's one of the things as well that I, I see so often when people are talking about these devices. There's so often this idea that you should only use it with the support of a provider, and that you need to have someone with you when you're trying to figure it out. And I didn't, but I'm a smart woman, played around, figured it out, and I think that we need to enable women to feel like that's a safe thing to do as well, that it's okay to experiment as long as you're going into it thinking that, okay, maybe the first three feeds will be a bit complicated.
Hmm. There's gonna be points where things go wrong, but it's also not the end of the world, and we troubleshoot that. As with all kind of infant feeding, right, there's never every time that it's perfect. You have issues with bottle feeding as well, and with breastfeeding obviously. So it's just another method of feeding that you have to learn how to do, and I think there are ways to make it easier.
[00:14:37] Emma Pickett: I, I think sometimes that comes from remits. You know, if you're a peer supporter, if you're a breastfeeding counselor, you maybe not have had the training to deal with some of this equipment. So it's implying that they have to go off and find an IBCLC and they'll, you know, oversee it, excuses that person from liability.
I suspect on some level it probably is literally coming down to legal liability. I hear that with nipple shields as well. You should only use a nipple shield in the presence of a qualified ba, ba, ba, but-
[00:15:02] Johanna Sargeant: Mm-hmm ...
[00:15:02] Emma Pickett: you know, at 2:00 in the morning and the Amazon delivery just came at 10:00 the night before, it's, it ain't gonna happen, not least because lots of people live in countries where there's not many IBCLCs.
I mean, in, in Switzerland, you haven't got a big team.
[00:15:13] Johanna Sargeant: No, exactly.
[00:15:14] Emma Pickett: Um, so yeah, I think that's really important, that idea of gatekeeping. Using a pump is flipping confusing, and no one says, "Don't open the pump box- Yes ... until you've got a lactation consultant sitting next to you." I mean, all the sort of, you know, membranes and clicking, and that's, I think that's more complicated than an SNS- I do too
in lots, in lots of ways, but no one ever says that.
[00:15:32] Johanna Sargeant: Absolutely.
[00:15:33] Emma Pickett: So you've got your little boy, he's on the breast, you've rigged it up.
[00:15:37] Johanna Sargeant: Mm-hmm.
[00:15:37] Emma Pickett: You've got the tube in his mouth.
[00:15:39] Johanna Sargeant: Mm-hmm.
[00:15:39] Emma Pickett: And it worked for you. It made a difference.
[00:15:41] Johanna Sargeant: Yeah. It meant that, uh... I mean, the first time we did it, he pulled the tube out of his mouth, and then I got covered in the milk all over my belly, which was, you know, one of the things then that we had to figure out, like, where do I put his hands so that he doesn't do that?
Or do I tape it to my breast so that this doesn't happen? How, how are we gonna solve this kind of problem? And then I had an issue with the flow rate was too fast, so he was gulping a lot, and then he vomited up so much milk afterwards as well. So there were kind of-- it wasn't like it immediately worked perfectly, but I could see that it meant that he was at my breast and was active, 'cause he was, I think with a lot of babies that are dealing with breastfeeding with low supply, he was very, very slee- sleepy at the breast.
And what I noticed straight away was that he was actively sucking the whole time. And when I was in a position where I did not want to pump, and that was my 100% I will not pump, then I could see, okay, this is, this feels different as well. So this is actually, he is active at my breast, getting more milk out from me, and he's getting full at the same time.
So I'm kinda ticking every single box of what I wanted to happen at that point.
[00:17:04] Emma Pickett: Yeah. And especially if you didn't want to pump, he is stimulating your supply, he is maximizing your production. Um, you know, that's one of the reasons why an SNS is a great choice for somebody that wants to increase their own production.
Mm-hmm. Again, as w- if, if we're speaking to aliens, let's spell it out. Why would someone want to use an SNS instead of using a bottle to give their baby additional milk? I'm gonna, I'm asking you to say, state the flipping obvious, but let's just spell it all out.
[00:17:30] Johanna Sargeant: I mean, there's a whole variety of reasons, but the simple ones would be that this means that all milk that a baby is getting is via a breast.
So we know that that means that they will learn to breastfeed better in the process. Um, it will, like I mentioned before, kinda maximize the milk, the, the breast stimulation in the process as well. It also make, like ensures that you don't have any kind of risk of, of nipple confusion, of bottle preference happening as well.
So- Very frequently we have scenarios where babies start to show a preference for a bottle and start to reject the breast, so we have no risk of that kind of thing happening, which is what was going on with my first. So the fact that I could get rid of that as a possibility was, was great for me personally.
And I think the other thing that doesn't get talked about is, is the mental health aspect of it. So the fact that actually that meant that I felt like I am a breastfeeding mother at this point, and whether or not it is my milk in that additional bottle coming out or donor milk or formula, whatever it may be, he is at my breast getting milk, and we are getting all of the other benefits that come from breastfeeding that is not just about milk transfer.
[00:18:58] Emma Pickett: Yeah. Thank you for expressing that nice and clearly. And, and also, what's the alternative if someone is not producing a full milk supply and their baby's gonna need extra milk? We start going into the awful world of triple feeding, dum, dum, dum. Yes. Which I know you talk a lot about. I've heard you talk about that burden of triple feeding and, and how it's a tool that's often overused in the breastfeeding world, and it's seen as a shortcut, but it ends up being medium term or even long term.
How can an SNS really help reduce that burden? And tell me, so just give us the, the quick version of why triple feeding is a problem and something we should be careful about.
[00:19:31] Johanna Sargeant: The thing for me with triple feeding is that it tends to be-- I now have a, a blanket statement with my work when I'm working with people that I would like all feeds, and that includes any pumping, any bottle feeding, any kind of extra that's necessary to feed a baby, I want all feeds to be done maximum 45 minutes.
And what I see with triple feeding is that it tends to be, the advice would be, say, 20 minutes on each breast, plus 20 minutes of pumping, plus we know that ideally when you're bottle feeding, so they don't get a bottle preference, you want the bottle feed to take as long as a breastfeed. So we're doing paced bottle feeding, let's say that ideally would be 20 minutes or longer for a bottle as well.
So we're already at an hour and a half, more than an hour and a half. Yeah. And we know that babies, particularly, you know, afternoon, evening, they're already hungry again. So when is this person going to eat? When is she going to do a wee? Like, when is she going to do any form of any kind of self-care in any way whatsoever?
It's not gonna happen.
[00:20:45] Emma Pickett: Yeah. And plus, if she's on her own with a baby, what's the baby gonna be doing? Not gonna be sitting there reading the newspaper while you're pumping. I mean, how does everything fit in?
[00:20:53] Johanna Sargeant: Exactly. Exactly. Yeah.
[00:20:54] Emma Pickett: Um, triple feeding assumes a second adult, doesn't it, really, in most cases? Um-
[00:20:57] Johanna Sargeant: Yes.
And then, you know, you have to wash everything as well. People forget about the washing. It's, that's like a whole other job on top of this, right? So, um, and the thing for me is that so often people are doing this and then don't see a big result, so they end up potentially just continuing to do it because they've been told this is the necessary thing to get to your goal.
And if they're in that hole, and they've been doing it for five days, seven days, and there's not really very much difference by that point, then for me, I really think there's no need for you to just continue doing the same thing endlessly. And there needs to be then a shift in what our plan is with these people.
And then we can look at, okay, what are the alternatives? We can look at SNS at that point.
[00:21:48] Emma Pickett: Yeah Yeah. So in a minute, I'd like to ask you a bit more about brands and different types of products available. Before we do that, you just mentioned there about washing. Something that comes up a lot is, but how the heck do you wash an SNS?
What's the requirement? You know, when a baby's got an NG tube in hospital, the NG tube stays in for days and days and days. No one's taking that out and flushing it with Milton sterilizing fluid. Um, how do you answer that question around cleaning and, and looking after an SNS?
[00:22:13] Johanna Sargeant: I say that I want you to-- Because, I mean, the, the issue with the tubes is that for any brand where it's not a silicone tube, uh, which is the vast majority of them, then you can't sterilize it.
So all we can do is usually it comes as a sterilized tube, and you've opened it, and then we are just flushing it with hot, soapy water two times, and then we're flushing it with clean water, and then you're good to go. What that kind of means is that I, you know, I'm based in Switzerland. I know the water quality here is never an issue, but I know that that's not the situation everywhere.
So people have to be aware of their water as well, where they are. And that usually means that you would need to have a-- Again, it depends on the device, but often you would then need to have a syringe that you're kind of using to push that water through as well, so we don't end up with a whole bunch of water left over in the tube afterwards as well.
[00:23:15] Emma Pickett: So a narrow gauge enough syringe that it will fit in the actual tube, you can push it through completely. Mm-hmm. Um, and I like the idea of kind of lasso, lassoing it to get the drop, water droplets out- Yeah ... and swinging it around your head. Um, that's, that's a good tip as well. Um- Yeah ... and I think that message is of you can't sterilize it, and that's okay, is really important because people are trying to put SNS tubes in kind of sterilizers and things.
That is never gonna happen. That's just not an option. Um-
[00:23:41] Johanna Sargeant: Yeah ...
[00:23:41] Emma Pickett: and, and that's okay if you can't. Okay, let's talk about brands. So the one you're talking about, I'm guessing some lovely Swiss midwife gave you a Medela photograph- Yes ... and it was a Medela SNS. I mean, I,
[00:23:51] Johanna Sargeant: I live 10 kilometers from Medela headquarters, so that was the one that was everywhere, like easily accessible for me, and same-day delivery at that point, so.
[00:24:02] Emma Pickett: So we've got a hard plastic bottle that sits on your chest. Mm-hmm. And they've just recently changed it, haven't they? What's your feelings about the new version of the Medela SNS?
[00:24:11] Johanna Sargeant: Oh, Emma, I have a lot of feelings. Um, it's tricky because I really, really don't like it, but I have to figure out do I not like it because it's not good, or do I not like it because I'm unfamiliar with it?
[00:24:26] Emma Pickett: Okay. Very honest.
[00:24:28] Johanna Sargeant: Yeah. I don't like it because firstly, it is not like a flat bottle.
[00:24:34] Emma Pickett: So it's a different shape, isn't it? For anyone who hasn't seen it, the old-fashioned one was a kind of, was it a pentagon shape or sc- certainly a rectangular thing that sat flat against your chest bone.
[00:24:43] Johanna Sargeant: Exactly.
[00:24:43] Emma Pickett: Yeah. And the new one is a round bottle that kind of bobs around a bit more.
Oh, interesting decision to change it. I wonder why they did.
[00:24:50] Johanna Sargeant: Yeah. Yeah. I think, I hope it's not gonna get you legally in trouble, but I think that it's just, uh, I think it's money-saving. So I think that, you know, it's the same bottle that they use- Aha ... for
[00:25:01] Emma Pickett: other stuff,
[00:25:02] Johanna Sargeant: right?
[00:25:02] Emma Pickett: Yeah. Fair enough. Which makes it more cost-effective for parents, Joanna, of course.
Um- Mm-hmm ... we're, we're taking that, that money savings to the customer, so that's a, an excellent corporate decision.
[00:25:13] Johanna Sargeant: If only it was therefore cheaper, but no, it's not. Um- Oh,
[00:25:16] Emma Pickett: okay.
[00:25:19] Johanna Sargeant: So that, like the change in bottle for one thing, I think makes it tricky because when it was like a, an, a thinner bottle against your body, it's much easier to kind of tuck it into your shirt, tuck it underneath your bra strap, and to be able to feed everywhere.
You don't have to kind of have, have it hanging on your body in full view, and I know that a lot of the barriers to this for a lot of the women that I'm working with are about- About the public perception of it-
[00:25:52] Emma Pickett: Yeah, sure ...
[00:25:53] Johanna Sargeant: as well.
[00:25:54] Emma Pickett: That circular one is bobbing around, isn't it? There's the thing about how- Yeah
if something's a circular shape, it never makes contact. There's always got infinity of ways to make contact with something. I mean, that is not gonna sit there. It's gonna be moving around a lot more. And, and the tubes themselves, am I right in thinking different provisions of tubes? So the old-fashioned one had different choices of thickness.
[00:26:15] Johanna Sargeant: Exactly.
[00:26:15] Emma Pickett: What's the current story?
[00:26:16] Johanna Sargeant: So this time you just get your medium gauge tube, and that's what there is. And that was my major thing that I really liked with the Medela one in the past, was that you could choose a small, medium, or large. And depending on, you know, what the issue is, so if, for example, someone has got IGT, insufficient glandular tissue, but the baby has got really strong, amazing oral function, then we don't wanna have a super fast flow tube.
It's gonna be too fast for that baby. We want a slower flow. They've got a very strong vacuum, got good control. They won't get overwhelmed. But if you've got a baby that has got, like we're working on oral function, they're really struggling to be able to pull any milk out at all with any kind of vacuum, then having a higher, uh, higher flow rate so that actually we do get the suck, swallow, suck, swallow, and not the suck, suck, suck, suck, suck, suck, swallow, then we need to be able to adjust the flow rate ideally for these babies.
So that's another major issue for me at the moment, is that they've taken that away, and we've just got one flow rate. And I really like the option of being able to play around with that. They do have like a little, um, what would they call it? Like a, a, a dial, I suppose. Yeah,
[00:27:38] Emma Pickett: a valve dial. That's, uh, the, uh, the Haakaa guys have got one as well.
A clamp. Yeah. Clamp with a little dial, so you c- you're squeezing on the tube, in theory, aren't you?
[00:27:46] Johanna Sargeant: Exactly. So you can adjust the tube in that way. You can kind of squeeze the little dial and make the tube narrower, and therefore slower. In practice, I found that it tends to just be, like, either on and off.
There's very little ability to actually adjust that very well, and definitely not the ability to make it particularly faster if we wanna make it faster for a baby. So it really seems like a on-and-off tube for me.
[00:28:14] Emma Pickett: Okay. Okay, so we've still got Medela, and where... And you can buy it by coming next-day delivery directly from Medela sales.
In the UK- Yeah ... people tend to buy it through Amazon. Um, there are some other individual stockists. Um, it seems to go out of stock quite a lot. I don't know whether that's, uh, something to do with the supply lines or, or what's going on there, but you can definitely find it if you need to find it.
[00:28:35] Johanna Sargeant: Mm-hmm.
[00:28:36] Emma Pickett: Not super cheap, though. Um, it's, uh... But I guess if you're gonna be using it every day, eventually that will become worthwhile. Tell me about some of the other products available- Mm-hmm ... some of the other companies making SNS-type products.
[00:28:47] Johanna Sargeant: Yeah. So, um, Ardo, which is another Swiss company, I don't know if you get that in the UK.
Do you get that? We
[00:28:53] Emma Pickett: do get Ardo. We have Ardo breast pumps. Yeah. We've got a lovely Ardo team based in Somerset. Um, uh, yeah, we, we definitely have Ardo here.
[00:28:59] Johanna Sargeant: Okay.
[00:29:00] Emma Pickett: And WHO Code compliant as well, let's just say.
[00:29:02] Johanna Sargeant: Yes. Um, Ardo has got a-- they, they just pretty recently put one out that has got that old bottle shape that the Medela SNS used to
[00:29:13] Emma Pickett: Ooh, okay.
Now, I don't know if that, that is available in the UK. Okay. But that's, so that's definitely worth, um, looking into. Okay. Sorry, I interrupted you. I was g- just getting excited. No, no. Keep telling us what it's... So it's, it's that old flat rectangular shape again.
[00:29:26] Johanna Sargeant: Exactly. Exactly, yeah. It's really very similar to the older version of the SNS, the, the Medela one.
Um, doesn't have the different tubing sizes, but as far as kind of putting it together and, and that process, and the way that it can sit on your body, very, very similar. And that one is pretty much identical. I'm not sure if it's 100% identical, but very, very similar to Lactation Hub has also got their own supplemental nursing system that is, that looks the same.
[00:30:02] Emma Pickett: And is that based in the States, Lactation Hub? Yeah. Yes. Okay.
[00:30:05] Johanna Sargeant: Yep. So those are the two that at the moment are-- they tend to be my go-to for more longer-term use.
[00:30:16] Emma Pickett: Okay. So we've got hard plastic bottles.
[00:30:19] Johanna Sargeant: Mm-hmm.
[00:30:19] Emma Pickett: Rectangular shape, sits against the body. Um, but we haven't still got, we haven't got those options with different tube thicknesses just yet.
Exactly.
[00:30:25] Johanna Sargeant: Right.
[00:30:26] Emma Pickett: And then tell us about Lact-Aid.
[00:30:28] Johanna Sargeant: Yeah.
[00:30:29] Emma Pickett: Is that still around?
[00:30:30] Johanna Sargeant: Lact-Aid, I mean, it is still around, US-based. I don't know if you can get it in the UK. It's very, very hard- I've
[00:30:36] Emma Pickett: heard of people shipping it- ... to get here ... um, but I've not heard of people buying it easily.
[00:30:41] Johanna Sargeant: Okay. Okay. It does have... So for me, Lact-Aid, the Lactation Hub one, the Medela one, and the Ardo one- The major thing that I think is great about all of those four is that the tube itself is very, very, very soft.
So any of the other ones that we end up talking about tend to be like a harder plastic. And so sometimes when we're working with babies that have got oral function issues, they also potentially have got higher sensitivity in their mouth. They've got maybe a high palate and a, a hypersensitive gag reflex as well, and having something that's a little bit harder in their mouth means that they won't latch.
So I tend to see that these are the ones that for these sensitive babies will also work better. The Lact-Aid is very different to the others in that it is disposable plastic bags filled with milk, and then it just has like a little clasp that you attach to the end of the plastic bag that turns it into this kind of feeding device.
So it is the kind of thing where I think when you buy it, you get 10, maybe 20 of the plastic bags with it. But if you're using that for every single feed, then obviously you're gonna need a massive supply of these disposable plastic bags. But the disposable bag then also means that obviously it can sit really flush against your body at the same time.
You can tuck that in anywhere that you want to. There's nothing hard against you. So a lot of people like it for that reason as well, that it can be super discreet and comfortable for them.
[00:32:23] Emma Pickett: Okay. And then in the UK we also have the Haakaa SNS-
[00:32:27] Johanna Sargeant: Yeah ...
[00:32:28] Emma Pickett: which kind of sells in two different forms. It's kind of got the very simple one that's just the tube, and then it's also got one that has a kind of atta- you know, a slightly more complicated attachment with even a bottle brush as well to clean through the tube.
[00:32:38] Johanna Sargeant: Mm-hmm.
[00:32:39] Emma Pickett: Um, have you, have you come across that one and used that one?
[00:32:41] Johanna Sargeant: Yep. And I do have that as well in my practice. It's not-- I didn't add it into my list just then because it doesn't fall into the category for me of having a really small, super soft tube.
[00:32:53] Emma Pickett: Yeah. It's quite a chunky little thing, isn't it?
Yeah.
[00:32:56] Johanna Sargeant: It's chunky, yeah. The really good thing about that though is that if you've got someone that is particularly worried about sterilization, is that it's made of silicone, so you can sterilize it. Um, but the flow, so the actual silicone itself is very thick in the tube, and the, the diameter of the hole is also very large, so the flow rate of that one tends to be really very fast.
So I find that it's very fast, and it's quite tricky for a lot of the babies to have in their mouth, but it is significantly cheaper.
[00:33:33] Emma Pickett: Yes. Especially if you buy the simple version. And, and it's also got one of those dial clampy things as well- Mm-hmm ... um, like the, like the Medela, which may or not, may not be super useful.
[00:33:43] Johanna Sargeant: Mm-hmm. Mm-hmm.
[00:33:46] Emma Pickett: 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. Okay, so we've got all these different products that are available, and obviously one of the barriers is going to be finding it and getting hold of it.
One of the other things that people will often use is just a regular NG tube. Yeah. And some lactation consultants will go to visit somebody and have a stash of regular NG tubes in their bag-
[00:36:07] Johanna Sargeant: Yeah ...
[00:36:07] Emma Pickett: to use for this purpose. Now, we get into slightly gray legal space in that you're not technically, as a lactation consultant, meant to use a product for a different purpose.
So let's put that to one side for a moment. If a lactation consultant says, "Listen, you might wanna try an SNS. Rather than spending this amount of money on a product that maybe doesn't work for you, why don't you take this tube home, take four of these tubes home-" Mm-hmm ... "have a play with them, see if they work."
And these are tubes that would be called infant feeding tubes by a medical stockist. They are used to literally put up babies' noses. We're not gonna be putting it up a baby's nose. Mm-hmm. We're gonna be putting it in the corner of their mouth. And do you use that... Is, is that something you ever talk about with clients, doing a homemade version if that's something they want to do?
[00:36:47] Johanna Sargeant: I am one of those people that has 20 in my bag all the time. What I tend to do is I will not get somebody to buy a more long-term version of it until I have tried that with the client first, because I wanna see Is the baby okay with that in the mouth? And how does the mum feel with that on her body as well?
I mean, I also have longer consultations, so I realize that sometimes you don't have the chance to kind of go through the whole thing with people and you just have to show it to them and say, "Look, do you wanna take it home and give it a try?" But for me, I will do it with them together, even if it's only five minutes and that's it.
Um, and I introduce it to them as, like I have one that's already put together in my bag and I pull it out and I show them this is this device, maybe you've never seen it, and it's just the NG tube with a 20 mil syringe that I have attached to the end of it. If they wanna give that a try, then we give that a try and we talk about, uh, like while they're doing it, we talk about all the stuff that we just discussed about how you can see the baby's much more active here.
Also, the reason why I wanna try it before we look at a longer term option or one of the more expensive options, is that I wanna see how your baby is reacting to this in their mouth as well. Sometimes I have people that feel so good about just doing that, that they just want to do that from that point onwards.
They don't want to get like a longer term softer option as well. That process in itself is, is simple enough for them that they just wanna manage to get their hands on a whole bunch of those, and that's, that's totally great. And I do-- Again, we talked about the legal implications of this. Um, I do have, there's a company in Germany and there is a company in the US that sell these NG tubes, but they are packaged as a feeding tube for supply line feeding.
And for me, that kind of takes away that worry as well, and it says on there What I prescribe to, which is that you can use them for two weeks as long as you are flushing them appropriately and washing them afterwards, then you can use it again.
[00:39:14] Emma Pickett: Ooh, I might get you the na- I might get the name of the Germany c- German company from you, 'cause that's not something I'm, I'm still being naughty and using NG tubes and, and, and cutting off the weird little extra thing and, and, and it, you know, it's, it's not perfect.
So the diameter of those tubes, French's 5 is what they talk about as the kind of- Yeah ... that, that's, and I don't even know what that means. Is French- I actually don't know what that means either. Bloke who measured the internal diameter of tubes, I suppose. I mean, he's not making them 'cause every- loads of people are making them, so, so that's, that's the diameter for the standard f- using an SNS for the first time.
And- Yeah ... it's interesting you talked about one end being attached to a syringe because I-- yeah, I mean, you've got much more expertise than me in this area. I've, I've got people sticking the other end in a bottle and- Mm-hmm ... possibly ruining a teat to jam it through so it stays in the bottle, and then the bottle is higher or lower to control flow.
[00:40:03] Johanna Sargeant: Mm-hmm.
[00:40:03] Emma Pickett: But actually pushing it through with a syringe is obviously more controlled, and you can then create positive pressure without depending on the baby having to create that negative pressure before the milk will even arrive. So that, that's, that's a good tip.
[00:40:15] Johanna Sargeant: Yeah.
[00:40:16] Emma Pickett: So you sort of hinted there about when you might work with a family for the first time and you might bring an SNS out.
A couple of times I've done that, and I can see this look of utter panic go across someone's face.
[00:40:28] Johanna Sargeant: Mm-hmm.
[00:40:28] Emma Pickett: You know, that is medically and weird and blah. I mean, how do you, how do you have these initial conversations? Do you have a kind of a way to sort of calm someone down if they're freaked out? Do you just accept, okay, this is not gonna work for this person?
What sort of things do you talk about?
[00:40:42] Johanna Sargeant: I think the big thing for me is what you mentioned very early is about I, I'm really passionate about the fact that I am not going to be a gatekeeper of information. So even if I worry that it might be a little bit too much for somebody, or that it might trigger something for somebody, then that's not enough of a reason for me not to show them that it exists.
It just means that I have to do it in a very particular way, so I have to be careful about the language I use and about the timing at which I introduce it with them. But I'm definitely not going to avoid bringing it up. One of the things for me, particularly if I've had a family with a baby that was in the NICU at some point, I know that that is immediately something that I kind of flag because that baby probably has had tubes involved in the process and potentially syringes involved in the process, so this can be a triggering scenario.
So usually the way that I tend to bring it up is that most of the time it is, it is a scenario where someone has been triple feeding for a while. Um, not always, but most of the time. And I can see that they are burning out, and I talk to them about, you know, we need to make sure that this has an end goal for you, and we ideally are gonna find like a sustainable, feasible solution for you long term.
So When your goal is to be able to have your baby at your breast, how would it feel for you if, if I showed you a device that will actually allow your baby to have the milk from the bottle and the milk from your breast at the same time? Are you interested in looking at something like that? And as soon as they say like, "Mm, yes," which they all do, right?
Like, "What is that thing?" The fact that they have actually opened up psychologically to discovering something new means that that barrier is not there anymore. So as long as I, like, I go into it asking them permission before I just pull it out and say, "Hey, look, maybe you haven't seen this thing. I wanna show it to you."
Talk to them about, "There is this device. Are you interested in having a look at it?" And then I bring it up and I show it. And I do flag the fact that I know it looks a little bit odd because we haven't seen people using it around. You probably haven't seen people using it. Have you heard of one before?
The other really small thing that I see makes a really big difference is that instead of talking about it being a tube, is that 100% of the time when I'm with a client, I call it a straw all the time instead of a tube. And there is something that I discovered that makes a massive difference for people's acceptance of this as a way of feeding their baby, and it isn't this thing that is potentially meant to be going up their nose, meant to be going directly into their stomach through their belly.
It is a straw, and that's a totally acceptable way for a person to eat.
[00:43:46] Emma Pickett: Yeah. Great tip. Okay, so couple of quick practical questions. Do you talk about tape? Do you like someone using tape? Does that seem to make it easier for most people? And where do you recommend people put, put it? So if a baby's maybe in a cross cradle hold or a cradle hold, are you tucking it in the corner of the mouth?
Are you putting it through the, a-around by their palate? What, what do you like to position? What-- Well, obviously it's gonna be the individual parent's decision, but- Mm-hmm ... what tends to work better with the people you're working with?
[00:44:13] Johanna Sargeant: Uh, so when I first introduce it, I don't mention the tape at the start at all, and I say that we are wanting the tube to be ideally around about two, one to two mil past the end of the nipple, and that it would be, we're aiming for like 10 o'clock and 2 o'clock in a baby's mouth, so like the top two-thirds of the way around the lip.
I don't want it to be directly- Not
[00:44:39] Emma Pickett: right in the corner of
[00:44:40] Johanna Sargeant: the mouth
[00:44:40] Emma Pickett: then.
[00:44:40] Johanna Sargeant: Correct. Okay. What I see is that when it goes directly into the corner, it seems like you've got about a 50/50 chance that maybe it's gonna end up going underneath the tongue.
[00:44:49] Emma Pickett: Okay. Yeah. Yeah.
[00:44:51] Johanna Sargeant: And then we have a scenario where no matter what kind of oral function is going on, what kind of suck, there is no movement of milk out of the tube.
And then it will be like either there's no movement or if the tube is just pouring milk out, then this baby's not swallowing it and it's just coming out of their mouth. So the thing for me is if we can get it a little bit higher than directly in the corner, then we have got a much, much, much higher chance that it's going to actually be on the top of the tongue at the, on, on the palate.
[00:45:22] Emma Pickett: Okay. And then tape maybe later on if there's somebody with an older baby or, um, it does seem like that might be useful. Do you ever use the, the trick of using a Band-Aid and people kind of tucking under the cushion of the Band-Aid? That's something I've heard people talk about.
[00:45:36] Johanna Sargeant: Yeah. So I said to you that, like, I don't use tape at all at the start.
What I do get people to do is, like, kind of show them where they can hold it at their breast, which tends to be on average, if we're talking about an average woman's areola, uh, it would be kind of at the edge of the areola, where we just then change to the normal breast at that point. Does that have a word, the normal breast away from the areola?
[00:46:02] Emma Pickett: What, the un-areolad breast?
[00:46:04] Johanna Sargeant: Yes, exactly.
[00:46:06] Emma Pickett: Um, I don't think there is a word for that, 'cause if we're doing a Venn diagram, areola is also breast, so.
[00:46:12] Johanna Sargeant: Exactly. Exactly. Well, you know what I mean.
[00:46:13] Emma Pickett: I know exactly what you mean. At that, at that edge. The un-pigmented, I don't even know, 'cause people are pigmented. I don't know, can't help you there.
Right, let's invent a word. TM, Joanna Sargeant invent a word for the bit of the breast that's not the areola.
[00:46:25] Johanna Sargeant: Okay. Exactly. I like un-areolad breast. We'll go with that. Um, I tend to get them to hold it there for the first time, and then I-- then, then we see can we get baby latching, how is that all going to work.
And then I mention there is the option as well that we can use some tape to hold it there in place. But I don't mention that at the very beginning because that's, like, another thing that you have to find the end of the tape, you have to organize that beforehand. For me, it is how can we make this as simple as possible for the very first time that they use it, and then we look at these are other things that if that's tricky, there are other things that can make it easier.
[00:47:09] Emma Pickett: Okay. What are some of your other tricks? I don't give, give you to give all your tricks of your trade away, but what are some of your other- No, I can't. ... some of your other hacks? If someone's finding it a bit tricky, what do they often find tricky, and what are your favorite solutions?
[00:47:22] Johanna Sargeant: Yeah. So, um, the main thing for me is 100% of the time get yourself some kind of a breastfeeding necklace, some beads, some k- something for them to cling onto with their hands, and I do that again from the first feed.
So I have, in my office, I have, like, just a little beaded necklace. I put that around the neck of the mom, and then I, and then I start to do things with the tubes, and what I do is I get the baby's hand right at the start and actually get their little hand holding onto the necklace at the beginning-
[00:47:59] Emma Pickett: Ooh,
[00:47:59] Johanna Sargeant: clever
so that they're not grabbing around. So then you
[00:48:01] Emma Pickett: can fiddle with the tubes and do all that stuff and set yourself up while they're fiddling with the necklace.
[00:48:05] Johanna Sargeant: Exactly.
[00:48:05] Emma Pickett: Good tip.
[00:48:06] Johanna Sargeant: Yeah. Um And I think that that is because when they do grab the tube, it's either going to pull it out of their mouth or I've also seen that sometimes if they, if they yank on it really hard quickly, then it actually breaks the whole system.
Like it pulls it away from the actual bottle, the connect-y bit. Okay. And then we have, okay, now how are we gonna feed that baby, right? If we are really working hard to avoid bottles, et cetera, then that can be really, really stressful. So having something for them to cling onto is the main thing for me.
The other thing is about, uh It depends on the baby, but often we need to get that kind of instant gratification for them. So we know that when a baby comes to a breast, it usually takes, say, 30 to 60 seconds or so for the milk to start to flow. And when we have got a scenario where then the milk does start to flow, and we maybe start to see milk starting to travel slowly down this tube because the baby now is developing a good vacuum, then what I would like is that we actually kind of squeeze the syringe a little bit or squeeze the bottle a little bit so that we get that milk right at the edge of the tube at the very beginning.
[00:49:20] Emma Pickett: Okay. So that's gonna be possible with some brands and not other brands, isn't it? So some of these hard bottles, not an option, but with the syringe for sure. Even with the hard bottle- You can, even with the hard, you reckon you can get enough of a
[00:49:31] Johanna Sargeant: squeeze? You can squeeze it a little bit.
[00:49:32] Emma Pickett: Okay.
[00:49:33] Johanna Sargeant: The only one that I find doesn't work with that is the one you mentioned before, where you've got the kind of homemade hack version where the end of the tube- It's a regular bottle
is in the bottle. Yeah, of
[00:49:43] Emma Pickett: course. Yep. Okay. That makes, that makes sense.
[00:49:46] Johanna Sargeant: Mm-hmm.
[00:49:47] Emma Pickett: Let's talk about what kind of milk is gonna be in the bottle. So obviously, s- lots of parents will need to use extra milk that's not necessarily their own milk.
[00:49:54] Johanna Sargeant: Mm-hmm.
[00:49:54] Emma Pickett: Um, some babies may have a suck issue that, and they can't necessarily take milk directly from the breast, but possibly could have some expressed milk in that bottle.
[00:50:02] Johanna Sargeant: Mm-hmm.
[00:50:02] Emma Pickett: Um, is it more difficult to use formula because it's thicker? Do we get clumps? Do we get problems with using formula with... Are some brands of SNSs better for formula than others, or not really a problem?
[00:50:14] Johanna Sargeant: It's just about the tube diameter. So, you know, ideally, we're going for a tube that is quite a small diameter, so therefore, ideally, we're making sure that if someone is using formula, it is, I tend to say, like ideally when you're first starting with an SNS, try to get the formula that is the, like pre-made formula, so it's not the powder.
Mm-hmm. Just because I see that you do have, even if you shake it up like crazy, there, there is still sometimes like a tiny little clump that is in there, and that blocks the tube and just causes a bunch of problems, right? And it's quite hard to then kind of flush it out. So I mean, when I used it with my boy, I used donor milk in there, and then I also had to use formula in there as well.
And at the time here, we didn't have the pre-made formula, so it was always the powder. And no matter how much I shook this thing, I'd say one in 10 times probably, it would get clogged. And it's, you know, it's not a major problem, but gee, it's annoying when you've finally got your baby on and you're ready to go, and then it's not working, right?
[00:51:27] Emma Pickett: Yeah. Yeah, super annoying 'cause you, uh, unclogging it is not a quick process, and you've got a little hungry person- Exactly ... who's pretty unimpressed. Um, how long did you use an SNS for, and, and have you come across people who use them for a long, long time? What's the sort of typical length of time?
[00:51:41] Johanna Sargeant: Yeah. I used one myself until, so from about 10 days, um, until about six months.
So when my boy started eating a lot of solids, he started with solids quite, like quickly. He loved it very quickly. And I kind of used that point to say, okay, I was at about 80% by that point of his milk intake. So I made the decision then to say, "Okay, I'm gonna stop with SNS and see how we go. Check the wee, check everything, see how we're going."
And we were going fine by that point, so we didn't need it anymore. I see, in my practice, I see it tends to be one of two things. Either somebody uses it for maybe about two weeks or so, that it's like just a little bridge that they have to get over, and that tends to be a scenario where maybe we've got oral function issues, someone's about to get a tongue tie release, we're doing some kind of coordination exercises with them, or you've got a baby that's really jaundiced, uncoordinated, we're working at them waking up and learning how to feed more efficiently.
In that kind of scenario, when it tends to be more about what's going on with the baby, it tends to be a shorter term solution, so two weeks or so I often see. When it is more about, uh, insufficient glandular tissue or some kind of hormonal issue with the mum as well, often I then see that this can be a super long-term solution, and they can-- I have people that have been using it for two years and are super happy to be using it for two years with no issue whatsoever.
It very much becomes an easy way of feeding your baby, and it tends to be, I see the people that are using it longer term feel like it is so much easier to just put the baby on the breast without the tube, and then while the baby is there, then you can fiddle around and make up your bottle, get it ready to go, and then swap them over to the other side with the tube.
So you kinda get this little mini moment where you're already doing the calming, you're getting a little bit of milk into them, you're calming them down, ready for all of the extra milk that they're going to need. And that, that tends to be, for a lot of my people, a lot easier than, "I'm gonna breastfeed and then bottle feed afterwards."
[00:54:10] Emma Pickett: Yeah. It's that whole thing about when do I take them off the breast, and oh, they've, they've fallen asleep, and I've gotta wake them up for the bottle. And if it's just all one continuous thing-
[00:54:19] Johanna Sargeant: Yeah ...
[00:54:19] Emma Pickett: it's such a different story, isn't it? Just taking you back to when you stopped using the SNS yourself.
Obviously, it's a while ago now, so I'm not expecting you to remember every moment, but I'm imagining it feels both amazing and a bit scary at the same time to- Yeah ... to lose that tool, and, and you have literally seen the milk go into your baby, and now you will not be seeing the milk go into them. I mean, how did that feel?
[00:54:41] Johanna Sargeant: It was scary, for sure, and I, I felt like I really needed to have... I mean, I am naturally a very anxious person anyway. I'm not a chilled out human being, so so I very much was on the ball as far as like what are the signs that he needs more, and Yes, that is very difficult when you don't have that instant gratification of, okay, this is how much milk went into my baby, so therefore they must be fine, right?
So I had to do all the stuff that, that we teach. I had to do, okay, can I hear swallows happening? Is he calm afterwards? And also he wasn't, you know, he was six months by that point, so we've not got that super tiny baby that is just sleeping all the time. He's going to be vocal if he's unhappy with the milk situation.
So very much like, is he calm after a feed? Does he seem satisfied? But well, I was really quite obsessive for the first two weeks or so of really making sure that his nappy output was, was good, and that one of the things I did, don't know how I feel about it in hindsight, but one of the things I did was I did not offer him any water when I first started solid food.
I was like, "If you are thirsty, then you are coming to my breast. That's all that I'm going to be offering you as far as fluid goes at the moment." And I was therefore having him at my breast quite a lot, but I could see in those first couple of weeks that we were doing okay and that my supply was doing fine, and it was stable, and he was taking in enough and was satisfied and happy.
Sleep didn't change. Everything was okay. So then I felt okay with, say, adding in the water and, and feeling a bit more relaxed about it.
[00:56:29] Emma Pickett: Yeah. I mean, that decision not to add in the water feels very logical to me. I mean, the way you phrased that, you made it sound like maybe that isn't something you'd do again, but that feels very sensible.
It wasn't like you were feeding on a schedule. If you were feeding responsively-
[00:56:41] Johanna Sargeant: Yeah ...
[00:56:41] Emma Pickett: and monitoring his nappies, that feels, that feels like a sensible thing to do. Um, yeah, I mean, thank you for sharing that and you're sharing your personal experiences around that. Um, so I'm thinking about, obviously we've got parents' anxiety, and we're thinking about how to help parents na- navigate using this, this equipment, and I'm also aware that some people listening to this will be breastfeeding supporters thinking- Mm-hmm
"This is scary for me as a professional. I don't want to go into interaction with a parent and not know what I'm talking about. I don't know how to have that very first time. How do I say to a parent, 'I've never used this before.'" You know, you're, you're a Swiss midwife. Let's take a leaf out of her book.
[00:57:17] Johanna Sargeant: Mm-hmm.
[00:57:18] Emma Pickett: How would-- How can someone use it for the very first time, and, and what would you recommend they buy if they want to put some stuff in their, in their bag?
[00:57:26] Johanna Sargeant: Yeah.
[00:57:26] Emma Pickett: What would be a f-first sensible purchase to get started?
[00:57:30] Johanna Sargeant: I would, like entirely just my own opinion, I would get maybe five NG tubes and five or more, eight, say, 20 ml syringes.
Have them in their pre-sterilized, prepackaged, ready-to-go little bags in your work bag. And What I would potentially do is make sure that you've got one of them that you've opened up, had a play around with, seen how does the syringe fit on the end, just got yourself some water and sucked it up and had a play around with how does this thing work.
See if-- I know it sounds weird, but one of the ways that you can play around with that as well is like stick the tube in your mouth and think, okay, if I-- do I need to press on the syringe or can I just leave, like rest my finger on the syringe? Or what happens if I don't push at all? And get a feeling of how fast things actually can flow through that tube as well.
That's the first thing is just like when there is no client around, that it is not a foreign thing for you. And potentially I wouldn't actually buy a full on device like one of these ones we talked about. I wouldn't do that yet. I would feel like it's okay to Give these more temporary ones to people and then fl- sh- show them where they can get these other ones.
It would be in my dream scenario if you've got infinite money that you would get one of each one so that you can also familiarize yourself with them and see how different they are and learn about how it might be better for different clients and different babies. The other thing for me would be when, when you then are with a client and you're thinking, "Hmm, maybe this is one of these scenarios where it might work, but I'm feeling quite nervous 'cause I've never done it before," then 100% be transparent.
I think that if you're at the point where you feel like this might work for this person, then there's already something about that person's situation that makes it feel like this would be a possibility. It wouldn't have even occurred to you if everything was completely falling apart with this family, that mother is, is a complete wreck, everything is a disaster, you wouldn't have considered it.
So if you're at the point where you think, "Okay, I might give this a shot", what I would suggest is that you say that to them. You say, "Look, I haven't done this before, but I've just learned about a new way of feeding. Can we-- Like, do you feel okay with looking at it together with me? And if you're interested in it, we can maybe try it out together, and you can help me figure out how this thing works as well."
And I do think, honestly, I do think that these new moms are so willing to help out supporters to become better at supporting other people as well. Yeah, for sure. So, so frequently people are like, "Yeah, let's, let's give it a try, and we are now a team as opposed to you teaching me how to do stuff." Yeah. And that is really strong, uh, like confidence build up for people as well.
[01:00:47] Emma Pickett: Yeah. I mean, actually that, that's a tip for any aspect of lactation support, isn't it? We're a team. I'm not the expert on high giving you this information and you're just the absorbing victim. I mean, we're a team working out lots of things together.
[01:00:59] Johanna Sargeant: Yeah.
[01:00:59] Emma Pickett: And that really helps the parent to feel empowered as well.
[01:01:02] Johanna Sargeant: Yeah.
[01:01:02] Emma Pickett: Um, lots of people in their training to become a breastfeeding supporter will have a very quick reference to an SNS and not much else. Are there any resources out there where people can learn more? Wh- where, where do you recommend people might go to do a bit more education on this?
[01:01:17] Johanna Sargeant: Um, the only place that I know is the thing that I do.
[01:01:23] Emma Pickett: Hey, this, you're here for a reason, Joanna. Tell us about the thing you do. Oh yeah. That's the whole point of you being here. You're showing your expertise. So you've got something online, have you- I do have something
[01:01:32] Johanna Sargeant: online ... that people can find?
[01:01:33] Emma Pickett: Yeah. Okay, cool. Tell us more.
[01:01:34] Johanna Sargeant: Um, I'm sorry, I'm uncomfortable plugging stuff, but here you go.
[01:01:36] Emma Pickett: Okay. Woman, come on. You're here to plug. You've got your expertise, and there's so little out there, so I'm really glad to hear you've got something that, that people can access. Yeah. Where will people find it?
[01:01:46] Johanna Sargeant: Um, and I do, I mean, that's why I did it, is that I feel like there, there is nothing else that is there.
So, uh, I do have... There's two options. I do have, uh, like a short, uh, one-hour presentation that I did with Gold that you can buy separately through the Gold website. Mm-hmm. That shows all of the different devices as well, and shows you what, like with case studies, what kind of device would work for which particular problem as well.
You can get that there separately. I think they also do it as a package with a bunch of other things, but you can find that there. Um, also I am doing, uh, with Babies in Common, there is Jeanette there does a lot of training about, um, pumping and about flange fitting, things like that, and she is doing a supply line presentation with me.
I think that's next week- Okay ... I believe that will be recorded.
[01:02:42] Emma Pickett: So by the time this goes out, this will definitely already exist 'cause this won't be going out for a few weeks, so.
[01:02:47] Johanna Sargeant: Right. So that will be, uh, like a three-hour- Wowzers. Okay ... really specific, uh, like I will be going through each of the devices, showing you how to put it together, again, case studies, and more of the science behind how that would actually work with building supply up.
How do we manage to figure out should we put pumping in, should we not put pumping in, all of the kinda nitty-gritty of it as well.
[01:03:12] Emma Pickett: Okay. So Babies in Common- Yeah ... Gold, we'll put those in the show notes. And if you're a parent who wants to find out more about it-
[01:03:19] Johanna Sargeant: Mm-hmm ...
[01:03:19] Emma Pickett: there are YouTube videos showing people using them.
[01:03:22] Johanna Sargeant: There are,
[01:03:23] Emma Pickett: yeah. With Jack Newman doing a homemade thing. It's a bit old now, and he's popping in the tube halfway through a feed. Yep. How do you feel about that? A baby's latched on, they're feeding, and you're tucking it into their mouth. Is that something you ever do?
[01:03:34] Johanna Sargeant: It is. I would prefer that they latch on with it in their mouth from the beginning so that we actually have it kind of at the nipple, and then the baby is latching.
But sometimes that doesn't work, and if that doesn't work, then yes, we kind of thread it in after they're latched. The tricky thing there is that you don't know how far that's gone into the baby's mouth. So one of the small things that I will do is on the tube itself, like about, say 10 centimeters back, I will put either a strip of tape or like a dot in a permanent marker just so that you've actually got something to look at to see how far has that gone into the baby's mouth.
And again, then we don't have such good control about is that above the tongue, below the tongue. But for some people, that absolutely works better. So try both ways. Yeah.
[01:04:26] Emma Pickett: Okay. I love the tip about the, the dot, uh, or the tape. That's super important. Mm-hmm. Thank you so much for your time today, Joanna. I'm aware you could have gone on for a lot much longer, and I am- Mm-hmm
so grateful that you, you've given your time to us. Is there anything we haven't talked about or any final words you want to give to someone listening to this going, "God, I'm so sick of triple feeding. Maybe I could do this SNS thing"? What would you want them to take away?
[01:04:47] Johanna Sargeant: Someone in that scenario, I think 100% just go for it.
I think anything that's gonna get you out of the hole and into a new phase of feeding that is going to potentially feel really good for you, then, then give it a shot, 100%. Uh, and I think as a supporter also knowing that that I have interviewed so many women as well that have used these systems, and to hear the stories from these women about how empowering it is to actually feel like, yes, they are breastfeeding, and yes, they are reaching their goal.
It doesn't matter what the milk is, their goal is to feed their baby at their body, and they feel like they have reached that goal. We know that that is so important for postpartum mental health as well, that they have that goal attainment. I think that we just need to start to talk about it more frequently, make it something that people know exists.
It's not this scary thing that maybe we're gonna introduce it the wrong way. Maybe it's gonna make people stressed. It's a bit too complicated. Doesn't have to be any of those things, and we just have to start to show it to people and talk about it more.
[01:06:02] Emma Pickett: Yeah. And give people the opportunity. Thank you so much.
I really, really appreciate your time.
[01:06:07] Johanna Sargeant: You are so welcome. Nice to see you.
[01:06:14] Emma Pickett: 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 Media.