Charlotte's story - a mastitis journey

This week I’m speaking to the lovely Charlotte Bowie from Oxfordshire, mum to nearly three-year-old Felix, about toddler breastfeeding, extreme sleep disruption (including split nights), and her struggle with repeated bouts of mastitis. Charlotte’s recurrent mastitis has spanned across nearly three years, including multiple antibiotic courses, a confirmed breast abscess drained via ultrasound-guided needle aspiration, and a later hospital admission with suspected sepsis. She also shares anxiety around breast lumps due to a family history of breast cancer. We discuss the updated mastitis guidance (avoiding vigorous massage and heat, using ice, anti-inflammatories, gentle lymphatic techniques, and managing hyperlactation/overpumping), and how a virtual consultation with breastfeeding specialist GP/IBCLC Dr Naomi Dow helped Charlotte self-manage and reduce recurrence as she continues to feed Felix. Charlotte would also like to acknowledge the support she received from La Leche League Oxfordshire. One peer supporter, Hannah, in particular was especially kind and supportive and sought advice on mastitis from the professional liaison team.

My picture book on how breastfeeding journeys end, The Story of Jessie’s Milkies, is available from Amazon here -  The Story of Jessie's Milkies. In the UK, you can also buy it from The Children’s Bookshop in Muswell Hill, London. Other book shops and libraries can source a copy from Ingram Spark publishing.

You can also get 10% off my books on supporting breastfeeding beyond six months and supporting the transition from breastfeeding at the Jessica Kingsley press website, by going to https://bit.ly/JKPbooks and using the code MMPE10 at checkout.

Follow me on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com 

Resources mentioned

Find Dr Naomi Dow at https://drnaomidow.com/ and on instagram @‌drnaomidow_bfmed

The new mastitis spectrum guidance can be read at https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/36-mitchell-et-al-2022-academy-of-breastfeeding-medicine-clinical-protocol-36-the-mastitis-spectrum-revised-2022.pdf

Charlotte would also like to mention that she received some great support from La Leche League.

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

Transcript

This transcript is AI generated.

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

Join me for conversations on how breastfeeding is amazing and also sometimes really, really hard. We'll look honestly and openly at that process of making milk, and of course, 

breastfeeding and chest feeding are a lot more than just making milk 

Thank you very much for joining me for today's episode. I'm going to be talking to Charlotte Bowie from Oxfordshire, who is the mother of the lovely Felix.

And as you'll have seen from the title of the episode, we're gonna be talking about mastitis, and I called it a mastitis journey 'cause you definitely have been on a bit of a marathon slog, Charlotte. 

[00:01:06] Charlotte: Mm. 

[00:01:07] Emma Pickett: Thank you very much for joining me today. You're feed, still feeding Felix, and he is two and a half-ish, nearly three-ish.

[00:01:14] Charlotte: Yeah. 

[00:01:15] Emma Pickett: Let's start with the toddler breastfeeding 'cause we always love to talk about that first of all. Tell us what a typical 24 hours is for Felix. 

[00:01:22] Charlotte: Well, you, you nailed it in your video on Instagram recently, um, where you kind of described the typical toddler feeding day. But basically, he goes to nursery four days a week.

Um, he doesn't obviously feed during the day. Um, although that's another story, 'cause I did actually have to feed him a couple of times at nursery to get him settled when he first started. But generally, he will not feed ... I try not to feed him in the morning. He'll go to nursery, and then he'll come home, and immediately as we're walking home from nursery, he'll say, "Feed, feed, feed sofa, feed sofa."

So we have to sit on the sofa, and he wants to feed, and then he says, "Lie down, lie down". And he likes me to lie down. He's very, very bossy. And then I will try and sort of ... I put a limit on it, so I've started introducing some boundaries. So I do a timer. I go, "Count down from 10", which sometimes if he doesn't want it, he says, "Stop".

But generally, he'll be quite happy with, um, count down, and then he'll have a snack of actual food. And then he'll have his dinner, and then he'll, and then he'll go to bed. But I do always feed him to sleep. I've done that every single night, um, of his life except for one night last week when I was away, um, for the first time.

But, and then he'll sort of feed, um, to sleep, and then he'll sleep. He lately started doing a five-hour stretch of sleep for the first time. Sometimes it's only four, sometimes three hours. And then he'll wake early hours. He'll feed. I'll have to go back ... I'll have to go through to him. He's on a floor bed.

Um, I'll go through to him, feed him back to sleep. And then from about 5:00 AM, he's just constantly feeding, which is very hard for me then to sleep because he's just going between breasts. And he'll do that until he wakes up about half past 7. 

[00:03:00] Emma Pickett: Okay. 

[00:03:00] Charlotte: And then we're back. 

[00:03:02] Emma Pickett: Yeah. So some people listen to that like, "Well, hang on.

He's nearly three, and he's only just about sleeping for five hours?" Yeah, that really can happen. That really isn't unusual. Um- Yeah ... and obviously parents can make any choice that feels comfortable to them, and some of them will not want to do that and will try and night wean, and, and they have every right to do that.

But that is not an unusual pattern for a child who's breastfeeding at nearly three Couple of quick questions. You went away for a night. 

[00:03:27] Charlotte: Mm. 

[00:03:28] Emma Pickett: First night you went away, how did that feel and how did he manage without you? 

[00:03:32] Charlotte: He managed okay, although he didn't go to bed till quite late and fell asleep on the sofa in the end with my husband.

And then he did go to bed, but then he was up in the night for like an hour, which he gen- he does do split nights still. So, so my journey maybe is not typical. I don't want to scare people to thinking this is normal because it's been absolutely exhausting. But sometimes he'll be up for two or three hours in the night just playing 

[00:03:56] Emma Pickett: Oh, crikey.

That's rough, Charlotte. It's 

[00:03:58] Charlotte: rough. I'm so sorry 

[00:03:59] Emma Pickett: to hear that. And you, oh, you are working, let's just clarify that. 

[00:04:02] Charlotte: Yeah, and I teach, so it's hard. Oof. I have, have to, like, teach a class on, like, four hours sleep. I work for the NHS, but, um, it's been extremely hard. 

[00:04:11] Emma Pickett: So those split nights, two or three hours of a split night in the middle of the night.

[00:04:15] Charlotte: Yeah. 

[00:04:16] Emma Pickett: Oh, gosh. I mean, I'm guessing you've, you've talked to everybody you can possibly talk to at this point, but- I've talked 

[00:04:21] Charlotte: to everybody, yeah ... what, 

[00:04:22] Emma Pickett: what's the ... So you've, you've ruled out sleep pressure issues. He's not having a big chunk of sleep in the day. It's not about too much daytime sleep. There's nothing else going on with him health-wise.

[00:04:32] Charlotte: No. I mean, I've, I've, I've spoken to sleep consultants. He does, um, still sleep at nursery for a nap, but that's only for an hour. But actually, interestingly, people keep saying, "Oh, you need to k- cap ... You need to stop the nap. You need to stop the nap." But the problem is if I stop the nap in the day, he'll then go to bed really early, like 6:30, 7:00, and then he'll definitely be up because he's had his sleep.

By the time it's 1:00 AM he's wide awake and ready and up. Yeah. So that's worse. 

[00:04:59] Emma Pickett: Yeah. It sounds like he's a low sleep need bloke, doesn't it? 

[00:05:02] Charlotte: Yes, 

[00:05:02] Emma Pickett: he is. And, and, and, uh, and he's, you're only gonna get that block of so many hours, and you've got to play around with maximizing when those hours are as to when you want them to be so you can sleep yourself.

[00:05:13] Charlotte: Yeah. 

[00:05:13] Emma Pickett: Um, what do you do during a split night? What's your response to that when it happens? 

[00:05:17] Charlotte: It's incredibly hard, and I feel a lot of shame, actually, around this because, uh, there's ... So sometimes he'll want to watch television, and I let him because I think, well, if I'm not, you know, otherwise he'll just be up playing or whatever.

But actually if I do maybe put on, um, like In the Night Garden or something gentle, then it maybe does make him a bit more tired rather than playing around with his toys and stuff. But he'll be, you know, he's, he's, he'll be demanding Shreddies, you know, cereal, all sorts at that time, which I, I'm trying to put boundaries in.

But it's really hard with a floor bed because when they're on a floor bed you can't keep them in a cot, you know? We- Yeah ... he's never been in a cot because he just used to try and climb out of it and it was awful. But floor beds, he can just get up and roam around, and I can't stop him really. He's quite determined.

But yeah, I do feel quite a lot of shame. People say, "You mustn't let him do that. You must keep him in his bedroom." And it's like, well, have you tried to keep a very strong almost three-year-old in their bedroom when they want to get out and play? It's quite hard. And you're, 

[00:06:14] Emma Pickett: and you're tired as well. It's not like you're at peak efficiency.

Um- 

[00:06:18] Charlotte: No ... 

[00:06:18] Emma Pickett: how often do you get split nights like that? 

[00:06:20] Charlotte: To be honest, like, it happened last night for my hus- uh, last week for my husband when I was away. But generally it won't happen that often anymore. Maybe, like, a couple of times a month. 

[00:06:30] Emma Pickett: Okay. 

[00:06:30] Charlotte: Um, yeah. 

[00:06:32] Emma Pickett: Still, that's too much. Yeah. Oh, gosh, gosh. Hard. Okay.

Thank you very much for sharing that. We've probably lost half the people who are terrified- ... and don't want to listen to anymore. This is the equivalent of a horror story for someone breastfeeding- That's my concern ... a toddler. But know what, you say that, Charlotte, but actually I do think it's really important that people hear not only what amazing women are doing and how- Mm-hmm

they are doing all this stuff that's incredibly hard while also functioning and having jobs. Mm-hmm. But also, let's not rose tint toddler breastfeeding. Let's not, you know, even though- Yeah ... I talk about it positively, who do we benefit by pretending it's all lovely and wonderful, and your, your lovely toddler with all these super-duper antibodies will be going to sleep at 7:00 PM and waking up at 7:00 AM.

No, there is a downside to this. Yes. Let's not pretend. You are giving something and sacrificing something, and quite often people are losing sleep and having a really tough night's sleep, and that is part of the story of, of continuing to breastfeed. It's not all roses and bluebirds and meadows. It's, it's- No

rough. 

[00:07:29] Charlotte: It's really rough. 

[00:07:30] Emma Pickett: Yeah. It can be really, really hard. And what do you do to kind of get through that? Obviously, you have chosen to continue breastfeeding. Have you had moments when you've come close to stopping? What, what's your kind of thinking around this? 

[00:07:43] Charlotte: Yeah, many moments. And actually, I've been told by a lot of professionals to stop breastfeeding.

[00:07:47] Emma Pickett: Because of your mastitis history that 

[00:07:49] Charlotte: we'll talk about- Yeah ... in a minute. Yeah. So most of the people I've seen about mastitis have said, "You need to stop feeding," because I kept getting mastitis, but also because I wasn't sleeping. Because when you talk about mastitis, you don't just talk about mastitis.

You talk about sleeping. Everything feeds into it because they all just, you know, it all does. And I never planned to breastfeed this long, really. It's just it was the only way of getting him to sleep In a way, sometimes I wished I wasn't breastfeeding, and I wish I never started breastfeeding. I'm so

Sometimes I felt jealous of people who, you know, they say, "Oh, my baby slept through from the beginning because my husband could give him the bottle," and I wish I'd have done that. So it's not always been great, but actually it's kind of a short ... In the, in the length of my life, it's kind of a short term, a short amount of time really.

[00:08:33] Emma Pickett: Yeah. I mean, that's how you kind of survive it, isn't it? Yeah. By thinking, you know, I've got socks that are significantly older than this, this period of time. And, but yeah, no, I thank you for being honest about that, Charlotte. I think it is helpful for people to hear how, how tough it can be. And I guess there's a world where the alternative u- universe of you not breastfeeding Felix, he could be a little bloke that needs seven hours of sleep at night, and, you know, you could still get split nights, and you don't even have the sedatives to be able to get him to sleep.

Yeah. And he's even h- more sleep resistant. So we don't know what life of a non-breastfeeding Felix is like. And I think it, I guess it's also important not to idealize that, and to imagine that he'd be fixed if you weren't- Yeah … breastfeeding him. Actually, potentially you might have been losing a tool, um, which I guess is the reason why you have continued, because that, losing that tool feels like a risk.

[00:09:20] Charlotte: Yeah. And, and you talk about that a lot in your podcast, and that's why I started re- listening to your podcast because you talk about, before you even start talking about weaning, you talk about it's not gonna fix everything. You know? It doesn't mean that they're gonna suddenly sleep through the night.

[00:09:33] Emma Pickett: So you're obviously continuing to breastfeed right now, and you don't have particular plans around your weaning journey, or, or what are you thinking about when the ending will come? 

[00:09:40] Charlotte: I'd like it to come now, but I'm just waiting for him really. And he is what they might call a booby monster. You know, he's, he's very keen on feeding.

And I think I've kind of given up on trying to wean really. I did start reading him your book, um, Jessie's Milkies. But, um, he, he thought that was a very fun book, but I don't think he saw the connection between breastfeeding. He just liked Jessie's, The Book of Jessie, as he calls it. And I've been to breastfeeding support groups, you know.

I've got in touch with peer support workers to talk about it. I've bought your, you know, I've bought several books. I've listened to podcasts. But I'm getting to the point where I've now got to start thinking about potty training, and I don't want to do that at the same time as ending breastfeeding. 

[00:10:22] Emma Pickett: Yeah.

That, I think you're right to point that out. I think, I don't think that's a great combination because actually potty training is all about agency. Yeah. And if, if you're pulling agency away from another area of their life, they're, they're potentially gonna push back. So yeah, may- it sounds like maybe potty training first.

It sounds like you've got a little bloke with some strong feelings who doesn't hesitate- Yeah … to say what he wants. Um- No … and when you do choose to do parent-led weaning, if that's what you do choose to do, a huge amount of this is gonna be you giving yourself permission- Mm-hmm … to hold boundaries in the face of a cross little Felix.

Um, um, you know, we can't necessarily remove his desire for breastfeeding as I'm, as I'm sure you know. And- But I guess it depends on what your motivation is and, and how determined you feel and, and how able you are to support him through. Sometimes when we're really tired, we're least able to n- to wean, ironically, 'cause that's, we haven't got the capacity to do it, so we need to have the capacity to be able to do it in the first place.

When you were away the other week, did you get a night's sleep yourself? Did you sleep the whole night? I did, 

[00:11:18] Charlotte: yeah. I slept, I slept for the first time, and actually I'm really pleased that people are talking about the fact that there are some parents who literally have never had a full night's sleep since their baby was born.

And it's not like he slept through a few times, it's like literally- Yeah ... I have never slept through. Or he has never slept through, and therefore I have never slept through since he was born. So for the first time in almost three years, yes, I slept from 11:00 till 7:00. Uh, no, 11:00 till 6:00, sorry. And my, um, smartwatch that tracks my sleep got very confused and said, "You had an unusual night's sleep last night."

[00:11:53] Emma Pickett: Excellent. Yeah, I mean, some, there's obviously loads of myths around, oh, you should wean just by going away. Go away for a few nights, and then that's how you wean. As, as you'll know if you listen to any of my material, I don't believe that works. No. And I believe there's a huge downside to that because we don't get to practice parenting without breastfeeding.

But it literally doesn't work. But having said that, going away for the night to give you s- give yourself the energy and the respite, and maybe that means you will have the capacity to put some boundaries in place, is, is not such a bad idea. So I have sometimes advised people to go away for a couple of nights before they start weaning, just so they've got the energy to do that.

But it's not that, going away isn't actually the, the weaning. Uh, just to state the flipping obvious for anyone who doesn't, doesn't know my stuff. Thank you so much for filling us in with Felix. Let's talk a little bit about your mastitis journey. So you have had mastitis constantly- Yeah ... throughout the whole time you've been breastfeeding.

[00:12:46] Charlotte: Yeah, yeah. 

[00:12:47] Emma Pickett: Every few months, is that the case? 

[00:12:49] Charlotte: Um, yes. Yeah, so I had it first of all when he was about a few weeks old. Maybe he wasn't quite, maybe he was a little bit more than that. And then up until the last episode was about a month or two ago. And yeah, I've had it, I've had, um, mastitis, but I've also had an abscess.

Um, and I've also ended up in hospital, um, with suspected sepsis. 

[00:13:09] Emma Pickett: Gosh. So we'll talk through your history- Mm ... but let's just talk about the darkest moment for a minute. Mm-hmm. So when you had the abscess, possible abscess diagnosis, you are- hospitalized, you're on a drip, IV 

[00:13:20] Charlotte: antibiotics I wasn't at that point actually.

So the-- Actually, sorry, there were two episodes when I had a query abscess, yes, and I was on a drip, and that's when they thought it could be sepsis because I was very, very unwell, and they thought it was an abscess. That turned out not to be an abscess, but I was on a drip. The time before when I did have an abscess, a confirmed abscess, yes, I, I thought it was a breast lump.

You know, I was worried about breast cancer 'cause I have a family history of breast cancer. My mum died of breast cancer. 

[00:13:48] Emma Pickett: Yeah. I'm so sorry, Charlotte. That's-- I'm get- wondering whether that's an added element into why you haven't weaned because you're aware of the link between breastfeeding and reducing risk.

[00:13:57] Charlotte: Yeah, exactly. And I did speak to, um, Naomi, who I'll talk about shortly, about that. But absolutely, I-- So I've been seen quite a few times at the, um, hospital for, you know, around breast lumps, and they're very good. They check them out. They always ultrasound them and everything. Um, and this time I saw, um, a doctor, actually.

She was a breast surgeon, and she said, "I think this is an abscess, breast abscess." And it was. It was a very big one, and it had to be drained under, uh, ultrasound guidance. But it was very weird 'cause I went there with my small baby, he was only a few months old. Went up to the hospital just thinking, "Oh, I was just gonna go and be told to go home again."

I was just there for an appointment really just to review the lump. I just thought, "Oh, they'll just say it's a benign lump. I've had loads of them before." So I just took my little baby, you know, and then I was there the whole day having to flip between, you know, the outpatients to the ultrasound department back again, trying to manage a small baby and breastfeed with an abscess was very hard

[00:14:51] Emma Pickett: Yeah. So actually, I think that's really valuable. I know we're jumping around a bit here with the timeline, but I think- Yeah ... actually it's really valuable to hear people understand that abscesses are not always painful. 

[00:15:00] Charlotte: No. 

[00:15:01] Emma Pickett: Th- when you look online, people are like, "Abscess, painful lump under the skin." Yeah.

No, actually, they can just feel like a, a bit of firmness in the breast and, and not even as painful as a blocked duct. They can be completely pain-free, and as you said, even a large abscess can potentially be p- be painless. So, so any unresolved lump obviously should always be checked, um, f- for cancer reasons, but also because it potentially could be an abscess that hasn't been detected yet.

Tell us about ultrasound needle aspiration for anyone who doesn't know what we're talking about. So if anyone's a bit squeamish- ... put skip on a few minutes- ... 'cause we're gonna, or look at the transcript to work out when you can rejoin us. Um, tell us what that feels like and what that actually is. 

[00:15:42] Charlotte: So yeah, it's, they do an ultrasound of your breast.

So, you know, like, when you have a, you know, when you're pregnant, they use the little probe, and they, um, they check over. Sim- so they do that when you have any l- breast lump, and they check to see, they have a look to see what they, what, what's in the tissue. And then because the, as I understand it, I'm not a doctor, um, but as I understand it, because the breast abscess, um, the breasts are very delicate, the tissue is very delicate, so they need to get it really accurate.

So they have to use ultrasound guided practice, so they're, they're sort of guiding where it is with the ultrasound whilst then ac- using a needle to remove the fluid. And the fluid is very, very thick. Like, I think it's, like, very thick, bloody fluid And they do ask you if you want to see it or not. I did want to see it.

I'm a nurse, you know, I can kind of cope with these things. But yeah, they, and it won't- they don't always just try to remove it over one appointment. Sometimes it has to be seve- well, in my case, several appointments, and they were just removing, you know, bits every now and again. But also they need to check the fluid to see what antibiotics, if, if you need antibiotics at this stage, which often you do at this stage, which antibiotics it's gonna respond to.

So they send it off to the lab. 

[00:16:50] Emma Pickett: Okay. So for anyone who's not familiar then, an abscess is a, a section, a section of the breast that is walled off. There is pus inside that area. Um, it doesn't have a lot of blood vessels running through it, so you can't just chuck antibiotics at it. You also need to give the body a chance by removing some of that, that fluid.

And needle aspiration means that using the ultrasound, the needle will be put into your breast, and when it hits that pus, then, then the needle is, you know, the syringe is, is drawn and that fluid is gonna come out. Um, and some people will not be able to have an abscess treated with needle aspiration- Mm

because the abscess is too big. In the UK, I very rarely meet someone who has a surgical incision and an abscess sometimes even left open, um, and the wound is packed. Usually in the UK they will try needle aspiration first and of- as you say, often several times, not least because the, it can refill again.

[00:17:48] Charlotte: Yeah. 

[00:17:48] Emma Pickett: Did they give you a sort of centimeter diameter of how big the abscess was? 

[00:17:52] Charlotte: Yeah, and I'm trying to find my notes and I can't. Um- Hmm. I wrote some notes for when I met with Naomi, but I can't find how big it was. 

[00:18:05] Emma Pickett: But obviously- Yeah ... the si- the size where they felt a needle aspiration was still worth trying.

So, um, and then you had to go back on several days, several days in a row, 

[00:18:13] Charlotte: or over- Yeah. I th- I think it was several weeks. I went week after week because also they wanted to check if the antibiotics were working, and at one point they gave me antibiotics that they felt weren't the right one, so then they gave me a different course.

And it, eventually it did clear up, but it took quite a while. 

[00:18:29] Emma Pickett: And some people have an abscess that's close to the surface of the skin, and it can sometimes erupt through the skin. This is the bit- Mm ... where I hope the squeamish people have, have, um, skipped. Um, but that obviously, that wasn't the case for you.

It was, it was deep enough that that wasn't an issue. And you carried on breastfeeding on that breast? 

[00:18:44] Charlotte: I did, yeah. And oh my goodness me, I have to say at first, so I think I have quite a high pain threshold, I've realized. I've had various things happen to me in the past where I've had a lot of pain, and I gave birth without any pain relief at all, actually, not even gas and air.

So I think I've probably got quite a high pain threshold. But the pain of feeding through mastitis is unreal, um, at times. And through an abscess, I think I was just so used to it at this point that I just got used to it. And I think it was only my husband said, "Oh my goodness, your, your breast is really red.

Like, is it okay?" And I was like, "I don't know." And that's when I went, and they said it was an abscess. Um, but actually the pain I think was bad at that point, but I just got so used to it. 

[00:19:25] Emma Pickett: Okay. Oh dear. Oh, that sounds really rough. Okay. Okay, let's try and go do some chronology. Yes. Let's 

[00:19:31] Charlotte: go back 

[00:19:31] Emma Pickett: to, let's go back to the beginning.

So, so when you had Felix, you mentioned that you're a nurse. Was breastfeeding something you absolutely knew you were gonna do without question? What was your relationship to breastfeeding? 

[00:19:41] Charlotte: No, I mean, I thought it's just what people did. I mean, I'm one of four children, one of four girls. Unfortunately, as I said, my mother died, and she died when I was in my sort of early 20s, so I never got an opportunity to talk to her about that because I wasn't interested.

I never thought I'd even wanted children, to be honest. I was very, you know, wasn't sure. So I didn't have my first baby till I was 35, 36. Well, he is my only child. I say first. Um- And I never knew if that's something I really wanted to do. But when I got pregnant, I thought, "Yes, I think that's, you know, breastfeeding sounds like it's a good thing."

I've always presumed it would be quite ... It ... I've got quite big breasts, so I thought it would be easy. I thought, you know, no problem. And yeah, I went to hypnobirthing classes, and they talked a bit about breastfeeding. So yes, I was, I was sure that's what I probably was going to try. 

[00:20:26] Emma Pickett: And tell me about your birth and early breastfeeding journey.

[00:20:28] Charlotte: Yeah. So the birth was really nice considering how anxious I was about, um, giving birth. So I went to, you know, antenatal education, and that often every- talk- everyone talks about this, that you're so focused on the birth, you skip past the bits where they talk about breastfeeding 'cause to be honest with you, it's, it's so alien at that point.

But it ... I had a, a really nice birth. I was very lucky. I know I was very lucky that I gave birth in the pool, and it was all very calm and natural, and, um, I just went into this sort of very zen-like state. I didn't really talk. But unfortunately, then my placenta got stuck, so I had to have manual removal of my placenta, which was very frustrating.

So you have to have, um, in order for them to pull it out manually, you have to have a spinal block, um, because obviously otherwise it's too painful, which meant I then had to stay in hospital. And of course, he did latch. When he first came out, he did sort of try and latch, but I think he struggled And then when I was waiting, there was a bit of hoo-ha around getting me to surgery and waiting for someone else to come out.

So I was sort of shoved in this, like, room at the bottom of the hospital waiting, and I was trying to breastfeed. I didn't really know what I was doing, but I was collecting colostrum syringes. So I was just giving him c- like, little syringes of colostrum in the hope that it'll be okay. And then I had to stay overnight, and unfortunately, you know, there's not many midwives on, on, um, postnatal wards.

It's mainly nurses, and they were just sort of, you know, they just put him on your breast and b- hope that he might, you know, feed. It was all a bit random. No sort of specific education or, or advice. And it was only when I got home, I literally just remember, like, being in the bedroom thinking, "What on earth am I gonna do?

Like, I don't know how to feed this, this child. Like, I can't feed him. I've got some syringes of colostrum. I'll just give him that." And it was the next day when the midwife came round, and she did properly show me how to feed, and that helped. It wasn't obviously resolving the whole thing 'cause I went on to have many challenges, but that really helped to establish breastfeeding.

Yeah. And then, um, I was also lucky. I used to work, um ... So I'm a mental health nurse, and I used to work in a perinatal mental health team. Um, and so I had a few contacts who were breastfeeding, um, specialists, one of which was, like, a support worker. And sh- we did some video calls, and she helped me kind of latch and stuff.

But then she felt that the problems I was having were too much for her, um, remit. So that's when I went on to see another professional. But yeah, really difficult at first, and I just thought, "I don't know what all this is about." 

[00:22:55] Emma Pickett: Yeah. Okay. I'm sorry to hear that. Um, Charlotte, that sounds rough. So, and you talked about your first episode of mastitis being in the early weeks.

So It sounds as though issues were coming up pretty early on. I mean, t- talk us through that very first time. I'm not expecting you, by the way, to remember every single episode of mastitis in detail, but, but talk us through that very first experience, if you remember. When did things start to kind of start to develop?

[00:23:22] Charlotte: Yeah. So I've just looked at my notes. He was five weeks old, and I started just becoming really unwell. I had really, um ... I was shivering. I was very cold. I was in bed. I ... The pain of feeding. And I'd had a lot of pain with feeding before because his latch was poor, and I ... He ... It turned out he was tongue-tied, and we had the, um, tongue tie removal.

So he'd always had a very poor latch, so I thought it was just like that. But actually, I was ... It was very, very painful. It was like toe-curlingly painful. I was getting hot. I was shivering. Um, I had a lump, and I just felt very, very unwell. As in, no, just the only way you can describe it is you just feel very unwell.

[00:24:00] Emma Pickett: So your body did not mess around. You went quite quickly then, didn't you, to ... I mean, there- Yeah ... people talk about, you know, you have a blocked duct first. You might have a bit of engorgement. You know, it's a kind of gradual onset. But you- Yeah ... you seemed to go full-on whole body response quite fast. 

[00:24:14] Charlotte: I did, and actually, but actually what I think is that previo- prior to that, I think I probably had problems but not really known that's what it was.

I probably did have lumps 'cause I also do have a benign breast lump anyway, which has been monitored for years. So I just thought it was like that, you know. I didn't- 

[00:24:31] Emma Pickett: Okay 

[00:24:31] Charlotte: So I prob- on hindsight, I probably did have a lot more going on than I knew, and I didn't really know what mastitis was. I just, I just thought mastitis was when you start getting really hot and sweaty and, you know, and really unwell, so

[00:24:42] Emma Pickett: And possibly with your high threshold, you had some blockages that maybe you didn't, you know, had blocked ducts anyway. We, I mean the- Yeah ... blocked duct is not a helpful term because it implies that there is a physical blockage in a duct, which isn't always what we're talking about. Um, but what we d- when we say blocked ducts, we normally mean inflammation before the onset of full symptoms.

But potentially you did have some tenderness and inflammation without having noticed those, those full symptoms. 

[00:25:06] Charlotte: And I think what I probably did instinctively at that point was try and massage it out and stuff like that because I thought, "Oh, maybe this isn't ..." You know, it's hard to remember all this stuff, but I think I probably did try and do some things which probably didn't help, and that led to me getting this full-blown mastitis 

[00:25:21] Emma Pickett: Yeah.

So, so I know I'm gonna tell you stuff that you know already, Charlotte, but let's just say it for anyone who's not familiar. Breasts have lumps in all anyway. Everyone's breasts have got lumps in. Mm-hmm. Our glandular tissue, our lumps, the grape-like structures, the alveoli, the lobules will feel lumpy. So I think one of the most important things people can do when they start breastfeeding is get to know what their breasts are like anyway.

Um, and obviously we should continue doing breast checks throughout our lactation experience. And sometimes when people feel a lump, they will Google and they will get pulled into some old blog or old article that talks about what we used to do for mastitis. So everything changed in roughly 2022 when the Academy of Breastfeeding Medicine brought out their new protocol about the mastitis spectrum.

When I first trained as a lactation consultant even, let alone as a breastfeeding counselor, we were talking about vigorous massage. We were talking about vibrating toothbrushes. Yeah. Told, told, yeah. Really, really, really getting in there, in adverted commas. Yeah, yeah. Um, hot compresses on the breast, heat, baths and showers, get in there with the toothbrush.

[00:26:23] Charlotte: Dangle 

[00:26:23] Emma Pickett: feeding. Because pe- yeah, dangle feeding. Yeah. Yeah. People were perceiving that there was a blockage in the breast, and if you could just shift it with your clever massage technique and push it out, the breast would suddenly be fine again. Mm. And, and we ... And it's, it's bizarre to think actually what we, what we thought mastitis and blocked ducts were.

You know, we were literally trying to push around imaginary bits of fatty 

[00:26:48] Charlotte: milk. 

[00:26:49] Emma Pickett: Mm. Rather than realizing that we were dealing with an inflamed organ that's a very sensitive inflamed organ, and the last thing we do when you've got inflammation of the knee is vigorously massage your knee and put an electric toothbrush against it, or put heat on it But that's what people were doing.

So you were alrea- even three years ago, you were, well, you were probably just on the cusp of that new information coming out, so it wasn't necessarily disseminated everywhere. You were get- Yeah ... you were getting that old advice about vigorous 

[00:27:13] Charlotte: massage. Yeah. And that's what gets passed around through, you know, WhatsApp groups of, um, people you met when you're, you know, NCT people you met when you're pregnant.

That's the advice people are passing about because someone will hear that from someone, and they'll pass it on to someone else without realizing there's updated protocols. 

[00:27:28] Emma Pickett: Yeah. Yeah. And now the information that is, as I said, based around research, and this protocol has now been disseminated around the world.

So the Breastfeeding Network website, the Association of Breastfeeding Mothers will now all be, you know, if you phone the National Breastfeeding Helpline, you're gonna talk to someone who is responding to this protocol. So we are not putting heat. I mean, occasionally- No ... it might help with comfort, but heat is not gonna be a treatment for mastitis, and we are certainly not vigorously massaging.

We are doing very, very gentle, gentle massaging. Light sweeping, the protocol says. Yeah. Like you're stroking a cat. Someone described it as... Yes. W- Yes ... I know. Where did that stroking a cat thing come from? 'Cause I couldn't see it in the protocol, but I like that phrase. 

[00:28:08] Charlotte: It's on a video about lymphatic drainage that actually was shared with me by a professional.

So it's like, yeah, as if you're stroking- 

[00:28:16] Emma Pickett: Yeah ... a cat. And, and people used to, like, get their thumbs and really press into the inflamed tissue, and now we're like, "No, no, no. Light sweeping because you're doing lymphatic massage." Mm-hmm. But you are not, you're not trying to push around a blockage. You're not trying to pop something so suddenly your breast gets softer.

That, that firm breast is a breast that is responding to all sorts of congestion, and there's all sorts of additional fluids in there. They're not gonna go away 'cause you push your thumb in a particular position. And we're also rethinking completely what caused mastitis, which- Yeah ... we'll come on to talk about.

It was very much Some people get, get inf- non-infective, but then bacteria comes along and it becomes infective, and most people in the UK are given antibiotics for mastitis. Mm. And I remember when I was first training, people would say, "Oh, in Italy or in Spain or in, you know, in France, you don't often get antibiotics."

And I was thinking, "Well, what are they doing differently?" It's odd 'cause in the UK if you go to a doctor, standard you'll walk out with a prescription for antibiotics. Yeah. That is v- very much normal because we think that that firmness must be bacteria related. But as we'll go on to talk about, there's a, there's a lot more going on.

So, so first time round then you are vigorously massaging, you're using- Yeah ... your hot compresses. Yeah. And did you get antibiotics in that 

[00:29:27] Charlotte: case? Yeah. So called the out... Sunday night, called the out-of-hours GP. She said, "Yep, sounds like mastitis." I w- and I think because I am a nurse, and I'm, I'm quite into sort of like evidence-based interventions, so I'm sometimes a little bit convincing, I guess.

So if I think I know something, I can sound quite convincing about that. And then I will, you know, the doctor's like, "Yes, you know, it sounds like you know a bit what it is. It sounds like mastitis. I'll give you some antibiotics. Can your husband come and collect them from the pharmacy?" So, you know, off he went and got these antibiotics, and lo and behold, it clears up, you know, quite quickly, which, um, I later learned that that's probably not the antibiotic effect that's happening there.

[00:30:02] Emma Pickett: But antibiotics also have a natural anti-inflammatory 

[00:30:05] Charlotte: effect. Anti-inflammatory, 

[00:30:06] Emma Pickett: yes. So lots of people will feel a resolution with the antibiotics- 

[00:30:09] Charlotte: Yes ... 

[00:30:10] Emma Pickett: but not because bacteria is being killed. Exactly. Because either it's time or the natural anti-inflammatory effect. That's one thing we're learning. 

[00:30:17] Charlotte: Yeah.

[00:30:17] Emma Pickett: I know I'm telling you stuff you know, but let's say it out loud for anyone 

[00:30:20] Charlotte: else who's listening Oh, yeah. No, 'cause I think this is so important. And I'm, I really get excited about telling people this stuff now because it's not ... You know, antibiotics can take several days to work. You know, so if they work very quickly, it's not the antibiotic effect that's happening.

But what I still am a bit unsure about, and I don't want to give ... I don't, I don't want this, people to get confused and get very unwell and end up, you know, with serious infection. I'm still not sure at which point someone does actually need antibiotics. 'Cause you do ... There are some people who are more susceptible to, to bacterial infections, so they might need antibiotics.

[00:30:52] Emma Pickett: Yeah. And I'm also not a doctor, so that's g- not gonna be my, my call either. But what I will say is, um, we ideally want someone who's gonna be looking at the whole story, because if you get recurrent mastitis- 

[00:31:03] Charlotte: Yeah ... 

[00:31:03] Emma Pickett: um, you know, if you take antibiotics the first time because we're belt and braces and we're, we're worried about someone with a high temperature, and we're worried about someone who's feeling unwell, you know, we don't want anyone to get sepsis.

We don't want anyone to be seriously unwell. We don't want an abscess to develop. 

[00:31:17] Charlotte: Yeah. 

[00:31:18] Emma Pickett: You know, I don't think that, that anyone's gonna consider that a bad thing. But if someone's getting ma- mastitis every few months throughout their lactation experience, then we need to be looking at things a little bit more deeply.

I mean, my gut feeling, and this is what we say on the National Breastfeeding Helpline training, is if, you know, if someone has the presence of pus in their milk or around the nipple, that's obviously indicative for, for possible antibiotics. Um, if someone does have a very high temperature, that suggests their body is fighting something.

But ultimately, this is gonna be a decision for, for a doctor at the end- Yeah ... of the day. Um, and as you say, sepsis is what we want, we're worried about. So, so the s- symptoms of sepsis will obviously be feeling very unwell, potentially having issues with your regulation of your temperature. Do you remember what you were feeling in those moments?

If s- if someone's only gonna listen to the first half of this, and we want them to just hear what, what the symptoms of sepsis are, what would, what would you say? 

[00:32:11] Charlotte: Um, so yeah, very, very ... So I can remember, um, one time when I did end up in hospital with it, it was ... We were going through a heatwave last summer, and it was, it was the hottest day of the year, literally.

I was under three duvets on my bed. Yeah. I was so cold. I couldn't get warm. Um, I got up, I fell over. I was very dizzy. I couldn't, I couldn't wee, and I felt very sick. 

[00:32:31] Emma Pickett: Yeah. 

[00:32:32] Charlotte: So that was kind of what worried, you know, the doctors, and that's when I got, um, you know, went straight to A&E 

[00:32:38] Emma Pickett: Yeah. You might also have issues with your breathing or be breathing very quickly.

You might also have blotchiness in your skin, depending on- Mm-hmm ... what your skin tone is. And then not making sense. I mean, in very severe cases, pe- people might even have slurred speech or acting confused. Yeah. So we obviously want the partners of breastfeeding folks to also know what sepsis looks like as well.

[00:32:59] Charlotte: Yes. 

[00:33:00] Emma Pickett: And, and then, you know, it's, it's, it's super scary. It's obviously ... And in some severe cases it can even be life-threatening, so- 

[00:33:06] Charlotte: Yeah ... 

[00:33:06] Emma Pickett: we d- we don't want to mess around. So the message of this, of this episode is not, "Hey, guys, never take antibiotics." Yeah. You know, you know, dance in a meadow and, you know, everything will be lovely.

This is not about that. This is not about an anti-antibiotics rant because we're worried about antibiotics resistance. 

[00:33:21] Charlotte: No. 

[00:33:21] Emma Pickett: This is actually about antibiotics not necessarily being the solution. Yeah. And, and people needing to understand what mastitis actually is. 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.

So let's talk a bit more about your journey. So you had that first case, you had your antibiotics, things did get easier. 

[00:35:41] Charlotte: Yeah. 

[00:35:41] Emma Pickett: W- what was gonna be happening next? 

[00:35:43] Charlotte: So then it all gets a bit more complicated because then we have COVID as well at this time. I know it was in 2023, but COVID was still very much a thing.

Well, it still is, obviously, but it was ... And my little boy, Felix, got admitted to hospital with COVID. Um, so he was only three months old, so we ended up in A&E with him. I thought, "Oh, there's something's going on." Oh gosh, Charlotte, that's, that, that is really scary. I'm so sorry. Yeah. This, this was actually one of the worst times of, probably of my life, actually.

So ended up in A&E. I thought, "Oh, they'll just..." I didn't even take enough nappies 'cause I thought they'll just tell me to go home, like, he's fine. But no, they tested, he had COVID. But also I had COVID, what I, that I didn't realize, and I also had mastitis at the same time. So I remember being in the hospital, in the children's A&E, in the sort of, like, bit where there's beds, but they didn't have a cot for him 'cause they were so busy.

They had so many kids in with COVID. So I had to, oh my God, sit on this, like, bed, like feeding him, trying to manage him with mastitis. I actually became septic, but that's another story. With him having COVID, and I genuinely thought, "This is just horrendous." My husband also had COVID, but he was at home, so he couldn't come in.

And I didn't even have any nappies for him. I didn't have anything to eat or drink myself. I couldn't leave him because he was so small. I couldn't leave him on the bed. He'd have fallen off. 

[00:37:02] Emma Pickett: Oh, no. Gosh. And Charlotte, so if you've got mastitis and you can't drink, that is 

[00:37:06] Charlotte: really- Yeah ... really tough. It was horrendous.

So I had to grab, I saw this doctor coming past, and I said, "Can you hold my baby? I mean, this..." And he, and they were like, "Okay." I was like, "I need the toilet and I need something to eat. Like, this is crazy." Do you know what I mean? I just, I ... Please just take, like, I can't leave him now. So you didn't have a, there wasn't a crib, there wasn't- There was nothing

there was nothing to put him in. They had, they had no cots available 'cause like I said, they had so many babies in with COVID at that time. There was, it was really bad, so they didn't have any. And in the end, I actually, and I've never done this before, I asked to go home. I asked to be, uh, discharged early.

And they were actually quite surprised, and I think they were like I think they were a bit concerned, but I said, "I'm so unwell", and I know ... And Felix was fine, like at this point, you know, I wasn't putting his life in danger. And actually what ... In the end they sent the children's hospital at home team to see Felix at home, um, because I was just so unwell.

I, I physically couldn't cope with being in the hospital without anything. 

[00:37:59] Emma Pickett: I wonder what your immune system is doing when you've got COVID and mastitis at the same time. I'm guessing your resistance is much lowered when you've got COVID. I mean, I- Mm-hmm ... haven't seen any research around that, but I can only imagine that if your immune system's taking a hit from COVID, you're, you're more susceptible to mastitis and developing an abscess.

[00:38:15] Charlotte: Yeah, 

[00:38:16] Emma Pickett: I'm sure. So y- were you, were you take ... Were you given another round of antibiotics at that time? 

[00:38:20] Charlotte: I wasn't even getting treated myself because I was there for Felix, and I just remember thinking, "I've got, I've got mastitis." But of course I was there for, you know, I just sort of, I just need to go home.

So I went home, contacted the doctor for myself because obviously, you know, when babies are under three months and they get COVID, it's quite worrying. At that point they didn't really know, you know, what it did to babies. And actually he was fine. Like, he was completely fine. But they're just very, they have to be very thorough.

But they couldn't, they were trying to do bloods on him. They couldn't get bloods out, so they wanted to keep us longer to try and ... Oh, it was awful. And in the end, one of the nurses did bring me a sandwich and a cup of tea, and I was so grateful. And luckily, a friend of mine was also in hospital 'cause her baby had COVID, and she was being discharged, so she brought me some nappies.

But they didn't even have nappies for him. Like, they had nothing. It was really surprising on a children's ward. And then I obviously got home and sorted myself out with my abscess, but with my mastitis, which had then turned into an abscess I later found out. Okay. So that 

[00:39:15] Emma Pickett: was, that was the abscess. So- 

[00:39:17] Charlotte: Yeah

[00:39:17] Emma Pickett: so the untreated mastitis, which is often, w- you know ... So if bacterial mastitis isn't treated- Yeah ... this is obviously an example of when we do need antibiotics, then you can turn into getting an abscess. So then you had those period of weeks of, um, of treatment. 

[00:39:31] Charlotte: Yeah. 

[00:39:32] Emma Pickett: Just, just to ask a dumb question, are you always getting mastitis on the same side?

Where is your mastitis happening? 

[00:39:37] Charlotte: No. Mainly, yes, but it has been on the other side, so it's, it's, it's not always the same side. 

[00:39:43] Emma Pickett: Okay. Okay So he's three months. You've g- had your second episode of mastitis now, which turned into an abscess. You're still being treated. How do things progress from there? 

[00:39:54] Charlotte: So then I think things calmed down a bit.

I then returned to see a, a breastfeeding professional who I, um ... At this point, I think Felix was getting a bit, he was getting a bit old. Oh, no, actually, sorry, I'm getting a bit confused with timelines here. I had another occasion, and I self-managed it, so I think I caught it early. It was actually some time after.

I think it was like six months after. But I caught it early, and I managed to, um, self-manage it with ice and anti-inflammatories, so ibuprofen, and I think it settled down on its own. It then got a bit more complicated 'cause Felix got teeth. 

[00:40:29] Emma Pickett: Had your latching got easy, by the way? Sorry to interrupt you.

Has, had the latching resolved itself w- uh, in this section? 

[00:40:35] Charlotte: He's never had a great latch. Okay. But yes, it had because I'd seen a, um, healthca- a lactation professional. She diagnosed tongue tie, and I got the tongue tie resolved, and his latch was much better. 

[00:40:49] Emma Pickett: Okay. But then teeth came along. 

[00:40:51] Charlotte: Teeth came along, and it was very difficult.

He was biting, and at one point ... I mean, I don't want ... This whole story does sound rather dramatic, so I don't want people to think, "Oh my God." It's just the way it was. And he was biting, and I got a lot of bruising. So I returned to see a breastfeeding professional because I wanted advice about how to manage the biting, and I was advised to stop breastfeeding at that point because, you know.

[00:41:12] Emma Pickett: Okay. Wow. 

[00:41:13] Charlotte: Yeah. 

[00:41:13] Emma Pickett: How old was, how old was he? 

[00:41:15] Charlotte: Um, he was about a year old maybe. 

[00:41:20] Emma Pickett: Right. Okay. Gosh, so that's someone who didn't really have anything else to offer. Um, okay. How did you feel about that? 

[00:41:26] Charlotte: Well, they helped. I think at that point I was very, very tired, and I think that probably came into the conversation, that I was very tired and he wasn't sleeping, and I think it was just I was also told that his latch won't change at this point, um, that you can't change a latch, which I've since learned from the internet that that's not the case.

Okay. 

Can 

[00:41:43] Emma Pickett: I just say for the record- Yeah. ... um, I know you know I'm go- what I'm gonna say next, Charlotte. Yeah. You can actually adjust latch of any age nursling. It is possible to change latch at any point. P- anyone who says, um, "No, no, that's it now, you can't change the latch," nope, sorry. We can hold bodies in different ways.

We can talk to toddlers. We can do all sorts of tricks and things, and it is possible to change a latch at any age. And obviously, if there's something anatomical going on, if we're talking about palate shape, if tongue function is still a factor, we've got some additional barriers. But no one should ever tell anybody that latching cannot be adjusted with an older child.

Mm-hmm. That is a prejudice against older nurslings, and that's someone who just doesn't have experience of, of breastfeeding support beyond 12 months. Thank you for allowing me to rant. Please continue- No ... what you were gonna say. 

[00:42:29] Charlotte: And you know, as a first-time mother, you're vulnerable to this information 'cause you don't know.

I had no idea. You know, you, you will just, you will just go with what you're told. So I just thought, "Okay, well, he's not going to." But anyway, I didn't give up breastfeeding. I kept going 'cause actually in the end they do stop biting. You know, you, you, you, you just sort of faster through it. There's no real, um- Is there anything I could really do that would help?

I think in the end he just stopped biting. 

[00:42:53] Emma Pickett: So there are s- just a quick chat for anyone who's, who's 

[00:42:55] Charlotte: dealing with biting Oh, sorry. I probably have things you can do. 

[00:42:56] Emma Pickett: No, no, no. No, I, I don't want you to think like, "Oh, you daft lady, you didn't find the answers". But I do, I do want people to think that, that it isn't, it isn't a case of just waiting, 'cause biting- Mm

can be absolutely terrifying, and it can really, really, really impact on people. Usually biting is connected to positioning, so if we don't have the tongue covering the gum ridge, those lower incisors are gonna come into contact with teeth. When a child is breastfeeding, the tongue should be covering those teeth, and they're not able to bite actually if they are feeding, because the tongue will be in contact with the breast and covering the bottom teeth.

To be able to bite, they have to retract that tongue. So you will usually find that biting happens when the chin isn't in contact with the breast, or when the child doesn't have a head tilt, or when they have purposely pulled the tongue back. And you will see a jaw shift quite often when they make that decision to retract the tongue.

If top teeth are biting, that's often connected also to positioning because it means that the child doesn't have that, that head tilt, um, and the teeth are coming into the breast perpendicular. If they do have a head tilt, the teeth come in at a much more gentle angle, and actually you can't really bite with the back of your teeth, if you see what I mean.

Children will also bite if there's a flow issue, um, fast milk or slow milk. And often a very common cause for biting around 10 months-ish is, "Actually, Mommy, I'm not hungry." And I... And you've historically been offering every two or three hours, and it's the only way- Mm ... way a little person can say, "Stop flipping offering me the breast.

I'm fine." Um, so quite often it's about waiting for proper hunger cues and delaying, um, feeds, and making sure that you're really confident that they want it, and feeling free to take them off when they finish actively swallowing. Mm. Because often a b- a bite will happen at the end of a feed, and you will see that jaw shift as they, as they move the tongue out of position.

It is obviously not possible to fix every single case of biting, 'cause some children are super quick, and some children do have a tongue restriction, which means the teeth aren't covered well with the, with the tongue. Um, but I don't want anyone to think that biting's something you just have to put up with, because the majority of breastfeeding throughout human history has happened with little people with a full set of teeth.

The, you know, the, uh, the years and years of people breastfeeding with full sets of teeth. I have met so many little people with a full set of teeth who've never bitten in their lives. Um, so don't think it is inevitable and that's how breastfeeding has to end. Um, th- again, thank you for allowing me to do my, my little shpiel.

No. Mm-hmm. Yeah. Um, but in, but in your case it, it, it wasn't gonna be fixed as easily. Potentially connected to, to tongue or palate issues, if he'd had a previous tongue 

[00:45:17] Charlotte: tie. Yeah, I think so. And I think just, just his, his latch maybe wasn't optimal. And I think he used... He, he does still do this where he's not always actively feeding.

He's kind of sucking for comfort. So I think having that as well kind of maybe contributed to him just messing around a little bit and biting. But, you know, I didn't give up. I just kept going because I'd say it's the only way I could get him to sleep. So I was just willing to go through anything, any pain just to get him to sleep.

And I kept feeding, but of course, I still kept getting mastitis. And I felt, because I'd been advised even by like specialist breast nurses to stop feeding, um, because of the mastitis, every time I went back to a, a healthcare professional with mastitis, I felt like I'd been naughty because I hadn't followed their advice.

And I almost had to apologize that I was still breastfeeding. 

[00:46:04] Emma Pickett: Oh, Charlotte, that's not a great place to be. So were you continuing to have repeated prescriptions of antibiotics? How many times did you have antibiotics? 

[00:46:11] Charlotte: I think I've had antibiotics maybe four or five times. So maybe- Okay ... I don't think I did every time because sometimes I was able to

Like, I can remember one time trying to call the out of hours GP on a weekend, and they never, they never picked up. They were so busy. And in the end it resolved. So I think there were times where I did just manage it on my own because I couldn't actually get ahold of a doctor, which is probably a good thing in hindsight.

[00:46:34] Emma Pickett: Yeah. Yeah And then you thought, "Right, this is it. I've had enough of this now. I need to, to go and get a second opinion." And that's when you, you came across Naomi, Naomi Dow? 

[00:46:43] Charlotte: Yeah. So, well, I, at this point, I was considering weaning 'cause I'd been sort of told by so many professionals to wean, to stop breastfeeding.

And I came across your podcast, and then I, yes, I was, um, recommended Naomi. So she's a specialist breastfeeding doctor, which I think is really key 'cause she's a GP who specializes in, in breastfe- She's also a lactation consultant. Yeah. Yep. In, and she's based in Scotland. And, um, I'd never heard of, um, like this before.

I, I'd just, you know, I'd met lactation consultants, but I didn't realize there were actually doctors specializing in breastfeeding. And so she actually offers virtual consultations. And at first I thought, "Oh gosh, how am I gonna be able to talk about all this onli- you know, online?" 'Cause that's a bit tricky.

But we had a, um, a Zoom call, and it was fantastic. And she honestly, like, if I'd have met her before I had Felix, I don't think I'd have had any of the issues I had. She explained, she spent a long time taking a full history. Like, she's very, very holistic. She looks at everything, not just the pro- The, the, the reason I approached her was to talk about recurrent mastitis, but she talks about everything.

About sleep. She talked about my concerns about, um, breast cancer, you know, 'cause of my family history. She talked about loads of things. And she properly explained the anatomy of the breast. You know, just thinking about how delicate breast tissue is. Talking about how, you know, heat doesn't help. How ice is what you need.

You know, all those things we've talked about, she explained that to me, which I'd never had before. And you know, I think we do place a lot of trust in doctors, and because she is a doctor, you feel like, you know, yes, she really does know. Not that I'm saying I don't trust lactation consultants. Of course I do.

But because of the prescribing element, she's actually- Yeah ... talked about the fact that she doesn't like prescribing medications, which is really refreshing to hear from a doctor. 

[00:48:27] Emma Pickett: So after that conversation then, what did you start to do differently? 

[00:48:31] Charlotte: Actually, I stopped approaching any ... And this may be, you know, I stopped thinking I need to see a GP every time I have mastitis.

'Cause I think actually a lot of GPs, like Naomi explained, that they don't always get a lot of education on breastfeeding in their training, and so it's not their own fault. But I remember actually I did have to see a GP after that for one thing. I was explai- I was educating him about what Naomi had told me, and he was very interested in it all, which was really nice.

Or he was maybe just trying to get me out of the clinic 'cause he had the next person to see. Um, but what helped was the fact that I didn't just go straight to the doctor for antibiotics. I started using ice. So she recommended using like frozen peas in a bag, in like a sandwich bag, and using them, a bit more malleable than an ice block.

Holding that on your, on the affected area for like 10 to 15 minutes and then taking it away. Doing that every hour So I was even doing that whilst I was working. One day I was working from home and I was able to just keep doing that throughout the day. Using ibuprofen because actually, like she explained, that antibiotics often it's the anti-inflammatory effect you're, you're, you're feeling straight away.

So I was using ibuprofen. She talked about lymphatic massage, so she sent me a really helpful YouTube video to look at with that, which is like when I was talking about stroking the cat. And what else did she talk about? Um, feeding as normal. And actually the one revelation that she gave me, she went through all of my red books.

So she went through all of the, the weights that Felix had been throughout his life, and she looked at it to see, 'cause he did lose weight in the first couple of weeks. Looking at that made her think that, because at the time it made me think I d- wasn't producing enough milk And she said where I'd had this kind of myth that I wasn't producing enough milk, I was advised to do things to increase my milk supply.

[00:50:16] Emma Pickett: Okay. 

[00:50:16] Charlotte: And the likelihood is I didn't have an under- under supply of milk. 

[00:50:20] Emma Pickett: It was to do with the latching. Yeah. That's why he wasn't getting, putting on weight- 

[00:50:23] Charlotte: Exactly ... because 

[00:50:23] Emma Pickett: of the latching, and you were then tipping into hyperlactation. And, uh- Yeah ... as anyone who reads the breastfeeding, um, the s- Academy of Breastfeeding Medicine protocol will know, so much mastitis is about hyperlactation, and sti- and overstimulating production.

Overstimulation, yeah. And, and so many people who are pumping from the beginning- Yes ... 'cause we've gotta pump, and we've gotta use the, the silicone thing on the other breast. 

[00:50:43] Charlotte: Yeah. 

[00:50:44] Emma Pickett: It's overproduction hyperlactation, which is so connected to mastitis. 

[00:50:48] Charlotte: Yeah. And probably the cause of my mastitis. So I was advised to pump, regulate, power pump.

Um, so, and also- Oh, gosh ... I was so desperate to get a supply of milk to pump so that I could feed him in a bottle, so my husband could take over, which never happened anyway 'cause he wouldn't take a bottle. So I was producing all this milk. I was ha- pumping all the, all day, and getting wearable pumps and, oh my gosh, the amount of pumps I've got.

I was doing things like taking fenugreek because I'd heard that could increase your milk supply. I was t- like making lactation cookies. All these things I was doing has probably caused mastitis. 

[00:51:22] Emma Pickett: Yeah. I mean, I think we can ... Anyone who reads the protocol will ... You're ticking all the boxes, aren't you? Yeah.

You are absolutely. So you got the latching issues, but it's the hyperlactation which almost certainly would've tipped you into this, you know, the ducts all narrowing, and the alveolar congestion. I can't even say the word alveolar. Um, you know, all the things that happen when our bodies overproduce, and then that tips into inflammatory mastitis, which then can tip into bacterial mastitis, as to what you've experienced.

One thing I'd just like to pick up on, 'cause I'm pretty sure that if Naomi's listening to this, she will have shouted at her, uh, uh, at her recording device earlier on. I'm sure Naomi would say that she doesn't want anyone to take away from this, "Don't go and see your GP when you've got mastitis." Oh, gosh, no.

Absolutely not. And I, and I don't, I know that's not what you meant either- No. Yeah ... but, but you, you had so much knowledge- Mm ... and so much experience, and you knew your body. Yeah. So when Charlotte is saying, "Okay, I'm not gonna go and see the GP on this occasion because I know my body, I know what's happening, I can see the symptoms," that is very different from- You know, first time mastitis person- Yeah

listening, listening to this and going, "Oh, okay, I'm gonna take away from this, don't bother to see my GP." Yeah. Naomi, it's okay. You do not need to shout anymore at your- ... at your podcast playing device. Um, we, we want people to go and see their GP, 'cause even if the GP doesn't know about lactation, they will be able to, to pick up on other symptoms and, and potentially help you, you know, look at what else might be going on with your body.

And we don't want anyone who may have bacterial mastitis or may be developing sepsis not to get help from a doctor. 

[00:52:54] Charlotte: No. 

[00:52:55] Emma Pickett: And, and I love the way that you educate your GP, 'cause that is such an important thing. If anyone can ... If we can all pr- print out the mastitis spectrum- Mm ... protocol, and probably let's be fa- let's face it, get Chat GPT to do a one paragraph summary of it, and give

then give that to our GPs, we're gonna be a, a long way along the road, I think. 

[00:53:15] Charlotte: Yeah, absolutely. Um, and yeah, you know, my point was, I guess, that I felt so much more empowered after speaking to Naomi, because actually we're not educated. Like, I think if we could be told before we had a baby, you know, all this stuff about the breast structure and how, you know, all this stuff, you know, how, how it works.

And I, I ... To be honest though, I probably wouldn't have taken it all in before I had a baby 'cause I'd have been like, "Oh, this isn't relevant for me." 

[00:53:39] Emma Pickett: But certainly the over-pumping. If the first time you'd had mastitis- Yes ... someone had said to you, "Do you know about the relationship between over-pumping and overproduction of mastitis?"

No one was making that connection for you. No. Um, all the people telling you to stop breastfeeding, if only some of them had said, "Can we talk about hyperlactation and mastitis risk? 'Cause you've got recurrent mastitis happening here, and we know that overproduction is very, very likely to be connected to that."

No, no one was putting that together, and instead we've got all this messaging, quite often from people trying to sell us stuff- Mm ... that everyone must have a wearable pump, everyone must be pumping s- regularly several times a day. What do you mean you're a breastfeeding mom that doesn't pump regularly?

You know, let's start pumping as soon as we can. Let's ... You know, it, it's, um ... We've got a real problem because I think one of the th- messages that wearable pumps have given everybody is that pumping should be happening all day- Yeah ... as part of everyday life. Everyone should be pumping, and we're going to get more and more people getting recurrent mastitis in this situation, and it's, it's scary really.

[00:54:40] Charlotte: To be fair to the, the breastfeeding nurse that I saw, the advanced nurse specialist at the hospital, she did say that she saw a lot of people with mastitis who were pumping, but I thought she meant, and she did say, that were just pumping. You know how some people pump- Yes ... and give expressed milk but they don't feed from the breast?

That's what I thought she meant, that that was the problem. But that probably meant, what she meant was they were over ... I don't know what she meant really. But anyway, my point is that- Well, you can, you can- She didn't talk about it ... exclusively 

[00:55:08] Emma Pickett: pump and not ... You can- 

[00:55:09] Charlotte: Yes, that's what I mean ... 

[00:55:10] Emma Pickett: overproduce even when you're, even when you're exclusively pumping potentially.

I mean, one thing the mastitis protocol talks about is this kind of- So dysbiosis, the idea that our breasts can kind of get out of balance, um- Mm-hmm ... and we can maybe develop a bacterial family that isn't the right family, and, and we can sometimes have subacute mastitis, which is ongoing and doesn't necessarily flare up into these big episodes, but we're just battling kind of ongoing pain, and there's a bacterial biofilm that may be narrowing the ducts causing more pain.

And potentially if you are doing a lot of pumping, theoretically I think the protocol suggests that you may not be getting the messaging from your baby's saliva. So, so maybe we've got some work to do for exclusively breastfeeding moms swabbing babies' mouths and rubbing the baby's saliva on their nipples, and maybe there's a whole world there where we should be actually encouraging people to get more kind of feedback loops from their baby's saliva and, and understanding a bit more about how, you know, bacterial families work.

Yeah. There's still a lot to understand, I think. But I'm really glad that you, you met Naomi. We'll definitely put Naomi's name in the, in the show notes if people want to have a consultation with her. 

[00:56:16] Charlotte: And I also wanted to say that even if people ... 'Cause I do understand that it's expen- you know, I've, I've spent a lot of money on lactation consultants, on, you know, on sleeping consultants, all these things, um, which sometimes when you're that desperate you will just sort of throw money at things.

But, um, what I wanted to say was that Naomi also has a really good Instagram page where she has some really good advice. So even if you can't afford a consultation, just please look at her, um, page- Yeah ... with advice on. 

[00:56:41] Emma Pickett: Yeah. Thank you. That's helpful. Did you ever take lecithin? That's something that the protocol also talks about.

[00:56:46] Charlotte: No, but Naomi talked about that, I think. Um, she gave me so much information, and I'm pretty sure that's something she talked about. 

[00:56:53] Emma Pickett: Yeah. I mean, sometimes if we do ... I t- I talked earlier about how, you know, mastitis isn't necessarily a blob of milk blocking a duct, but if you do have, you know, the narrowing of the ducts that can result from these biofilms or, or sometimes from inflammation, it possibly could be the constituents of the milk is, is causing an issue as well.

And, and potentially lecithin changes how our, the fat, how the fat works in our milk, which, which may, may reduce the risk of problems with the narrowing of the ducts. Um, yeah, so- Yes, you mentioned that ... so people can read, people can read a bit more of that online. But essentially it is cool compresses- Yeah

it is le- learning, you know, to manage your supply in a way without overproducing, which is scary when you live in a world where lots of us are frightened of not having enough milk. 

[00:57:38] Charlotte: Yes, and that's what exactly happened with me, yeah. Yeah. 

[00:57:40] Emma Pickett: So tempting to tip into overproduction. 

[00:57:43] Charlotte: Yeah. 

[00:57:43] Emma Pickett: Um, but that, that does seem to be one of the leading issues.

And then the, the protocol also talks about ultrasound. That's not something you ever had access to. Obviously, you did for your abscess, but you never had therapeutic ultrasound. 

[00:57:53] Charlotte: No, and I asked Naomi about that, and she wasn't, um ... I think that we felt it probably, the benefits weren't that great. W- weren't that significant.

It is helpful, but I don't think it's that ... She said, "Yeah, it's very different to the ultrasound you have when you're just checking the breast for a lump. It's, it's therapeutic ultrasound." And Naomi might, again, be shouting at the speaker here- ... but I think she was saying that for me it might not ... It probably wouldn't have given that significant results.

[00:58:22] Emma Pickett: Okay. And then what about probiotics? Is that something that was ever talked about? 'Cause this thing, idea about the dysbiosis and potentially there being some kind of imbalance in your microbiome. 

[00:58:31] Charlotte: Yeah, and I'm really interested in the microbiome stuff. And yes, so probiotics are really good to take when you're taking antibiotics because antibiotics

She did explain that taking antibiotics can then change your microbiome, which can then cause mastitis, so it's kind of a bit of a, um, catch-22. But yes, taking even just like probiotic yogurt and stuff like that I was doing, um, just to kind of help feed, feed the good bacteria, which I try and do anyway.

But she also, the other thing she did talk about, like was with wound healing, 'cause I was also getting a lot of like milk blebs, which I can't fully remember 'cause it was a long time ago. I haven't had them for a while, but that's where you get the kind of, um, bit of dried milk on your 

[00:59:09] Emma Pickett: nipple area. Yeah, so it's, so it's not necess- It's not so much dried milk, but there is, there is basically a blockage essentially on the end of the duct.

Um- 

[00:59:18] Charlotte: Yes ... 

[00:59:18] Emma Pickett: so th- you know, so rather than it being deeper in your breast, it's appearing at the, at the duct ending, and it looks like a blister really. It looks like a blister f- filled with milk. 

[00:59:26] Charlotte: And that can also cause a lot of pain when feeding. 

[00:59:29] Emma Pickett: Yeah, for sure. So I think 

[00:59:29] Charlotte: that was also contributing to my pain.

And so she talked about wound healing, and I think she's done an Instagram post about it. But basically, um, she talks about a lot of the products we're sold, um, so silver cups and all that kind of stuff, and how actually you don't want to make it more moist. So I, I think you can just go have a look at that 'cause I'm probably not explaining it very well, but that's something she was talking about.

[00:59:49] Emma Pickett: Yeah, I mean, the, the silver cups are, are very popular at the moment, and some, some people, not everybody, some people are using them too much. Yeah, I did. So the nip- the nipple, the nipple becomes kind of macerated, a bit like, a bit like trench foot essentially, and the, and the- Yes ... w- the wounds cannot heal in that situation.

So we want to use them, you know, not constantly, and if the nipple looks like it's becoming white, and soggy, and very, very saturated with fluid, then we probably need to stop using them for a bit to let the nipple recover. Yeah. So, so you have, um- Obviously you've still got concerns around latching though.

Is that... How, how are you feeling about his latching at the moment? 

[01:00:24] Charlotte: It's, it's got better. I've looked at the sort of some pictures and some guidance around latch. It's got a bit better, but I think he, he is very much in the sort of where he just, um, feeds for comfort a lot of the time, so he kind of just sucks without sort of...

And Naomi did review his latch. I sent her some videos of him feeding, um, so that was helpful. She could tell me that actually he was very much kind of just sucking on the nipple. So I've tried to improve that, but it's a bit harder with a toddler 'cause he's getting big You know, you can't just lie him across your lap like in a cradle.

Um, he'll sort of be upside down and kicking me all sorts- Yeah ... at the same time. 

[01:01:01] Emma Pickett: Quite often you have to talk to them, and you have to- Yeah ... really say, "Right, listen, mate. This is the story." 

[01:01:06] Charlotte: Yeah. "

[01:01:06] Emma Pickett: This is what I need, and if you can do this, boobies are very, very grateful, and boobies will say thank you very much."

And, and make a game out of it. Mm-hmm. "So this is where you have to put your chin." I mean, I've had people put stickers on their breasts before. "You've got to touch the sticker with your chin. Can you feel the sticker?" A little puffy sticker on someone's breast. Mm. And, and getting people to look up at, you know, looking up to get the head tilt, so you put something in their line of vision.

"Can you, can you see, you know, how many fingers I'm holding up?" Or something a bit more exciting than that. You have to kinda get them to be a partner in the process, really. Mm-hmm. And, and, uh, the, uh, and at Felix's age, helping him to understand why. Why does this need to change? Mm-hmm. It's not Mommy being awkward.

And it, it... yeah, I'm not saying it's easy. Sometimes they will still want to readjust. Um, but it, it, it, it is possible to have a go and see what you can do. Um, so the last time you had mastitis was a couple of months ago. A 

[01:01:58] Charlotte: couple of months ago, yeah. It was actually when I spoke with Naomi. 

[01:02:01] Emma Pickett: Yeah, I was gonna say, that was when you met Naomi and spoke to her.

[01:02:03] Charlotte: Yeah, and so I could just self-manage it, and, and I ha- and, and it went away. Um, and I haven't had any problems since, actually. But when I went away for the night, I asked her for some advice beforehand around how I should manage that when I'm not with Felix 'cause I was very worried about getting mastitis when I wasn't with him, 'cause he does feed so much still.

And she just said, "Don't pump. Just hand express if you need to." And she also talked about reducing your milk supply very slightly with things like peppermint tea can help, because you don't wanna have too much milk when you're not with the baby. So all those things were really helpful, and I didn't have any problems at all.

[01:02:38] Emma Pickett: Okay. That's good to hear. 

[01:02:39] Charlotte: Yeah. 

[01:02:40] Emma Pickett: Gosh, well, everybody listening to this is crossing their fingers, Charlotte- ... that you do not have another episode of mastitis, and if you do, it gets resolved very quickly. I mean, one of the reasons that we tend to have slightly less mastitis as we get further on in our breastfeeding is because production does reduce.

Um, people are less likely to be frantically pumping, you know, in the second and third year. So, um, let's really hope that that's the end of your mastitis experience. But gosh, what a journey you've been on. Is there anything that we haven't talked about that you want to make sure people understand? 

[01:03:12] Charlotte: Um, no, not really.

I think just, um, getting the information as early as possible, really, and just understanding, I think, when breastfeeding doesn't go well, and what the kind of complications can be, um, is just helpful. And just like you said at the beginning, just knowing your breasts, knowing what's, what's normal for you, what lumps are normal And also just being armed with the kind of evidence.

So looking at the protocol, um, perhaps that'll be linked on the, um, podcast Yeah. I'll p- I'll put the 

[01:03:39] Emma Pickett: protocol in the sh- show notes as well. 

[01:03:41] Charlotte: Yeah. Just reading that. 

[01:03:43] Emma Pickett: Yeah. Yeah. I mean, it's, it's ... I'll be honest, it's not an easy read. No. If somebody doesn't have a lot of experience- That's true ... and c- as a healthcare professional, obviously it is for you.

But, uh, you know, if ... I would encourage someone, I'm not kidding about Chat GPT, we can have a whole conversation- No ... about how unethical AI is. But actually, that's, this is the one time when you could upload the protocol and ask someone to summarize it for you. Um, but you know, as I said, ch- websites like The Breastfeeding Network will have a- Yeah

description of a simplified version of, of what we want to do when someone has mastitis. Um, you know, the breastfeeding support sites should now be updated to ref- to reflect that. Um, and you can always call the National Breastfeeding Helpline if you're worried as well. 

[01:04:19] Charlotte: Yes, absolutely. There's so much support out there, and I think it's just arming yourself with what is, what is available, because I don't think I did.

Um, and you're not necessarily always going to be advised. So just, just finding out what's available is really important. 

[01:04:32] Emma Pickett: Thank you so much for your time today, Charlotte. I really, really appreciate it, and cross fingers that's the end of your mastitis. 

[01:04:38] Charlotte: Yeah. Thank you so much.

[01:04:44] 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.