Alexandra's story - breastfeeding after reduction

This week’s guest is the inspiring Alexandra Baskerville, who is talking about breastfeeding after breast reduction surgery aged 19. Alexandra describes having very large breasts as a teen, choosing reduction surgery in 2010, and later becoming a mother at 34. Her daughter Connie’s birth was a home birth, and early feeding was complicated by Connie’s small size, slow weight gain, nipple pain, suspected tongue-tie, and the extra uncertainty of reduced milk-making capacity. An NHS lactation appointment left Alexandra feeling she had been told to stop, despite only giving small top-ups, so she sought private help from IBCLC and tongue-tie practitioner Polly Powell, who improved her pumping setup, offered support, and eventually arranged a tongue-tie procedure at around 10 weeks. Alexandra triple fed and pumped for months,  and although it took longer than expected for her full supply to come in, she stopped pumping around 10 months, and is continuing breastfeeding at nearly 14 months.

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 - 

BFAR - Breastfeeding After Breast and Nipple Surgeries https://www.bfar.org/index.shtml 

IBCLC Polly Powell is @‌pollythemidwife on Instagram and https://www.polly-powell.co.uk/ 

Plastic Surgery and Breastfeeding - Physician Guide to Breastfeeding https://physicianguidetobreastfeeding.org/surgery-and-breastfeeding/plastic-surgery/#breast-reductions 

Guidance on goats’ milk formula https://infantmilkinfo.org/wp-content/uploads/2021/10/Cows-and-goats-milk-protein-based-infant-formula_February-2025-1.pdf 

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

Transcript

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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 really excited today to be talking to Alexandra, Alexandra Baskerville.

Am I saying that right? Baskerville. You are. Baskerville. 

[00:00:55] Alexandra: Yeah. Ba- 

[00:00:56] Emma Pickett: Baskerville 

[00:00:57] Alexandra: Baskerville. 

[00:00:57] Emma Pickett: Baskerville. Okay. It's really hard not to talk about your surname and how cool your surname is. Okay, I'm n- I'm not gonna focus on that. It's okay. 

[00:01:02] Alexandra: Don't worry. 

[00:01:03] Emma Pickett: I was hoping- I've 

[00:01:04] Alexandra: probably heard it all before, but 

[00:01:05] Emma Pickett: You probably have.

Um, so we're gonna be talking about your breastfeeding journey, um, particularly in the context of you having had a breast reduction when you were younger, and breastfeeding after reduction is a subject that we need to talk more about. It's not something that gets discussed, and lots of people are told that breastfeeding journeys won't be possible, and you are very much testament to the fact that it is possible because I've just met the lovely Connie, who is 14 months, 15 months.

About to 

[00:01:30] Alexandra: be 14 months, yeah. 

[00:01:31] Emma Pickett: Okay, okay. So you are, spoiler alert, breastfeeding now, so you did work it out. Mm-hmm. Um, but we're gonna talk about how that journey happened. Um, thank you very much for joining me today, Alexandra. I blew my cool by referring to your surname at the beginning, so let's just get that out of the way.

Is that a fr- is that your partner's surname? Is that your surname? Where did that come from? 

[00:01:49] Alexandra: No, that's actually a bone of contention. Um, I am married, but I kept my name. 

[00:01:53] Emma Pickett: Okay. 

[00:01:54] Alexandra: Excellent. I've also just become ... I think when you marry a bit later in life, you establish a bit of an identity, and no disrespect to his surname, but the other challenge, if I took his name, I'd end up exactly the same as his sister, so there'd be two Alexandra Chapmans.

Okay. And, um, in my egocentricity, I decided that I just wanted to be one Alexandra Baskerville, so I've carried on with that. 

[00:02:14] Emma Pickett: Yeah, makes perfect sense, and is that a French origin name? Uh, we've lost everybody who doesn't care about surnames, but I'm, I'm a word nerd, so I 

[00:02:22] Alexandra: don't care. No, no, it's fine. I think it's Norman, yeah.

I mean, I looked it up as well 'cause I tried to work out what it means 'cause surnames often relate to a profession, don't they? So I... Ville is town in French, and then there's ... I think there's ... I'm gonna get called out here from someone who actually knows French much better than I do from GCSE, but I think it's something to do with town crier potentially could be a crude translation, but that's totally my maths on- 

[00:02:45] Emma Pickett: Okay

[00:02:46] Alexandra: French. 

[00:02:47] Emma Pickett: Excellent. Thank you very much for sharing. I appreciate you indulging my nerd. Let's talk about your feeding journey. Let's talk about the lovely Connie, who is, um, a bit of a stunner. I just met Connie with her granny. What's a day like breastfeeding right now, just, just before you hit 14 months?

What's a typical 24 hours? 

[00:03:04] Alexandra: I've definitely entered your, uh, term or the term of booby monster period. She actually was unwell fairly recently, and so everything kind of took up pace quite violently when it comes to breastfeeding again, but I'm just going with the flow and seeing how it goes. I mean, I, I think it's such a superpower to be able to breastfeed.

I don't ... I genuinely look at other women and think, "How on earth do you soothe and manage your child without this?" Because I really would be, um, you know, a little bit lost without that ability to regulate her. So, you know, it, it comes and goes 

[00:03:39] Emma Pickett: Yeah. So 24 hours a day through the night. What was last night like, for example?

[00:03:45] Alexandra: Uh, it was pretty good. I co-sleep with her, um, so it's very easy. Sometimes she wakes up at 3:00 and wants a feed. Sometimes she'll go through to 5:30, have a feed. I mean, if I didn't feed her, she would be up and awake like my, uh, nephews who are also-- No, that's right, isn't it? Nephews. They're her cousins. Um, my nephews who are in the house who are up at 6:30, but she sleeps in very regularly till 8:00 because she wakes up at 5:30 for a feed, and then she'll have another feed at 7:00, and I'll get up and do things, and she'll be happily sleeping away until she gets up.

So everyone thinks that she's very, very chilled, of course, but the reality is not always the same. 

[00:04:23] Emma Pickett: She's drugged with the sedatives in your breast milk. 

[00:04:26] Alexandra: Yeah, 

[00:04:27] Emma Pickett: it's fantastic. Su-super efficient. Okay. And you're with her during the day? You're together all the time at the moment? 

[00:04:31] Alexandra: Yeah, I, uh, I have my own business, so I'm lucky enough to be able to spend all the time that I can with her.

So yeah, sh- we're very, um, we're very bonded. It's a really special period, and my brain chemistry changed entirely. I worked in the city when I was pregnant, and I thought that I was going back after six months, and then she popped out and changed everything, and I don't regret a minute of it. 

[00:04:52] Emma Pickett: Yeah. Yeah.

I've been working with a couple of people who are right in the middle of that right now. They think they're-- they thought they were going back to work to a busy corporate life- Mm-hmm ... and they've suddenly had a complete crisis of, of con- confidence and a complete realization that doesn't feel comfortable and not what they wanna do and, and very brave to actually rethink that.

Obviously, financially, not everyone's got the opportunity, but, but really brave to actually realize that's not what you want to do and, and make a big decision like that, 'cause I don't think society always supports that. Um, we're expected to get back on that track, aren't we? 

[00:05:26] Alexandra: Mm. 

[00:05:27] Emma Pickett: Let's go back in time to when you were a young lady.

Um, gosh, I've used the word lady, and I've used the word lady. Um, before you were 20. That's okay. You were 20 when you had your surgery. 

[00:05:38] Alexandra: Mm-hmm. 

[00:05:39] Emma Pickett: Tell us a little bit about that experience. But let's go back even before the surgery. I'm guessing you had larger breasts as a teenager. 

[00:05:47] Alexandra: Mm-hmm. Yes. 

[00:05:48] Emma Pickett: And as did I.

Join the large breast club. High five. Um, not easy. No. Tell us about your experiences of being a large-breasted person in your teenage years. 

[00:05:58] Alexandra: I honestly feel like I was a different person pre-surgery in some capacity. Um, not to say that I was desperately unhappy, but I, I was-- I had Body confidence issues. I always felt that I had these-- I mean, I had en-enormous breasts, to, to be honest, Emma.

I mean, we, we're talking GG plus, and I've-- have a small frame, so it was just impossible to get clothes. I was very sporty, but it was really hard. The problem perpetuated, you know, the older I got, the more and more they seemed to grow, and I felt that people would see my breasts before they saw me, which sounds a bit ridiculous, but I- No, 

[00:06:34] Emma Pickett: I, I absolutely get it.

Honestly, I totally relate to this. 

[00:06:37] Alexandra: It was my identity- 

[00:06:38] Emma Pickett: Yeah ... in a way. I mean, I didn't have the sporty thing, which I think adds a whole other complication. I don't think anyone can understand what it must be like to be athletic and sporty and physically not being able to do the things that you need to, what you want to be able to do because of your breasts.

Oh, I 

[00:06:51] Alexandra: would wear multiple sports bras. Um, you know, I would s-s-- bind them down almost, and it was just very depressing actually. And so my fa- in my family, big breasts are in my family. My mom had a breast reduction, uh, so I'd seen the transformation in her. She had a breast reduction after children when she was much older, but she was so transformed after it that I considered it, and I'd ha- happened to have s- I'd saved up some money, and I spoke to my mom at length about it.

And I, I think I was mature enough at the time to make a decision that I felt was quite balanced And so even though it was quite young, at 19, I did have the surgery, and I remember one of the big points around the surgery was, "Well, do you want to breastfeed?" And I felt very far away from motherhood at that point.

So that's the only challenge when you are g- undergoing such a, a transformative bit of surgery at that age, is that my perception of who I wanted to be and how I wanted to mother was really not mature at all. But I also remember the surgeon saying, "Well, it's 50/50." And I thought, "That's all right odds."

[00:08:10] Emma Pickett: Yeah. 

[00:08:11] Alexandra: And of course, what I didn't understand is it's 50% you can't do it, and 50% you might be able to do a bit or some or something. So it's 50% of maybe getting something as opposed to what I interpreted 50/50 to mean is it'll either work or it won't. 

[00:08:25] Emma Pickett: Yeah. Gosh, that's interesting phrasing, 50/50. I've heard someone else say that, and their surgeon meant, "We can't tell you either way."

That's what they meant by that. We meant w- it just meant that there's no guarantees. We don't know. 

[00:08:38] Alexandra: Hmm. 

[00:08:38] Emma Pickett: But it's interesting how some are interpreting that as a sort of statistical thing. It's just a mys- mystery, isn't it? And we'll talk in a minute a bit more detail about your actual surgery. But before we, we do that, I'd love to hear a bit more about your decision to find your surgeon.

Was it the same surgeon your mom had used? How did you find them? 

[00:08:53] Alexandra: Yes, it was actually. It was the same, and therefore I knew, I knew him, and I knew that he had done a good job. I mean, I was a case for potentially doing it through the NHS, but the thing about getting NHS, uh, surgery is not only are you on a very long wait list, but actually because they want to go through the surgery fairly quickly

Now, this may be different now, Emma, so don't quote me on this. But my understanding at the time, and we're talking about 2010 here, was that you would have a surgeon doing each breast, so you are, you know, it would be quite likely you might get an asymmetric result because they're trying to do it quickly.

What else is two 

[00:09:29] Emma Pickett: individual people at the same time working on- 

[00:09:31] Alexandra: Yeah, 'cause speed, right? You know? Oh, oh, yeah. Okay. And so you get put under, you get two surgeons, one's doing one, one's doing the other, and, and then, and then you're, you're in and out much quicker. It's much more efficient- Okay ... and cost-effective, I would imagine.

[00:09:43] Emma Pickett: Okay. So that conversation about breastfeeding, I mean, I guess in a way I'm glad to hear it was, it even came up because I have heard from people that it was a leaflet, you know, paragraph eight of a leaflet, and it wasn't even a personal conversation, but at least your surgeon did have an actual conversation with you.

Did they talk to you about what we're gonna do with your nipples and whether your nipples will be completely detached and whether nerves will remain intact? What kind of conversation did they have about sort of surgical technique? 

[00:10:11] Alexandra: He didn't have a amazing bedside manner, to be honest. I chose him because I had seen the outcome of his practice, and I thought that's really good.

But in terms of detail, he said, "We'll do everything we can to give you the best result to retain your feeling and function." And there was only one way of doing a breast reduction at that point, which was a sort of anchor where they, they move your nipple and they, you know, they take the tissue out, so you end up with this an- they call it anchor 'cause you end up with a scar that's like an anchor.

And so I think had I had that surgery now, I'd be much, much more inquisitive. I'd ask a lot more questions, and I'd get more information. But I think as a 19-year-old, I was very willing to accept that he would do his best, and that was the best I was gonna get. 

[00:11:01] Emma Pickett: Okay. Yeah. No, fair enough. I mean, you were obviously a very mature 19-year-old who was ab- able to think through this sort of big decision.

I'm not sure I'd have even been able to ask any of these basic questions at that point. And even me, even though my life is breastfeeding, I can also see how I wouldn't have had breastfeeding in the front of my mind either. It just feels very hypothetical and far away. So just for anyone who doesn't know the kind of implications of having breast reduction surgery, obviously there are two elements here.

We're talking about The ducts and the bits that make the milk being removed and taken away, and ducts being severed. And we're also talking about nerves. So we've got the intercostal nerves that serve the areola and the nipple, and those are the nerves that are gonna g- going to send signals to your brain to release the oxytocin, and, and prolactin and oxytocin are both produced in the brain.

And it's the letdown reflex particularly that can be impacted by that nerve being cut and that nerve being damaged during surgery. So if you haven't got that s- the sensation from the areola going to your brain through that nerve, potentially that milk ejection reflex is gonna be more difficult. And so that's an element that not everyone focuses on because we tend to think about, oh, breast tissue being removed, ducts being removed, you know, alveoli and, and lobules being removed.

Um, and because everyone's got different amounts of milk ducts, no one's gonna have the same outcome to surgery. So somebody might have 20 milk ducts, somebody else might have four. One piece of research found the average was about nine. So you can see how the person with four milk ducts could potentially have all of them cut, and the person with 20, m- not so much of an impact.

Um, and ducts can join back together. So you were-- you had this surgery 15-odd years ago, 16 years ago? Yeah. And in that time, recanalization of ducts is absolutely possible, and even potentially nerve repair as well. Um, and we'll find out a bit more in a minute about, about what happened to you. If somebody has the surgery at 20 and then gives birth at 23, we may be talking about different outcomes.

So it's not necessarily just about the surgery itself, it's also about the time that's happened since your surgery. Thank you for allowing me to put that public information bit in the middle. Let's go back to you having the surgery. So you had the pro- process. You're at university at this point, you're working.

What were-- how did that recovery, how did that recovery period go for you? 

[00:13:24] Alexandra: I did it in the summer of my first year, um, at uni, so I came back to university in second year s- sort of slightly transformed. Um, and it was-- I, I maintain it was the best decision I ever made. It was really good for my mental health.

It was really good for my physical health. I was so much happier, and There was-- has only ever been one period in my life when I was in the depth of the 12 weeks postpartum where I regretted the decision. At every other moment, it was genuinely the most fantastic thing that I decided to do, and I was really proud of it, and I wasn't afraid of kind of sharing that journey with other people because, um, a lot of-- I think because also it's labeled as plastic surgery can be associated with vanity and a bit of shame as well.

[00:14:13] Emma Pickett: Yeah. 

[00:14:14] Alexandra: And there was dimension to it, to be honest, where there was an element of vanity because I would go into-- I remember every time I'd go shopping, I'd stand in a changing room and want to cry 'cause I'd feel like I couldn't button anything up. 

[00:14:26] Emma Pickett: Yeah. Button shirts. You can button shirts now, Alexandra.

That's 

[00:14:32] Alexandra: so exciting. Can't wait. I know. I've definitely regrown quite a lot of breast tissue since then, that's for sure. But, um, yeah, I, um- I'm, uh, was, was incredibly happy post, post that, and I feel like everything in my life, you know, getting Connie would never have-- it wouldn't have been the same journey had I not gone down that path.

So I'm, you know, I, I'm very happy with the decision I made. 

[00:14:50] Emma Pickett: And, and the recovery period itself is-- I mean, were you in a lot of pain? Were you on drugs for many, many weeks? How did you-- or you were-- were you still not quite healed by the time you got back to university? I'm just curious at what the recovery period's like.

[00:15:05] Alexandra: I think subsequent to that surgery, I've had other health things happen, so I've compartmentalized it and can't really remember it being that bad. I remember washing being a bit of a nightmare because you c- you know, you, you have to sort of bend yourself. I remember being in the car being difficult because you don't realize how much your breasts move all the time with every movement of your body.

So when you're healing in that area, it's, it can be very, very uncomfortable. But I don't think it was-- I-- look, I was younger. I think I rebounded pretty quickly, and I was so spirited by the aesthetic of suddenly looking at myself and thinking, "Oh my gosh, these enormous knockers have decreased," that- Yeah ... I felt quite sunny about the recovery process.

So it, it wasn't, it wasn't too bad. But again, we're talking quite a long time ago. So I would say that it probably took, it took a lot longer t- for my scars to heal. I'd never had c- I'd never had cuts, so I didn't know if I was going to be a good or a bad scarer. Turned out I was a pretty bad scarer. So only since I started breastfeeding and had I, and having had Connie, have I now not got any marks on my breasts basically.

[00:16:11] Emma Pickett: Okay. Wow, interesting. So that shows what breasts do in the sort of birth, post-birth experience, all that extra- Well, exactly ... growth and- 

[00:16:18] Alexandra: Yeah ... 

[00:16:18] Emma Pickett: all that skin tissue changing. That's fascinating. So, so post-surgery then you have these anchor scars. So under the nipple you've got that vertical line. You've then got- Yep

the bottom of the anchor, the curves coming up underneath your breast, presumably in, in the crease of your breast. 

[00:16:32] Alexandra: Exactly. 

[00:16:32] Emma Pickett: And, and what was nipple sensation like post-surgery? Could you feel nipples? 

[00:16:36] Alexandra: I never had really sensitive nipples beforehand, so I think that was quite useful because then the transition wasn't quite so shocking.

But there was definitely a lot of loss of sensation f- initially. I really c- you know, you couldn't, you couldn't feel being touched on the underside of the breast, and that has come back, but that took years to come back. And I think my nipples are still probably not as sensitive, and in some aspects for breastfeeding, that's been quite useful in the initial stages.

Um, but 'cause I got quite a lot of, I got quite a lot of, um, pain ar- associated around my nipples, and I think that had I had full sensation, it would've been quite difficult for me. But I definitely had some nerve damage Which kind of comes with the territory, really 

[00:17:21] Emma Pickett: Okay. But it's interesting you saying that sensation came back, which would fit with the possibility of nerve repair happening.

So nerve repair is very, very slow, um, doesn't happen for everybody. But if your sensation came back, that suggests that, that that was a, that was already happening before you gave birth. So let's fast-forward to thinking about having a family. How old were you at that point, and when did that breastfeeding conversation start to come back into your mind again?

[00:17:50] Alexandra: When I met my husband, we got married after being together for a couple of years, and we knew we wanted to have kids. Um, and he was older. Uh, we met when he was 36, so not, we're not talking old, old. But, um, I fell pregnant at 34, um, and we'd always spoken about our ideologies as parents, and we are quite aligned with quite a holistic kind of view of things.

So it then suddenly came into sharp focus that I wanted to be able to breastfeed. And I educated myself quite extensively about the birth process, and I did hypnobirthing, and I actually did a biomedical degree at university, so I've always been really interested in science and being as informed as possible.

And it became clear to me that it was a bit of a, well, you won't know until, you know, you know. And I started to be a little bit anxious about it, but I was so focused on the birth that I thought, "Well, it is what it is." And I was quite glass half full and a bit fatalistic at the same time, so it wasn't a source of great pressure at any stage.

I remember being right before the birth and being given by my midwife the colostrum collection and, uh, you know, syringes and stuff, and being in the bath and squeezing and thinking, "Well, yeah, there's a little bit coming." But I was looking at these, this bag and all of these syringes and thinking, "There's no way I'm gonna fill up all of those."

And started to s- and then the reality started to set in a little bit at that point, thinking, "Hmm, I wonder how this is gonna work if it's not gonna work for me." And I'd done some research about getting a breast pump, you know, a medical-grade breast pump, and I'd read up about all of the things, some of the things you've just mentioned about the likely kind of outcomes and sensations and all of that stuff, and I-- but I just thought, "Well, rather than stress myself out with that on top of everything else, let's just see at how it goes, and then plan accordingly."

So It didn't occupy a huge amount of brain space, but I think I probably was just pushing it to the back of my mind, hoping it would all work swimmingly. 

[00:19:56] Emma Pickett: Yeah. But I guess that's all you can do really. I mean, one of the things about breastfeeding after reduction, and I'll, I'll ask you in a minute about some of your favorite resources around this.

You know, there's a lovely website, bfar.org, which is Breastfeeding After Reduction, which includes other breast surgeries as well. Um, there's a book called "Defining Your Own Success." There's lots of people talking about this, but one of the messages that you will get antenatally is you really, really don't know, which I suppose in a way is a mini version of what everyone does when they're giving birth.

We don't necessarily know how breastfeeding's gonna work out. But with people who've had reduction surgery, you, you literally may not even be able to produce a mouthful of milk. You just, you just don't even r- know what's gonna happen till baby's born. And- 

[00:20:36] Alexandra: Yeah ... 

[00:20:36] Emma Pickett: letting go of that fear of, and letting go of that feeling of control must be pretty intense.

And I think the approach that you took of, "Well, I'm just gonna have to put it to the back of my mind," is probably all you can do, and then lining up the support immediately afterwards, so making sure you've got people who can help you maximize positioning and help you understand what swallowing looks like and help you understand how you can assess how much milk a baby's making or, sorry, receiving.

That's the bit that, that's super important. Um, and a, uh, other bit I think that we'll probably go on to talk about is your breasts will keep changing even after birth. Your ... You go through a period of breast growth and breast changing. Um, you know, your breasts cha- are changing during pregnancy. It's not like a, you know, we've, we've closed the door on your breasts still developing.

I remember once hearing a, a speaker at a c- association of breastfeeding mothers conference who every time she had a child, and I think she had three in the end, her lactation blossomed further and further and further as more breast cells grew on top of other breast cells. And even though she had to do a lot of supplementing with baby one, with baby three, she was exclusively breastfeeding.

So breasts change a lot, which is also part of that unknown and not necessarily being able to predict what's gonna happen. So you talked about having contact with the midwife and the midwife giving you the colostrum harvesting kit. Do you think she did that because of your history? Was she talking to you about your reduction?

[00:21:59] Alexandra: We did talk about it, and the stories that you mentioned are stories that I found online as well. So I, I mean, I found the resources fairly slim in this area, though, to be honest. It, it's-- there wasn't a huge amount out there, and I kept getting hit with the same retort, which is, "Well, you just don't know."

So it felt like I was kind of on a bit of a frontier in that sense, on my own. And I had been told by a friend to, you know, line up a lactation consultant, and Connie is my first child. I didn't really know anything about lactation consultants, and I felt like that was probably a bit overkill. I mean, I wish I had done, knowing what I know now, but I didn't.

I felt that there wasn't necessarily a need, and I think often in this situation, you, you get quite desperate before you reach out for, for help, rather than line yourself up with the right tools. I had incredible midwives. Um, the home care midwife, uh, midwifery team for the Royal Surrey are, they're just incredible, and they were really, really supportive.

But it did feel like they probably don't come across my case that often as well. Um, so yes, she, uh, it's pretty standard that they get handed out to everyone. Um, and of course, I was part of m- antenatal groups, and people were collecting quite a lot, and so I was starting to think, "Oh, crumbs. Okay, maybe this isn't gonna be so straightforward."

But I did my best ostrich and just kind of powered, powered on. 

[00:23:22] Emma Pickett: Yeah. I mean, I, I probably would say if I would, if I'd been having a conversation with you at that time, your colostrum harvesting isn't gonna tell us a bean. It's not gonna tell us anything. If you're getting a, a bead of colostrum, that tells us your ducts are joined up, which is, which is great.

Um, the volume of colostrum you get doesn't indicate anything about your outcomes once baby's born. And there are lots of people who have very successful breastfeeding journeys, if not overproduction, who can't express anything antenatally at all. Mm-hmm. Um, so that wouldn't necessarily have given us a lot of information.

But you being able to hand express and having that skill would, would be useful in those early days. Um- Mm-hmm ... and antenatal harvesting is not just about having the milk, it's also about how, you know, how you learn about your body's work, how it works, and learn about the process as w- as well.

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 you gave birth.

Tell us a little bit about Connie's birth and those, those very early experiences of trying to feed. 

[00:26:22] Alexandra: Well, her birth wasn't straightforward. It was 36 hours. But I think also the expectation of birth now is a bit unrealistic because so much is hospitalized. I'm not anti-hospital at all. I support everyone's choices, but I know that going into hospital you tend to have slightly quicker outcomes with slightly quicker sort of timelines to be thinking about, whereas I was just left to my own devices, which is what I wanted.

So, you know, I had 24 hours laboring at home on my own with my husband, watching films, trying to get some rest, um, not able to eat very much, not able to rest very much, but it was kind of within my expectation bands. And then when the latter stages kind of kicked in, it took a really, really long time. Um, and I had a water-- Well, I had planned a water birth, and she came out on the bathroom floor in the end upstairs after I'd been told by my midwives that I'd been fully dilated probably for too long.

Oh, 

[00:27:11] Emma Pickett: wow. So you were at home? 

[00:27:13] Alexandra: I was at home the whole time, yeah. 

[00:27:14] Emma Pickett: Okay. And that was ... Sorry, was, that was planned, was it, that you were gonna have a home birth? 

[00:27:17] Alexandra: It was planned, yeah. 

[00:27:17] Emma Pickett: Okay. 

[00:27:18] Alexandra: Yeah. 

[00:27:18] Emma Pickett: Okay. Um, we-- Sorry, I should establish that. No, that's fine. Um, okay. So, so home birth. Home birth. Fantastic. What a great opportunity.

Yeah. But, uh, and were midwives with you when that was happening? 

[00:27:28] Alexandra: Yeah, midwives were there. Um, it was all ... It was offered to me, and I initially said no, um, to a home birth 'cause I thought, "Oh, I surely can't do that as a first-time mum. I don't know what I'm doing." And then I did a hypnobirthing course and realized that actually, if I arm myself with enough knowledge, that I absolutely know how to do this and my body knows how to do this, and I hate hospitals.

I don't know anyone who really likes them, and it would not make me more relaxed to be in that environment. So I wanted to be at home. I wanted to be with my husband, and I got most of what I wanted, but it was very hard. It was a long labor, and she kinda got stuck, and I couldn't get her out towards the end, but sh- her heart rate never faltered.

W- she was never in danger. They were more worried about me and my exhaustion levels. 

[00:28:11] Emma Pickett: Okay. 

[00:28:12] Alexandra: But I'm quite headstrong, so I went off upstairs to the bathroom and pushed her out on my own on the bathroom floor, having thought the classic that I was, you know, needing to go to the loo, and actually no, she popped out in her sack and exploded all over the bathroom floor, so.

Oh, wow. 

[00:28:25] Emma Pickett: Well, hello, Connie. Welcome to the world. Yeah, she, she came quite an entrance. So, so in, in that moment then, you weren't with anyone else in the bathroom. You were alone at the very, very moment she came out. 

[00:28:33] Alexandra: Yeah, with my b- with my husband standing in the doorway with a face that, you know, I will actually always remember of total shock and horror and adoration all in one.

[00:28:44] Emma Pickett: Overwhelm. Oh, that's fantastic. So, so there she is on the bathroom floor, and we're now just about to do our first breastfeed. Did you leave the bathroom floor to do your, to do the next stage? 

[00:28:54] Alexandra: Yeah. No, I did. I did. Um, at the first ... She latched really well after we all got ourselves cleaned up And it looked, it looked okay.

It-- but again, my expectation, well, I had no expectation of what it would be like. The midwives looked at it and said, "Yeah, she seems to be latching well." But she was very small. Um, she came out, she was five pounds fourteen, and she, you know, she was dinky. So that immediately puts a lot of subliminal pressure on her putting on weight.

That became quite quickly not subliminal, very overt pressure of she needs to put on some weight, um, because she was born in the third percentile or thereabouts, I think. 

[00:29:35] Emma Pickett: Okay. 

[00:29:36] Alexandra: So that made it very, very much more difficult to start the feeding journey. Perhaps, you know, had she been born very chunky and then lost weight, I probably would've felt the same.

But there's a, a particular pressure on having a small baby and everyone telling you, "Oh, she's tiny," and you wanting to feed your baby and feeling like you're not doing a g- you know, you're not giving her enough, and also having no way of really understanding what you are giving her or how your breasts are working.

There were quite a few things, to be honest, Emma, because after I, I stayed under midwifery care for quite a long time because she was, took a long time to put w- to put weight back on. She never dropped below 10% of losing, uh, you know, her birth weight, but she just grew at a really, really, really slow pace.

And the midwives straight away thought she had a tongue tie, but they said, you know, "It's not a, it's not a major one, but I can see something's going on here." So there were a few things in the first six weeks when I was under midwifery care when she was slow to gain weight, and I was weighing her all the time.

And I've heard other conversations you've had with women about that kind of trauma around weighing your child incessantly and feeling- Yeah ... so, so depleted by the defeat of putting them on the scales and seeing they've gained nowhere near enough and, you know, you've been feeding them all, all blooming day and you just think, you know, you feel very despairing because everyone is saying, "Put a bottle in her, put a bottle in her."

And I didn't have a choice but to put a bottle in her, so I was triple feeding because I thought, "Well, it's irresponsible of me because I just don't know if- Yeah. Yeah ... the problem is me." 

[00:31:17] Emma Pickett: There's an extra element, isn't there, on top of everything else. You know, people- Yeah ... sort of, "Oh, maybe it's my body.

Maybe I'm not making enough milk." You've got that in, in spades because there is obviously a logical medical reason why you, you may not be making enough milk. Mm. You, you mentioned to me that you'd had a conversation with the specialist at the hospital. Tell, tell me about that conversation. 

[00:31:35] Alexandra: Yeah. So, uh, I initially went through NHS care to see the lactation consultant at, um, my hospital, and that was a real She was lovely.

She's very stretched. She clearly sees a lot of people, but it was very soul-destroying for me because I sat in her room and Connie at this point must have been, I don't know, s- uh, uh, probably about the six weeks stage where I'd really been trying. Maybe it was a bit earlier than that. Maybe it was four or five weeks.

I'd really been trying with the breastfeeding. I'd been pumping incessantly. I'd been topping up with little bottles and doing everything that I could. And I sat there and put her on the scales in, in front of this lactation consultant, and she watched her with the tongue tie and said, "Well, she's, her positioning's good.

I don't think the tongue tie is a problem. You know, you're, you're the problem," effectively. And I looked at her and I said, "I, you know, I really feel like I, I could keep going," 'cause my milk had come in and I, I was getting the letdown reflex, and I was feeling tingling in my toes, and I was able to express and I was able to pump not particularly well, because by the way, in the beginning I didn't un- understand pumping and my flanges were all wrong and I was giving myself, you know, blisters and doing everything because I didn't have the right guidance and that was making it even worse for my milk production.

But I sat in her room and she just said, "I've never seen a successful case of this, Alex." And the way that she said what she said about the prognosis for someone with a breast reduction, I just burst into tears. And she said, "You know, if it were me, I think, you know, the time has come now to transition onto, you know, formula and p- and put this to bed and, you know, your-- you need to think about your mental health.

You're not doing well. You know, you're, you're g- you're pushing this outcome, and you're not gonna get there." And I left the room, and I turned round to my husband, and I kind of said, "She's not right. I know my body," in a way that makes you feel really irresponsible as a mother because you think everyone must be looking at me thinking this isn't working, but my body is saying to me, "Just keep going."

Yeah. Because I felt like things were happening, and I could see my breasts changing. The morph... You know, even the morphology of my breast was different, and I, I thought, "Okay, I know that you're supposed to, your full supply is supposed to come in after a certain amount of weeks, but I know mine isn't there yet, and I feel like I, I want to keep going as hard as this is."

I, I really f- I suddenly felt so much more passionate about the benefit of giving Connie any breast milk than I ever anticipated having learnt what I learnt about, you know, all of the, you know, amazing qualities that we share with our children in breast milk that I thought, "Well, uh, I, I'll be damned if I don't give her something.

I can't-" 

[00:34:18] Emma Pickett: Yeah. 

[00:34:18] Alexandra: Gosh. "I can't give her everything." And I just, I used it as a sort of almost as a, a little bit of a mark in the sand to turn around and go, "Well, you said I couldn't, and then wa- watch me, watch me try." Yeah. 

[00:34:30] Emma Pickett: Watch me now. Wow. I mean, gosh, that says a lot about who you are as a person, Alex, that you were able to take that conversation and, and use it as a way to kind of feel inspired, but also that you knew your body.

You knew that something was changing and, and despite the expert, in inverted commas, telling you otherwise, to have faith in your body like that is something to be incredibly proud of. And as, and as we've seen, you, you were right. You ended up being right. Yeah. 

[00:34:56] Alexandra: But it took so much longer, Emma. It w- everything that I had read about how breast milk is supposed to, y- it, for me, it took months for my supply to come in properly.

It really did, and I thought, "Well, this isn't, this can't be right." And I, and I, I was talking to my mum about this recently. I did so much pumping to begin with, and I only stopped pumping when she was, I think, about 10 months old because I was so anxious to make sure that there was enough milk for her all the time because I was so anxious for her to put on weight that I was, you know, I would be making sure that my supply never, never dipped.

And I probably became a little bit obsessed with the whole thing, frankly, and I channeled so much energy into it all. But it It didn't follow the path that I thought it would follow. Like for example, people would say to me, you know, uh, I'd watch women have no trouble with breastfeeding, all my friends and, you know, milk gushing from their nipples and think, you know, oh my gosh, that doesn't happen to me

Or my mom say, "Oh, have you ever had it yet where you've squeezed them and it squirts across the room?" And in my back of my head thinking, no, that doesn't happen. Oh gosh, that must be another in- indication that, you know, my boobs don't work properly and I'm not getting the nutrition into my child that, that I need to get in.

And when I stopped pumping, actually the milk seemed to flow a lot easier. Now, I don't know whether the pumping initially helped thread everything together, and it was a really important stage, and if I have another child, I would try and avoid doing the pumping again if I could, because it's, uh, apart from people who-- and I have so much respect for people who want to exclusively pump and go down that road.

I mean, I find pumping horrendous. I don't know many of my friends who have enjoyed it. I feel like the whole journey since I've stopped then, now I can squeeze my boobs and, you know, milk goes flying. But we know we're, we're nearly 14 months in and it's re- the-- and then I just think, okay, well, that's just my journey.

My body has taken a really, really long time to stitch itself back together, and I'm in so in awe of the ability of the body to do that, and I think it's probably massively, massively under-researched around what breast- Yeah ... tissue can do. 

[00:37:05] Emma Pickett: For, for sure. I mean, there's no doubt there's not anything in the literature that says it takes 10 months for your milk supply to, you know, we say six weeks, six to eight weeks, you know, that after that you're pretty much plateaued and- Exactly, yeah

you know, some people can relactate and some people can increase their supply, but it's gonna be much more difficult. Um, there is so little information out there about, um, r- you know, lactation after reduction surgery. There's the case studies and, and bits and bobs here and there. I worked with a mum about four or five years ago who had complete detachment of the nipple and was successfully breastfeeding, and that is something- Wow

that is very rarely reported. Uh, just coming back to that conversation with that specialist, I think anyone listening to that would say The bit that really doesn't feel okay about that conversation is the idea that you should stop doing any breastfeeding, which is the implication that she was giving you.

[00:37:56] Alexandra: Mm-hmm. 

[00:37:56] Emma Pickett: That you would, you should be s- closing the door on breastfeeding. You should be moving to being a 100% bottle feeding, formula feeding mom. That's the bit that's particularly shocking. I mean- Mm-hmm ... for her to say, "Oh, I've never seen it being successful", okay, well, that might be true of her case, but if we, if we read the literature, we know it's not quite that black and white.

But for her to actually say, "I don't think you should be trying to breastfeed anymore", that is the bit that I can imagine would light a fire under anybody. Um, that, that doesn't feel okay. Because, because up to then, it doesn't sound as though, you know, she didn't lose more than 10% even when- No ... you were going through that period of exclusive breastfeeding.

How much formula were you using roughly were, this, 

[00:38:34] Alexandra: in those first few months? I mean, I was giving her top ups of 30 mil maybe two, three times a day. So really in the grand scheme- Oh, not, not a lot ... very, very, very little. Yeah, really not a lot. Uh, but enough to make myself feel ... I just needed to see that she was feeding.

I think that was part of it, you know, and if I could expr- if I was pumping, then I was putting it in a bottle, and it was getting it down her, and I was seeing that it was going in. But of course, when she was at the breast, I was having sensation, and I was thinking, "I think this is going well." There was audible swallowing, but I wasn't sure, and then the weight gain was so slow.

And the whole experience really from, you know, a medical perspective, until I got private support, was really pretty rough because they made me go and see a pediatrician, which I was sort of against doing, but I thought, "Okay, well, I'll go with it." And, you know, I went and saw the pediatrician, and I did one of those kind of sitting there and nodding and saying, "Yes, okay", as he told me she had cow's milk protein allergy and thinking, "She doesn't have cow's milk protein allergy", you know.

And him saying, "Oh, I think you should supplement with a, you know, specialist formula. I'm gonna prescribe some", and me going, "Okay, fine", you know. 

[00:39:35] Emma Pickett: What were the symptoms that he was attributing to cow's milk protein allergy? 

[00:39:39] Alexandra: Well, it's quite funny 'cause I said, "Oh, well, she's got quite a s-", she had diastasis recti quite, you know, as all babies do, but it was quite pronounced, and she was quite bloated.

Um, and now I think that the bloating was I don't know where that came from necessarily, but when I took her for her eight-week check, the GP said, "Well, she looks a bit distended in the stomach." Now, she'd just fed when I, just before I took her in there, and she was small, so it was quite exaggerated. And she said, "I'd like you to see a pediatrician about it, and the weight gain, and all of the kind of the, all of the kind of factors around this."

And I thought, "Oh God, here we go. Something else here," you know? And I remember saying to him, uh, I mentioned, I used the term diastasis recti, and he sort of looked at me in shock and he said, "Are you medically trained?" And I said, "No, I'm just an informed mom." And, um, he went, "Oh, well, never had, uh, never had someone sit here and say that.

Well, I, I think this is what you should do." And I discharged myself from his care after that point 'cause I just thought I knew that wasn't the issue. I cut out dairy from my diet just in case, but that kind of remains an unresolved dimension of her earlier stage as she was kind of progressing. She was always a little bit of a pot belly, but it's, it settled, it settled down, like all of these things do.

Yeah. And only with the wisdom of being a mom do you know 

[00:40:47] Emma Pickett: that. Just a pot belly. No eczema, no unusual stools, 

[00:40:50] Alexandra: no blood- Nothing ... black stools, no mucusy No mucusy. N- n- n- no symptoms. But I think it's another thing that's very readily over-diagnosed at the moment. Ooh, yes. I know a lot of people who have cow's milk protein allergy, and I, like statistically, that's just not, not possible 

[00:41:03] Emma Pickett: based on- Yeah.

And, and it makes it so hard for the people that genuinely have that problem- Yeah ... to get the right information because they've gotta fly through this whole sea of nonsense where all the misinformation's flying around, so no one is benefit- fitting, the people who aren't getting the diagnosis and the people who are being over-diagnosed.

It's a- 

[00:41:18] Alexandra: Yeah ... 

[00:41:18] Emma Pickett: complete car crash at the moment So let's go back to that moment you came out of that appointment with the hospital specialist thinking, "No." This-- If this was a Hollywood film, this is where the swell of music comes in. 

[00:41:30] Alexandra: Yeah, exactly. 

[00:41:31] Emma Pickett: Um, you look to your husband and say, "Damn it, we're going to fight another day.

We're not gonna let this, you know, we're not gonna let this beat us." You walked out of there with determination. But y- I, gosh, it, it is so interesting to hear what you're saying about how little formula you were given, and yet that- Mm ... is the message that she was giving you. 

[00:41:49] Alexandra: Yeah. And the other thing that was frustrating was I felt there was an issue with latch.

My nipples were ... She was destroying my nipples. They were coming out really misshapen, and she had said to me, "This isn't a case for tongue, the tongue-tie. The problem is you, unfortunately, Alex. It's not the tongue t- it's not a tongue tie. We can try and sort of label it as something else, but, you know, you've, your breasts aren't up to the job."

And I left and had to convince my husband to support me to keep going, understandably, because, you know, he's also just looking at the situation thinking, "Well, you know, medical professionals are saying your baby's, our baby's isn't, isn't thriving, and you're telling me something different, and I'm trusting you, but you're not a medical professional."

So you're kind of... It's a very isolating position to be in, and you've brought it upon yourself as well because you did this surgery to yourself. So, uh, you kind of go through quite a loop of mental health stuff when, you know, you're struggling to feed in that scenario. But I, I felt there was an issue with her tongue tie, and I took her to see, to see a private lactation consultant who changed everything for me, and she was incredible and was very, very supportive, went above and beyond, and would give me hugs and ran a, you know, feeding clinic and was my sort of lifeline, and I moved away from hospital care and NHS support to working with her directly and letting her do the weigh-ins and her give me the advice on, on what to do and educate me on how to pump effectively.

[00:43:26] Emma Pickett: So what's her name, if you're happy to give her a shout-out? 

[00:43:28] Alexandra: She's called Polly. She's a specialist tongue-tie practitioner, but she's called Polly Midwife, and she's an IBCLC obviously, um, based in Farnham, and she's just incredible, um, and so accessible and just warm and, you know, everything you would want from someone in your profession.

[00:43:45] Emma Pickett: Is it Polly Powell? 

[00:43:46] Alexandra: Oh, it's Polly Powell, yeah. Polly. 

[00:43:48] Emma Pickett: Yeah. So it looks like that's her professional name. So polly-polly-powell.co.uk is her, um, is her ... Yeah, I can see her lovely picture. Hello, Polly. I'm looking at you at Google, smiling away. 

[00:44:00] Alexandra: Oh, great. Yeah. Sorry, Polly. I can't remember your surname. That's terrible.

[00:44:01] Emma Pickett: Yeah, and Polly the Midwife on, uh, Instagram. Uh, we'll put her stuff in the show notes. 

[00:44:06] Alexandra: She's just, just amazing, and she kind of was a bit of an angel for me. She sort of swept in and told me that I could ... She gave me so much confidence and so, so much, shared so many amazing resources with me and things to look at and really lent into my interest in medicine and, you know, sent me some f- um, there's something that I have to share with you as a follow-up 'cause I can't remember what it is exactly, but some woman in America who has done loads and loads of stuff on, uh, breast tissue, and she sent me some gory links about, you know, surgeries that she'd done and things that she'd seen, and it was just, she-- honestly, Polly was amazing.

And Polly looked at her tongue tie and said, "Yeah, she does have a tongue tie." But I think on the score of tongue ties, I think she scored 11. So she scored that she-- I can't remember the scale. She was literally on the border of saying, "Well, this could be causing a problem or not, and you could go one way or the other."

And Polly is a big advocate for not doing a tongue, you know, not doing a procedure if, you know, if possible. Um, because again, I think probably there's quite a lot of tongue, there's a lot more tongue ties around now than there ever was. So we left it, but she got to the point where she was watching the feeding as, as Connie was getting a bit older and saying, "I think, Alex, we should give this a go 'cause I don't think this is a problem."

And so we did actually have, um, that done at about 10 weeks, I think it was fairly late in, um, and that made a big difference as well. So I mean, I really ... Everything that I could have had as a challenge to feeding with this gorgeous child of mine, I, I pretty much had. 

[00:45:46] Emma Pickett: Yeah. Yeah. And, and Polly also helped you with the flanges, getting the right sizing for pumping.

[00:45:51] Alexandra: Exactly. Measured everything up and told me how, what to, you know, what to do to make it a lot more comfortable and, um, also was really good at saying stop, because what I'd got into was pumping incessantly because I was so frightened of my supply dipping and, um, you know, my initial advice from the hospital was, you know, pump eight times a day and, uh, you know, then feed and also, you know, do top ups and

Yeah, it's just you literally don't have time to do anything other than feed, pump, repeat. So she was good at saying, "Kind of calm down. You're not helping yourself with this." 

[00:46:27] Emma Pickett: Yep. So, so you mentioned a little while ago that the first 12 weeks postpartum is the only time in your life where you felt regrets about that surgery.

Mm. Um, and, and we're just coming up now to, to that period of time, so almost kind of two weeks after the tongue-tie procedure had been done- 

[00:46:45] Alexandra: Mm-hmm ... 

[00:46:46] Emma Pickett: things started to feel easier. Yeah. I think you started to feel more confident. Do you remember a moment when you thought, "This is happening, this is working.

I'm, I'm reaching my goals"? Was there kind of an epiphany, or did it just kinda gradually creep that way? 

[00:46:59] Alexandra: Honestly, that didn't come until nearly six months. You know, it took such a long time. I guess this is the reason why I wanted to talk to you, because there were so many times when I felt that there's no possible way I could keep going.

But every morning I wake up and say, "I've ... I'm gonna, I, I, I'm gonna keep going," because I had such a strong sense of wanting to do the best for her. You know, I think as a mother it can be sometimes a bit dangerous 'cause you're almost, you know, for this ... You, you prioritize their needs so much that you probably, uh, someone could rightly say at a stage, you know, I needed to probably look after myself a bit better and stop, you know

And there's an argument to say that that might have been perpetuating some of the supply issues because I didn't have all of the nice sort of lovely hormones that I could have had because I was putting myself under so much pressure. But it just took such a long time, but it did come, and I cherish the breastfeeding even when it wasn't working that well.

You know, that bond between us and the ability for her to get what I was making for her and, and see ... I mean, I was just sitting at the table this morning with my mum And she said, "Connie just looks so well. She's such a lovely color. She's such a healthy baby." And she said, "I, I think it's might be the breast milk."

And I said, "Do you think?" You know, just that's so gratifying. Um, and- Yeah ... you, you know, it was, it was worth it all for sure, and I'll, I'll continue to do it until such a point as it doesn't make sense for us anymore, it doesn't make sense for Connie, and I'm so at peace with that, and it's such privilege, and I wish I could have seen myself now when I was in, you know, six weeks in and despairing and feeling really low and really resentful of my body that, you know, to have faith in it and it would all come good and- Yeah

you listen to yourself. 

[00:48:52] Emma Pickett: Giving yourself that time, that I think that's the, the thing I've sort of taken from your conversation, giving yourself time and understanding you have a different timeframe, and that's okay. Um, you, you mentioned that you had some worries about her slow weight gain at the beginning, and that was obviously you're getting messages from health professionals around that as well.

Um, when did weight gain stop becoming something that, that felt scary? When did those weigh-ins start to feel easier? 

[00:49:18] Alexandra: About a month after the tongue tie procedure. And actually, I just stopped weighing her. I think that was part of the thing. You know, when you're weighing so regularly, it becomes very, very difficult, and y- y- I, I could see she was fine.

Everyone was saying, "Oh, she's so bonny. She's..." You know, and I just thought, "Okay, put this to bed. Leave it. Let," you know. And I had a-- The one healthcare professional that came round to my house after she wrote on my notes that I was recovering well from a C-section, which always makes me laugh 'cause I didn't have a C-section, so it just shows how much attention she was paying.

[00:49:53] Emma Pickett: Whoa. What, what scar was she looking at? That's kind of 

[00:49:55] Alexandra: weird. I have no idea. But I remember her saying, "Oh, well, she's in the..." At this point, she was probably, you know, ninth percentile or something. She said, "Oh, she's in the ninth percentile, so I'd like to come, I'd like you to come back into the clinic and weigh her again in a week's time."

And I said, "What's your logic for that?" And she went, "Well, she's just small, isn't she?" And I said, "Yeah, but what Polly taught me was it's really about the line, so it doesn't matter where she is. What matters is what she's tracking." And from the moment that she stopped dipping or plateauing, she tracked beautifully.

And for a while, for maybe a couple of months, she just stayed on the ninth percentile, but she was exactly on the ninth percentile going up in increments. And I said to the healthcare professional, I said, "Well, if you look at her chart, she's not dropping." And she went, "Yes, but as I said, she's small." And I said, "Well, if the chart line was 50th percentile, would sh- and she was doing the same thing, would you be advising me to come in and weigh her then?"

And she went, "No." And I said, "Well, then why are you advising me now?" And she looked really stumped, and she went, "Well, what's your point?" I went, "Well, she's just small, but she's gaining the right amount of weight. She's gaining 30 grams a day. We're looking at that, so I don't, uh, you're making me feel like there's a problem.

Are you sure there's a problem?" She went, "Actually, you're right. No, no, I'm gonna strike through that. You're right. Yeah, you don't need to weigh her. Yes, it's okay." And I sort of sat there and I thought, "Why is everyone so obsessed with small babies? What's the big..." You know, it's, 

[00:51:19] Emma Pickett: ninth isn't even that small.

I mean, we've got smaller babies than ninth, so we've got, we've gotta redo the charts if, if ninth is abnormal because this is not the way- Oh, I hate ... not the way the statistics work. Gosh, we need to clone you, Alex, because you're so good at, at speaking up. Lots of people would have that situation and just, just nod, and then the minute someone's left their house, they'd think of all the things they should have said.

You're, you're great at saying things in that moment, which is, which is fantastic. So let's clone you, and we'll- ... put you in every situation where weigh-ins are happening. There's 

[00:51:47] Alexandra: probably problems with that as well, I would imagine. 

[00:51:50] Emma Pickett: So this, this health professional was obviously on autopilot and not- Yeah

thinking because to be honest, any qualified health professional would realize that a baby that's putting on 30 grams a day is not a baby that we're gonna be worrying about. So I suspect she'd probably looked in your notes and was just worried about your history, and that triggered something that wasn't logical.

[00:52:07] Alexandra: I think it was the breast reduction thing, though, again. Yeah. 'Cause the mi- seriously, the minute you say I've had a breast reduction. Every healthcare professional I worked with until I went sort of privately just looked at me and went, "Oh, well, you're gonna need some extra help." "Oh, well, you probably need to supplement," or, "Oh, we should check the weight.

We should make sure things are all work-," you know. And it just was the default response that there was gonna be a problem, which is responsible in some aspects, and I can appreciate where it's coming from, but actually just makes you feel, it, it robs you of any power and autonomy to make decisions about your own body again.

[00:52:43] Emma Pickett: Yeah. Yeah. Well, well spoken. So you are pumping for the next eight months. Yeah. You're pumping until she's about 10 months old. How many times a day were you pumping through those months? 

[00:52:55] Alexandra: So I got it down to just one pump, extra pump in the morning so that I could give the top-up as my breast milk. And one thing I forgot to tell you, going back to when she was a bit sort of bloated, one of the things that we did do is I was giving her, at the time, just regular cow's milk formula in these 30 ml top-ups.

But I had read that goat's milk was more like breast milk, and I felt that the more like breast milk probably was a good thing. And so I had, I've always g- only given her goat milk I d- from that point onwards because it, it, she did just, you know, it, it was easier for her ti- to digest, I felt. Okay. Um, not that there was any proven sort of cow's milk issue.

[00:53:37] Emma Pickett: Yeah. Li- a little asterisk if you wanna read more about cow's milk versus, um, goat milk formula, the f- First Steps Nutrition Trust have their infant milks website where they discuss that issue. I'm not sure we have a lot of evidence to say that goat's milk is necessarily gentler or more superior, but if, if you found it worked better for Connie, it obviously did work better for Connie 'cause you're the expert.

Um, but we can read more about it on the, on the First Steps Nutrition Trust resources. So you were giving cow's milk formula until what point? 

[00:54:12] Alexandra: Um, probably f- for the first month or two, and then I switched it to goat milk. But again, you know, as, as we said, it was a very, very small amount. And then if I've ever given her formula since then, it's always been a bit of goat milk because sh- she liked it more.

[00:54:30] Emma Pickett: Okay. And you'd stopped pumping when she was about 10 months old. Do you remember there being one particular day when you thought, "Nah, that's it. Now we're done"? 

[00:54:37] Alexandra: Well, I just suddenly realized that it was pointless because I was just feeding her what I was pumping. You know, I, uh-- It, it sounds a bit ridiculous because I was doing that for quite a long time, but I, I just remember sitting there and thinking, "Why am I doing this?

Because I'm just giving it to her." You know, and I've got myself into this loop where I became a bit obsessed about making sure that I'd protected my supply. But by that point, I felt that the supply wasn't needing to be replenished, and she was going to the breast really well, and, you know, she was on solids as well.

So I was thinking, "Okay, this is really over the top. Why am I pumping to give her a top-up of breast milk and giving myself some bottle dependency when I really don't need to have any bottle dependency? I could just put her to the breast and give her solids." And she was a really, really good eater. She loves food.

So it felt completely over the top, and it was almost like a safety net of thinking-- I mean, I haven't really spent any time away from her. I've been lucky enough that I've changed my whole life so that she and I are always in fairly close proximity. So this idea that I was having to pump to have something in case I wasn't there was just unnecessary, and I was so, so pleased to put the pump in-- Well, I say the pump.

Obviously, I had five pumps by this point, um, to put them all in a box and put them up in the loft. Obviously, keep out one just in case, you know? Yeah, for emergencies that, um, I used a few weeks ago when I went up to London for the day and thought, "Oh my gosh, this is horrendous. I'm putting this away and not doing it again."

[00:56:12] Emma Pickett: You mentioned that she was a good solid eater, and, and for some people, that's actually a bit scary because if you're worried about your milk supply, some people think, "Oh gosh, what happens if suddenly she's eating loads of solids and my milk supply dips, and my milk supply gets less stimulation?" But it doesn't sound like that was a worry for you by that point you felt 

[00:56:29] Alexandra: comfortable.

No, I thought, I thought it was r- it was really gratifying to think that having had such a struggle to get her to enjoy her first foods, you know, in brea- from a breast milk perspective, to see her really thrive with actual food took a bit of pressure off as well to make me feel like, okay, I can really just enjoy the breastfeeding because I know that she's getting the nutri- nutrition that she needs from food.

And so the breastfeeding can-- I can really lean into all the other dimensions around breastfeeding that are really important beyond that of just providing milk for her. 

[00:56:58] Emma Pickett: Yeah. No, that makes perfect sense. So your plan is just to keep going as long as it's working for both of you, as you said. You don't have any particular deadlines in mind or, or goals?

[00:57:07] Alexandra: Not really, no. I think that one of the things is the sort of circadian rhythm that I'm in is that my breast milk is much, much more plentiful, and I, I learnt this off Polly that this is quite normal kind of overnight and in the morning, and sort of less so in, you know, in the afternoon. So for me, I guess the goal is really to be able to use that to help her regulate and sleep well and have a morning feed and be connected with me, and then phase that out as she's more distracted with things that happen in the day.

And yeah, we'll just see though. I, I haven't put any expectations in because I've learnt through motherhood that expectations tend to be the things that you beat yourself with the most, and all of my expectations around birth or my breasts or how she would behave or what my life would be like all fall down the minute you, you tie them too tightly.

Um, so I, so I really, really do try. Otherwise, you just, you know, you self-flagellate at everything that you're doing wrong rather than appreciate the things that go well. 

[00:58:14] Emma Pickett: Yeah. We can, if we can embroider that on a pillow, if we find a pillow big enough, 'cause that was beautif- beautifully expressed. If someone's listening to this and they're a breastfeeding supporter or a health professional that works with, with women or people who've had breastfeeding reduction surgeries, what would you want them to know before they have a conversation with somebody antenatally about breastfeeding outcomes?

[00:58:33] Alexandra: Oof. Um, if you're a healthcare professional, I think it's around Holding the hand of that woman and really listening to what they want to achieve and, and why, and respecting their choices. I, I understand you have to walk a fine line of what's responsible, and I can understand that there can be some judgment that you can't avoid there when you think about the wellbeing of a child.

But, um, no, no case from a reduction perspective is born the same, I imagine. So it-- and it can just take a really, really long time. I'm testimony to it taking an unprecedentedly long amount of time from a medical perspective, and so supporting that woman to go through a longer journey, preparing them for it being a longer journey.

I think it has to depend on the woman as well, you know, the level of resilience and determination in that individual as to whether they can kind of, sort of see it through. But they, but they absolutely can do it. And having the message that Polly gave me of, "Well, even if you can just give her a bit, that's amazing-" Mm.

because a bit of breast milk gives her..." And that was the thing that really helped me, because I sort of felt like it was kind of exclusive breastfeeding or formula feeding, and anything in between was a bit nuts 'cause like, why would you do, why would you make your life that complicated? And she said-- And she wasn't breastfed, so she's really-- And she uses her own experience to talk about it.

And she said: Look, Alex, if you can give her 30 mils of breast milk a day and that's all you can give her, you're giving her 30 mils of breast milk, and that's amazing. And you should be really proud that you can do that, because that's got 30 mils of antibodies and loads of stuff in it that formula doesn't have.

But any- and if you can't do that, she's gonna be totally fine as well. So it doesn't matter, but keep pushing for that 30 mils 'cause you might be able to do a bit more if you want to or don't, whatever. But the way that she gave me permission to feel like a bit of breast milk was good- Yeah ... when I was beating myself up and thinking, "Oh, a bit of breast milk means my breasts don't work," and that, and it's very easy to get into that.

If it's not a full production that's easy, you often feel like, well, formula then is better because it's more consistent. Or I can see what they're getting and it's-- And you, you do have to operate in this space if you're triple feeding of not ever really knowing how much milk your child's getting, and that's kind of weird, and it's uncomfortable, and it feels like it would be easier to just go with formula a-a-as a result of that, 'cause then you could sleep at night knowing they've had whatever they're supposed to have had.

And that's just not true. And we know that breast milk volumes are very different, and maybe I don't have-- I, I also think that I learned that my capacity was maybe a bit less than other people, which is why it was quite difficult for me because my mom would come around or people would come around and go, "Oh my gosh, you're breastfeeding all the time."

And I would feel a bit abnormal. I'd feel like a bit of a freak. Like, oh, well, your child breastfeeds and gets full and doesn't breastfeed again for three, four hours, and my child breastfeeds every 45 minutes. Yeah. And that could have been the case regardless of me having a, a breast job or not. But, you know, again, recognizing that little bits, if you can do it and you can, you can power through that, is another way of feeding your child.

It's just a different rhythm. 

[01:01:50] Emma Pickett: Yeah, for sure. I mean, smaller storage capacity, more frequent feeding is an absolute part of the normal range, and we need to talk about that more because we went through a horrible phase where everyone was thinking, "Oh, you've got to get to three hours, and if you don't feel, if you don't get to three hours, something's horribly wrong with your body."

That's... Someone's never gonna get to three hours, whatever their surgical history has been. 

[01:02:08] Alexandra: Um- A- and another thing that's actually very dangerous for women now is with social media, is watching pumping stuff. You know, 'cause obviously your phone listens to you, and it feeds you all of this material. And I remember finding it really difficult, and Polly helped me with this, because I would watch videos on Instagram of women producing huge quantities of milk, you know, and having a who- and then you...

I would sit there and pump and produce 60 mil and think, "Oh, no." And then I would-- And then there was another, um, IBCLC called Katherine, I forget her surname, and she posted that their normal range of breast milk for any... It was something like between 60 and, no, 30 and 60 mil per breast or... And I remember looking at it and thinking, "Really?

Oh, brilliant." You know, because I'd been watching these videos of women sitting there and producing five ounces in, you know, 10 minutes and thinking, "Oh, wow. Yeah, my boobs don't work 'cause I can't do that." 

[01:03:05] Emma Pickett: Yeah. Yes, the algorithm pulls you sometimes into unhelpful places. I think that's really important to remember.

Thank you so much for your time today, Alex. I re- I really, really appreciate how, how honest and open you've been and how much information you've shared. I- is there anything we haven't covered that you think we need to mention before we end? 

[01:03:23] Alexandra: I could talk about this subject forever, so, um, probably. But no, it's been really lovely.

I just hope that it helps inspire someone who was in my position to have the confidence to, to keep going and to try if they want to, um, because it, it can work. And I hope to be able to tell you if I have another child that things are even easier that time around 'cause I know that that sometimes can be the case.

So- 

[01:03:46] Emma Pickett: Yeah ... 

[01:03:46] Alexandra: I will let you know. 

[01:03:48] Emma Pickett: I look forward to it. And, um, and if you have any thoughts about resources, you mentioned that particular resource that, okay, that I think Polly recommended to you. We'll, we'll put them in the show notes. Yeah. Um, so if people want to have a look for some extra stuff, that's where they'll find it.

Thank you so much for your time today. Really appreciate it, and very best of luck with the rest of your journey. 

[01:04:05] Alexandra: Thanks, Emma. 

[01:04:06] Emma Pickett: Thank you.

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

This podcast is produced by the lovely Emily Crosby Media.