I am a Health Visitor

This episode links really well with our previous episodes about combination feeding and giving top ups (linked in resources section below). In this episode Jen shares all her IBCLC wisdom with us on expressing breastmilk. How much do you know about flanges?! We talk about: - when to express - the emotional and physical load of pumping - how to pump - 'hands on' expressing - does the flange fit - how much milk to expect Resources and Further Reading: Our previous episode on Combination Feeding with Lucy Ruddle (IBCLC and author of 'Mixed Up'): https://soundcloud.com/iamahealthvisitor/combination-feeding-with-lucy-ruddle-ibclc?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing Our previous episode on Top Ups: https://soundcloud.com/iamahealthvisitor/top-ups-when-what-how-and-how-much-to-give?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing Breastfeeding twins and triplets charity (Kathryn Stagg IBCLC): https://breastfeedingtwinsandtriplets.co.uk Hand Expressing Video: https://globalhealthmedia.org/videos/how-to-express-breastmilk/ Hands Free Pumping Bra Hack: https://www.youtube.com/watch?v=8stY-2fxt4M Flange Sizing: (see our instagram account 'IamaHV' for a visual) Hands On Expressing: http://www.nancymohrbacher.com/articles/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html Some social media pages to follow and recommend for free resources: Olivia - Hospital Lactation Consultant https://www.instagram.com/olivia_lactation_consultant/?hl=en Stacey Zimmel at Feed Eat Speak: https://www.instagram.com/feedeatspeak/ Kathryn Stagg IBCLC https://www.instagram.com/kathrynstaggibclc/

Jen and Amy delve into the murky world of infant poo in the first six months! What to expect, what is a worry and what isn't. How is poo different between formula and breast or chestfed babies? Or mixed fed babies? What does that green poo mean? What about giving a bit of fruit juice or water for constipation? We answer all your questions and as usual it turns out to be more complicated than we imagined! Thanks to a listener for this request! Do get in touch with any questions, comments or suggestions for future episodes on [email protected] Thanks for listening! Amy and Jen Resources The baby poo gallery: https://www.facebook.com/babypoogallery/ Philippa Pearson-Glaze IBCLC on green poo: https://breastfeeding.support/why-is-my-babys-poop-green/ Drugs in Breastmilk Advice: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/ Child Liver Disease on pale stools: https://www.childliverdisease.org/wp-content/uploads/2018/01/Yellow-Alert-Stool-Chart-Bookmark.pdf Frequency of stool slowing - Carol Smythe IBCLC: https://www.carolsmyth.co.uk/breastfeeding-resources/posts/2016/december/should-my-breastfed-baby-poo-every-day-or-is-breast-milk-all-used-up/ First Steps Nutrition: https://www.firststepsnutrition.org Our previous episode on the Aptamil formula changes: https://soundcloud.com/iamahealthvisitor/those-aptamil-formulation-changes GP Infant Feeding Network on constipation: https://gpifn.org.uk/constipation/

Amy and Jen take a dive into a recent research paper suggesting there may be a newly identified biomarker for infants at high risk of SIDS. We look at the recent paper in detail, review the statistics and the methodology and consider what we are able to say and what we are not, as well as possible harms that might come from misinterpretation of the results. We also discuss the article in the context of the current theoretical approaches to SIDS research and general safe sleep advice which importantly still needs to be followed. We love to hear from you. Contact us with suggestions or ideas for future episodes at [email protected]. Thanks for listening, Amy and Jen References and Resources for further reading: Harrington, Hafid & Waters 2022 - the full text article: https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00222-5/fulltext Media coverage: 1. https://www.biospace.com/article/researchers-answer-how-and-why-infants-die-from-sids/?utm_content=207502735&utm_medium=social&utm_source=facebook&hss_channel=fbp-10530620221 2. https://www.theverge.com/2022/5/13/23071364/sids-research-hype-science-studies for context - there is so much about SIDS deaths we still do not understand: https://www.nejm.org/doi/full/10.1056/NEJMp2119221 Critical analysis of the media hype: https://www.theatlantic.com/health/archive/2022/05/sudden-infant-death-syndrome-cause-study/629886/ Lullaby trust statement about this article: https://www.lullabytrust.org.uk/our-response-to-new-australian-sids-biomarker-study/

Amy and Jen chat to the inspiring Alison Spiro who has a PhD in anthropology as well as practicing as a health visitor. Listing all her achievements is a podcast summary in itself, but across her career she has worked as a breastfeeding counsellor herself, established an incredibly successful peer support service, taken both a hospital and community trust to BabyFriendly accreditation, worked on the world breastfeeding trends initiative report in 2015, contributes to the APPG on infant feeding on behalf of BestBeginnings, volunteers with the Breastfeeding Alliance, has been the iHV expert advisor on breastfeeding. Most recently, she is the author of 'Breastfeeding for Public Health: A resource for community healthcare professionals'. We discuss with Alison some of the most important issues in breastfeeding support - from culture and anthropology to emotions, wellbeing, mental health and therapeutic communication skills. We talk about the importance of debriefing your own infant feeding experiences and bringing an unbiased listening ear to your interactions with families. Hopefully this will be an interesting and relevant discussion for your health visiting practice. We would love to her your thoughts and comments at [email protected] Reading & Resources: Alison's new book - 'Breastfeeding for Public Health: A resource for community healthcare professionals': https://www.amazon.co.uk/Breastfeeding-Public-Health-Healthcare-Professionals/dp/0367689561/ref=sr_1_2?crid=3M4VF06U18GP7&keywords=breastfeeding+for+public+health&qid=1652711900&sprefix=breastfeeding+for+p%2Caps%2C71&sr=8-2 World Breastfeeding Trends Report: https://www.worldbreastfeedingtrends.org/resources/publications Becoming Breastfeeding Friendly with Yale University: https://ysph.yale.edu/bfci/ Kathryn Stagg IBCLC: https://kathrynstaggibclc.com Eve Canavan lived experience story: https://www.app-network.org/news-events/news/personal-experiences/story-eves/

This week Jen talks to Maria Renshaw who runs a local sling library in Colchester about her experience of slings and all things baby-wearing from a very practical perspective. She goes through different types of baby wearing from soft wrap slings to buckle carriers with some tips on the differences, fitting, safety tips including the TICKs acronym, common worries about hips and knees, how to find your local services for sharing with parents. Thanks so much Maria for sharing your experience and knowledge with us! As ever we love to hear from you, contact us with your comments or feedback on [email protected] Amy and Jen References and Resources: Maria's website: https://www.beautiful-bonds.co.uk/meet-the-team The TICKS rules for safe baby wearing: http://babyslingsafety.co.uk Sling Pages (to find a local sling library): http://www.slingpages.co.uk 'Why Babywearing Matters' by Rosie Knowles https://www.amazon.co.uk/Why-Babywearing-Matters-Pinter-Martin/dp/1780665350 Babywearing training and resources: https://www.carryingmatters.co.uk/training/

Amy and Jenny chat to the lovely Alice from the Baby and Infant Sleep Information Source (BASIS) about sleep pods and nests. We cover the evidence base - what can we and can't we say about these products. Are they safe or not? In what circumstances? How do we actually know one way or the other? We talk about what manufacturing standards these products are held to, as well as some of more the hidden risks and implications the use of these items have. We also consider the disproportionate impact on families who live with a low income, who may be tempted to recreate homemade versions and leading to a cluster of co-occurring SIDS risks. Alice tells us about her research from a recent survey with parents about their use of sleep pods and we discuss how to have appropriate conversations with families to help minimise risk while sticking to the evidence base and avoiding scaremongering or judgement. We have quite a few other episodes on sleep now - so do check back through our back catalogue if this is a topic that interests you! Thanks so much for listening everyone - we would love to hear from you with any comments or suggestions to [email protected] Resources and Further Reading: The BASIS website - check out their resources if you haven't ever used them, they're brilliant: https://www.basisonline.org.uk Professor Helen Ball webinar on "What is Normal Infant Sleep: The View From Anthropology": https://www.youtube.com/watch?v=g5fOogsUpIk Lullaby Trust Resources on Baby Products: https://www.lullabytrust.org.uk/safer-sleep-advice/sleeping-products/ and: https://www.lullabytrust.org.uk/wp-content/uploads/The-Lullaby-Trust-Product-Guide-Web.pdf Specific to sleep positioners: https://www.lullabytrust.org.uk/are-sleep-positioners-safe-for-babies/

Jen and Amy go through the world of contraceptive advice. Although not directly our work, it's definitely connected and very relevant to health visitors. Often a bit of a neglected topic, it can be something we feel uncomfortable or poorly prepared to discuss with families. We hope our discussion solves some of those problems as we go through the contraceptive options for families, talk about contraception and lactation and the more emotional side of the conversation about physical intimacy after the birth of a baby. References and further reading: Faculty for Sexual and Reproductive Health Guideline: https://www.fsrh.org/documents/contraception-after-pregnancy-guideline-january-2017/ NHS Contraception Guide: https://www.nhs.uk/conditions/contraception/ Lactation and Breastfeeding: https://www.breastfeedingnetwork.org.uk/contraception/ iCaSH Sexual Health Service & the C-Card Scheme: https://www.icash.nhs.uk/contraception-sexual-health/c-card-scheme Emotional Factors and broader conversation prompts: https://www.nct.org.uk/life-parent/sex-after-baby/sex-after-baby-10-questions-ask-yourself

Jen and Amy gently guide you through the main headlines of the huge, massive, overwhelming and generally awe inspiring 'CHILD Cohort Study' all about the human microbiome. We will discuss how all the things you might expect, and some very unexpected factors, can all impact the infant microbiome and the important long term impacts this can have on that child's health. If you would like to look more into the myriad of research which has been produced from the CHILD dataset, just do a quick google scholar search and you will find heaps to keep you going. For a more curated starting point, check out our further reading down below! We love to hear from you, contact us on [email protected] Thanks for listening! Further reading: YouTube Summary of the CHILD study: https://youtu.be/eL9dAGiCNLU Study website with the key discoveries highlighted: https://childstudy.ca/portfolio/key-discoveries/

We discuss postnatal anxiety, specifically the measurement of anxiety after birth. In practice we are often using generic anxiety measures which are simply just not appropriate for use in this specific period of a parent's life. Listen in to learn more about the scale, how it can be used and how you might be able to incorporate it in your clinical practice. As ever, we love to hear from you. Get in touch with comments or suggestions at [email protected] If you would like to use the PSAS in your practice or you would like to be involved with her stakeholder engagement research then Vicky would love to hear from you! Email her at [email protected]. Resources and Further Reading: Dr Vicky Fallon - other relevant publications mentioned in the episode: 1. A feasibility trial of a single session Acceptance and Commitment Therapy intervention to reduce fear of childbirth in first time mums. https://www.tandfonline.com/doi/full/10.1080/08870446.2021.2024190 2. Challenges and opportunities for child health services in responses to the COVID-19 pandemic https://www.tandfonline.com/doi/full/10.1080/02646838.2021.1890422 THE POSTPARTUM SPECIFIC ANXIETY SCALE - Research Background: Parent Infant Foundation Briefing Paper: https://www.researchgate.net/profile/Sergio-Silverio-2/publication/351736241_The_Postpartum_Specific_Anxiety_Scale_PSAS_Briefing_Paper/links/60a6c586299bf1031fbe1378/The-Postpartum-Specific-Anxiety-Scale-PSAS-Briefing-Paper.pdf Validation study: https://link.springer.com/article/10.1007/s00737-016-0658-9 Short form validation: Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF) https://pubmed.ncbi.nlm.nih.gov/33900462/ Childbearing specific validation - predicts infant feeding outcomes: https://link.springer.com/article/10.1007/s00737-017-0775-0

Amy and Jen discuss a government guidance document published in the past year which reviews the Hepatitis B selective immunisation pathway for pregnant people and newborns. We look at this guidance from the perspective of health visitors in practice - what do you need to know? What should be happening, what actually IS happening and what do you need to do when this crops up on your caseload? As ever we love to hear from you with any comments or thoughts by email on [email protected]. Resources and Further Reading: I am a HV episode on the Hexavalent vaccine: https://soundcloud.com/iamahealthvisitor/changes-to-the-immunisation-schedule-august-2017-episode-2 Guidance Document - Hepatitis B antenatal screening and selective neonatal immunisation pathway. https://www.gov.uk/government/publications/hepatitis-b-antenatal-screening-and-selective-neonatal-immunisation-pathway