Thrive Lactation Consultants- Josie Plant RN IBCLC

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Josie Plant, Registered Nurse, BFHI Coordinator and educator, experienced in child and family health nursing, Paediatric nursing studies cert, IBCLC Lactation Consultant, Certified Babywearing Consultant

Have you been fitted for pump fl**ges in hospital recently?Chances are, you may have been incorrectly sized.Today we are...
12/02/2026

Have you been fitted for pump fl**ges in hospital recently?
Chances are, you may have been incorrectly sized.

Today we are talking about the latest on pump fl**ge sizing.

In the birthing sites I work in, the Medela pump fl**ge sizing tool is still used. Medela pump fl**ges come in sizes 21mm through to 36mm.

This is a problem.

Research on sizing shows that most mothers/lactating parents will fit somewhere between a 15mm and 19mm. The Medela tool does not accommodate for the majority, so pump fl**ge sizes are almost always too big in the hospital environment.

My trusty silicone b***y has an average sized ni**le.
Even the smallest hole in the Medela sizing card is too big.
We no longer upsize or add mm to the size of the ni**le, as suggested on the Medela card.

So, keep in mind, even if you have been measured up, that measurement is restricted to the equipment that is available and the education of the health professional measuring you, and may not be a true reflection of your sizing.

Ni***es come in all different shapes and sizes, and if you do fit a larger size, you are still perfectly normal!

With my other hat on, as a BFHI (Baby Friendly Health Initiative) Coordinator, I am undertaking a quality improvement project to improve access to pump fl**ge sizes in hospitals and provide education to midwives in measuring accurately.

For more detailed information, the Babies in Common "Fl**ge Fits Guide" is a great resource.

As this season and time of year brings outings, social catch ups and business, remember that your baby is your baby.You ...
24/12/2025

As this season and time of year brings outings, social catch ups and business, remember that your baby is your baby.

You have the right to ask for your baby back.

You can filter out well-meaning advice. You know your baby better than anyone and you choose how to parent.

You don't have to justify your decisions to anyone (although it can be an opportunistic time to educate).

Babywearing can help to protect your baby and your breastfeeding/chestfeeding from too much external handling.

You shouldn't be expected to hide away while feeding your baby- if you want to participate in social activities, continue to do so with confidence. If you need a quiet space to manage sensory overload, don't be afraid to request this.

Watch out for signs of mastitis. (see my previous post on this).

You can have a drink, (or 3!), if you want to. https://www.breastfeeding.asn.au/resources/alcohol-and-breastfeeding

However you celebrate or spend this time of year, I hope it's joyous and full of love.
Merry Christmas.
Happy Holidays.
and a safe and happy new year.
Love from Josie xx

One course down, one to go.My posts have been erratic over the last few months (enrolled in 2 university courses at once...
17/12/2025

One course down, one to go.

My posts have been erratic over the last few months (enrolled in 2 university courses at once), and I dare say this will continue over the coming months as I work to complete my current study commitments.
But continuous education for health care professionals is vital for quality care.

Holiday season series:Did you know that mastitis risk goes up over the Christmas and holiday period?This may be due to t...
14/12/2025

Holiday season series:
Did you know that mastitis risk goes up over the Christmas and holiday period?
This may be due to the extra stress during the holiday season, being busy, having other people holding the baby and passing baby around, missing or delaying breastfeeds, getting dressed up in fancy and ill-fitting clothing for gatherings, travel and different routines, different feeding locations, baby not feeding well due to being overstimulated, out of routine, being influenced by the well-meaning advice of others, family dynamics and questioning your own instincts, triggering of family traumas or grief, sleep deprivation, perhaps you don't have a comfortable place to feed, feeds may be short, fussy or ineffective.
Some strategies to prevent holiday Mastitis:
- Keep baby close to mum/lactating parent
- Babywearing
- Alert family and friends to immediately give baby back for a feed if showing signs of being unsettled or hunger cues
- Keep feeding frequently and don't skip feeds
- Rest and relax when possible
- Take care not to wear clothing that restricts the chest area
- Stop regularly for feeds and rest breaks if travelling distances by car (at least every 2 hours)
- Request a quiet space if visiting others and if baby is overstimulated or highly distracted
- Ensure every feed has a good deep latch
Stay well this holiday season.
xx josie

I love to see nature doing its thing.I recently went hiking with my son at Anstey Hill (North of Adelaide, South Austral...
12/12/2025

I love to see nature doing its thing.

I recently went hiking with my son at Anstey Hill (North of Adelaide, South Australia) and there's always a lot of roos and wallabies to see in the morning and evening.
For this evening walk, we were privileged to see this joey having a feed from mum, and mum being totally unfussed about feeding her baby in public ;-)

From one mammal to another, I see you doing your thing, nurturing your baby. What a beautiful sight.

Too Much Milk?Some people intentionally try to bring in an oversupply, for different reasons, maybe to stock the freezer...
30/11/2025

Too Much Milk?

Some people intentionally try to bring in an oversupply, for different reasons, maybe to stock the freezer. An accidental oversupply can happen from over-working the breast. Early pumping is a common culprit.

Some people have medical conditions or are on medications that cause overproduction of milk.

Some people are natural hyperlactators, without known cause.

Whatever the reason, hyperlactation or oversupply or too much milk, can cause complications.

The abundance of milk could cause milk flow to be intolerable, leading to coughing, choking, latch issues, short feeds and breast refusal. Full breasts can also cause engorgement, also contributing to latch issues, breast discomfort and interrupting sleep.

High milk volume can also cause lactose overload and gut discomfort in baby, overfeeding and vomiting.

Hyperlactation is also a known risk for mastitis and inflammatory breast issues such as blebs, localised breast inflammation and abscess.

Trying to bring in an oversupply does not come without risk, there can be as many issues with too much milk as there are not enough milk (if not more).

See your IBCLC for advice on managing supply.

Have you heard the recommendation "ni**le to nose" in your feeding journey?It's a problematic saying as it is often misi...
29/11/2025

Have you heard the recommendation "ni**le to nose" in your feeding journey?

It's a problematic saying as it is often misinterpreted.
The ni**le does not need to touch the nose at any point during latching.
Trying to touch the ni**le to the nose can result in suboptimal latch and ni**le pain.
Research has found that dragging the ni**le over the nose to encourage latching can increase risk of ni**le pain.

The ni**le can ideally be level with the nose (which is the most appropriate interpretation of "ni**le to nose") but should not touch the nose during the latch process.

The most important part of baby to make contact with the breast is the chin.

Chin contact triggers the "gape reflex". The breast touching the chin before latch encourages a wide-open mouth.
The head position from chin leading allows for wide-open mouth and deep latch (touching the nose to the ni**le causes the mouth to not open as wide).
Anchoring the chin into the breast during latch allows for effective sucking and breast stimulation.

Rather than "ni**le to nose", I suggest "chin to skin".

29/11/2025

Tips for successful breastfeeding.

I often hear (or read) "I'm planning to breastfeed if I can, how can I make sure I'm successful".

First of all, I want to say 2 things:
1. We are designed as a species for breastfeeding/chestfeeding to be the biologically normal way for babies to feed, and only a very small percentage of people are unable to breastfeed/chestfeed.
2. Your "success" in breastfeeding/chestfeeding is dependent on a lot of factors that are often your of your control. While motivation, determination and education will go a long way, there are a lot of factors, such as birthing hospital policies and processes, birth complications, maternal/baby health complications and a heap of other things that might make feeding more complex.

I have compiled a list of things that can help make establishing breastfeeding/chestfeeding a smoother process., but please keep in mind, the success of your journey and in meeting your goals is not solely your responsibility- it's highly dependent on the structures, systems and support you have around you.

Ni**le BlebsWhat is a ni**le bleb?White or yellow spot on the ni**le. can look like a hard pimple.Often painful.Can bloc...
26/11/2025

Ni**le Blebs

What is a ni**le bleb?

White or yellow spot on the ni**le. can look like a hard pimple.
Often painful.
Can block milk flow from the affected external ni**le ducts.

What causes ni**le blebs?

Blebs are an outside and visible representation of underlying internal breast inflammation. This may or may not be associated with other symptoms of localised breast inflammation (previously known as blocked ducts) or mastitis.
Breast inflammation can be caused by mammary dysbiosis (imbalance of bacteria/microbiome from caesarean birth, use of antibiotics or probiotics, pumping, iron supplements), hyperlactation (too much milk and overworking the breast- can be caused by pumping) and breast or ni**le trauma (can be caused by poor latch, tongue tie, ill-fitting clothing, deep breast massage, injury to breast, poor fitting pump fl**ges or improper use of pumps).

How do we treat ni**le blebs?

Although it can be tempting to pick or poke the bleb, deroofing the bleb or sticking it with a needle/sharp object can actually make the inflammation worse and can cause the bleb to keep coming back (because its cause is inflammation, you might end up in a tricky cycle).

> Identify the cause of the breast inflammation.
> Manage the cause of the breast inflammation.
> Commence anti-inflammatory treatments- cold therapy, non-steroidal anti-inflammatory (Ibuprofen), gentle lymphatic drainage, therapeutic ultrasound, resting the breast as much as possible (no additional feeding/pumping).
> soften the bleb pre feed with food-grade oil (like coconut oil or olive oil) or a warm moist cloth/water soak.
> persistent blebs can be treated with a 0.1% steroid cream (speak to your doctor or pharmacist).

See your IBCLC for individualised support and advice.

Further information can be found here:

https://www.breastfeeding.asn.au/resources/white-spot

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

https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/

Breast massage and mastitis/ localised breast inflammation (blocked ducts)..........Why massage is no longer recommended...
26/11/2025

Breast massage and mastitis/ localised breast inflammation (blocked ducts)..........

Why massage is no longer recommended for management of mastitis and localised breast inflammation (previously known as blocked ducts).

The breast contains fragile ductal tissue.
previously, when painful lumps were thought to be "blocked" or "clogged" or "plugged" ducts, massage was a recommendation, expecting that the plug could be squeezed out.

THIS IS OLD ADVICE

We now understand that ducts do not get clogged in the way we used to think. We now understand that there can be areas of inflammation that causes swelling and pain. This is localised breast inflammation. "Blocked ducts" are NOT blocked ducts. It's important we understand what's going on under the surface and understand the importance of the correct language to apply to this issue, so the right management can be used.

Digging your fingers into the breast to fruitlessly extract a "clog" can cause your breast significant damage, or at the least, exacerbate inflammation and cause recurring issues. Increasing inflammation can cause localised breast inflammation to worsen to mastitis, and may cause mastitis to worsen to an abscess or phlegmon.

This example pictured, is from Katrina Mitchell's amazing website, showing damaged breast tissue (needle-aspirated from the breast), that had been massaged into a soup of blood and damage ducts. Shocking, isn't it. Obviously, this is not ideal.

If massage is to be used, try *gentle* lymphatic drainage, toward the lymph nodes. Never try to extract lumps toward the ni**le. Don't roughly handle your breasts. Avoid vibration.

DONT TURN YOUR FRAGILE BREAST TISSUE INTO A SOUP

For more info, see the ABM protocol 36 or Katrina Mitchell's website. https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/

Have you ever co-bathed with your baby?Having a bath with your baby can be a lovely method of facilitating skin to skin ...
18/11/2025

Have you ever co-bathed with your baby?

Having a bath with your baby can be a lovely method of facilitating skin to skin and can be a very effective strategy for recovering from breastfeeding/chestfeeding challenges.

Our babies co-regulate, meaning that our babies are dependent on us to tell them how to feel. If we are stressed, our babies get stressed too. Getting in the bath can be a way of regulating our own emotions, relaxing and reducing stress and in turn, helping to regulate our babies.

Co-bathing maximises skin to skin and supports a natural reclined position, both of which optimises baby's built-in breast seeking and latch behaviours.

The feeling of floating in bath water may help newborns to feel a calm and familiar environment, which regulates their nervous system and supports their feeding behaviours. The process of floating in water and then moving to skin to skin on the chest mimics the process of birth to an extent. For those who feel they have missed out on skin to skin and a positive first feed experience, this method of co-bathing and "rebirthing" can be a positive and empowering way of reclaiming and reframing that experience.

Co-bathing can help a baby who has experienced stress and struggles at the breast/chest to redefine the breast/chest as a positive place to be, supporting recovery from breast refusal.

I often include co-bathing in my lactation management care-plans.

Make sure you plan ahead when co-bathing- having a support person to assist baby in and out of the bath (as trying to get in and out of a slippery bath while holding a baby can be hazardous). An alternative, if you don't have the option of a support person, is to have a bouncer or blanket on the floor next to the bath to place baby into while you get in and out.

These resources explain more:
https://llli.org/news/co-bathing-a-useful-technique-to-restart-breastfeeding/

https://www.youtube.com/watch?v=Ygesrlpn8kY&t=17s Shout out to Oasis Lactation Services for producing this video.

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