Nicole Gale

13/06/2023

Come and join us!

Dr Nicole Gale is a Perinatal General Practitioner and International Board Certified Lactation Consultant who works exclusively in Breastfeeding Medicine and Maternal/ Infant Health in Melbourne, Australia. She has undertaken further training in Newborn Behavioural Observation and Neuroprotective Developmental Care. She addresses complex perinatal, breastfeeding and mental health concerns in consultations in both her private rooms and adjoining St Vincent’s Private Hospital. She believes in holistic, comprehensive and evidence-based care and is passionate about health professional education.

Dr Gale will be speaking to attendees at the Advanced workshop about laryngomalacia - how to identify it, its natural progression and ways to support affected dyads.

Register here: https://na.eventscloud.com/website/54917/home/

26/04/2023

A little something I wrote for YourZen Your Zen Mama.

“Newborns are magical and somewhat mysterious creatures. Seemingly so delicate, parents are in awe of the little person they now hold in their arms, and perhaps wonder who will become and how they will navigate this. Many parents feel a heavy responsibility, knowing that they are captain of the ship of growth and development for their baby and feel as if it is their task alone to navigate this, or perhaps be told how to do so.”⁣
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Continue reading ‘Caring for your new baby: A modern evidence-based approach on why your baby is your guide’ by Dr Nicole Gale () now live at yourzenmama.com⁣
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15/04/2023

From six to twelve months, guidelines around infant intake become far more flexible as solids are introduced. This is because babies move to a combination of caloric intake from milk and some caloric intake from solids. Many families feel pressure to push solids from 4-6 months. However it takes time for babies to adjust to solid food intake with both oral development and digestion and bowel movements adjusting.

Solids, generally, have a lower calorie density than milk. During this transition, milk is still the main source of caloric intake and should be given before solids until babies are well established on solids around 9-10 months (at the earliest).

However like anything in life, there is variability in this. Some babies establish on solids closer to the 10+ month mark and so will have frequent breastfeeds or large bottles of milk a few times a day. Other babies will devour solids soon after 6 months and then start to drop milk intake much quicker (breast or bottle). Both of these situations are normal and so long as the little one is growing, meeting milestones (they’re usually very happy!) then there is no issue. Well babies won’t starve themselves and are well attuned to their appetite.

So if you’re worrying about too much milk or not enough, know that if your little one is growing and happy and developing then they are doing their own thing and this is perfect.

03/04/2023

👶 Infant Growth Parameters: What’s normal and what’s not.

NORMAL:
✔️Up to 10% loss of birthweight after birth
✔️Taking 2 weeks to return to birthweight after birth
✔️Fluctuations in measurements in the context of scale inconsistency, feed inconsistency, measurements too close together or post illness
✔️Baby tracking their growth curve, including well babies at the 3rd and 98th centiles

NOT NORMAL:
✖️Consistently not gaining good weight on the same scales and may be unsettled or not meeting milestones
✖️A drop of more than 2 centile lines
✖️Charting breastfed babies growth on CDC and WHO growth charts

Ultimately any concern should be addressed with your doctor. Child health nurses are trained to screen and identify *potential* issues but this is broad to make sure no one is missed. Any concerns should then be medically assessed.

Please note: this does not constitute individual medical advice and concerns should be addressed with your medical professional.

13/03/2023

NEW BLOG: Why courtroom breastfeeding deserves applause, not shame.
Musings on the right to parent (including breastfeeding) in public spaces and how basic rights of parents should not be infringed upon, even in a public courtroom.
Link in bio to read more.

19/01/2023

There. I said it. A “contact nap” is just a nap. It seems like semantics but it implies that this nap is different. It is other. It is not. We don’t name our other naps. We don’t do this as adults. Sleep is sleep. Now if you’re having a baby sleep on you 24/7 and it’s not working for you, that is completely ok and I would definitely advise that you seek all the help you need. But cuddling your baby to and during sleep is normal. It’s a biological norm. A contact nap is just a nap. End rant.

16/01/2023

When fatigue is more than sleep deprivation postpartum….

Of course having a baby is tiring and there is an element of sleep deprivation causing fatigue. Parenthood is indeed a marathon and not a sprint.

There are times however when medical conditions creep up causing fatigue that is hard to distinguish and can be missed if not looked for. These can include:

1. Iron Deficiency +\- Anaemia
2. Thyroid dysfunction, particularly postpartum thyroiditis
3. Depression and Anxiety

If you’re feeling exhausted and not sure if it’s normal, a good place to start is your GP, for whom this is their bread and butter. You matter too and your well-being important.

10/01/2023

Hormonal and physiological benefits of fat stores postpartum

Just as not all weight loss is healthy, not all weight gain is unhealthy either. Whilst individual factors apply, weight gain during pregnancy serves a purpose, as does retaining it after birth. Our bodies are not designed from a hormonal, nutritional and metabolic perspective to lose weight rapidly.

Adequate fat stores are required to:

🤎 Protect nutritional needs postpartum which are HIGHER than during pregnancy
🤎 Potentially mitigate bone mineral density loss during breastfeeding from low oestrogen levels and increase resistance forces on bone
🤎 Reduce toxins in the blood and store them, reducing breastmilk levels and infant exposure
🤎 Assist in mental health wellbeing, reducing fatigue, anxiety, irritability and low mood

If you were carrying more adipose tissue prior to pregnancy, your gain and loss might be less than someone who had minimal adipose stores prior who may gain a significant amount.

Ultimately, our bodies regulate weight, based on our individual needs and situation. This is not to say that anyone needs to lose weight after a baby, or ever, or to say that benefits may not be found with focusing on health.

Evidence shows that what is most helpful is focusing on:

🩺 Good quality nutrition and food - fruits and vegetables, protein at every meal, high quality fats, regular meals, reduced processed foods

🩺 Joyful movement on a regular basis which can be as simple as going for a walk for 20 minutes

🩺 Protecting and prioritising sleep and rest where possible for metabolic health

🩺 Time spent in nature as a mental health balm, mindfulness practice, grounding, increasing fresh air, sunlight exposure for wellbeing and vitamin D levels

Our bodies are smart and deserve recognition for all they do growing and birthing a baby but significantly AFTER also in what they do to protect our and our baby’s wellbeing - including gaining and carrying weight!

05/01/2023

ADHD (Attention Deficit / Hyperactivity Disorder) and Pregnancy/ Postpartum

Many women are now being diagnosed with ADHD who were missed during childhood and others are coming of age. Many are also coming into motherhood at a similar time and yet there has been little recognition of the unique needs of this population.

Considered the most common mental health ‘diagnosis’, ADHD is barely on the radar when thinking about pregnancy/ postpartum for most institutions.

Neurodiversity, or the spectrum of neural wiring relating to many cognitive functions, is highly heritable (genetic) and connotes unique traits and advantages that have allowed significant human evolution. However modern society and cultural practices favour the neurotypical.

More research has been presented over the last 2-3 years.

Major findings include:
- Pregnant people with ADHD require ADHD informed care
- Obstetric complications are greater in those with ADHD
- Pharmacological treatment during pregnancy reduces the risk of complications including preterm birth, miscarriage, GDM, APH, pre eclampsia, hyperemesis
- Distress and the risk of depression following the birth of the first child is greater in those with ADHD
- Treatment and comprehensive support post birth reduces distress, improves executive function and increases harmony
- ADHD medications may be used in pregnancy and appear largely safe in large scale studies except for a low increased risk of one subtype of cardiac malformation*

*this does not constitute medical advice

What does this mean if you’re planning pregnancy or are pregnant with ADHD?

- Know that you deserve comprehensive ADHD informed care during and after your pregnancy
- Have a discussion with your healthcare providers about the best way forward for you
- Get your support team together early and plan for more breaks
- Know it’s ok to take a breather and that you are statistically still very likely to have an uncomplicated pregnancy
- Know that there are many wonderful parents with ADHD with loving attachments who find great joy in parenthood

02/01/2023

A crash course on the science basics of infant sleep. 👶💤

It’s essential to start from a place of understanding of what is normal biologically and how sleep works from an evidence based perspective.

The reason there isn’t one approach to sleep is because it’s dynamic and individual from one human to another, including babies.

Generally my approach to sleep consultations and questions is:
1. Education about infant sleep
2. Understanding what is normal
3. Working out if this “normal” works for you or whether you want to change things
4. If required, workshopping the individual circumstance in a tailored way

For many families, once they understand and don’t feel pressure to approach sleep in one way, there isn’t an issue (I.e. a set “wake window” or “sleep per 24 hours”).

Did you know that there is NO evidence for wake windows and sleep /24 hours by age? This doesn’t mean it may not be a helpful guide for you. But following your baby and not a prescription is generally more effective.

If issues persist beyond education, that’s ok and there are approaches and tweaks that can be taken in a respectful way, from a variety of perspectives. It doesn’t mean you can’t make changes.

A pivotal part of this picture is ensuring rest and care for parents in dynamic ways also and flexible arrangements.

29/12/2022

You’re planning or having a baby? Here’s what you need from a Perinatal Specialist Doctor:

(Shh 🤫 it’s not a fancy bassinet or another onsie…)

1. Continuity of care

🩺 A trusted health professional is pivotal for wellbeing, best if they can support you over time consistently - someone you can trust as a point of contact
🩺 This could be a Midwife, Obstetrician, GP (not limited to)
🩺 Choose your pregnancy care providers and set up networks prior to birth in preparation for after the babies arrives

2. A protected cocoon

🩺 Rest, recovery and bonding are essential
🩺 Parasympathetic nervous system (rest and digest setting) is optimal for recovery and requires safety
🩺 Partners can be helpful with protecting boundaries, regulating visitors, ensuring food and helping with domestic duties

3. Proper nutrition

🩺 Nutritional requirements postpartum are HIGHER than during pregnancy
🩺 This continues until weaning of breastfeeding, which can be days - weeks or years
🩺 Proper nutrition prevents mood and anxiety issues, protects milk supply, assists with energy and recovery
🩺 Three meals / day plus snacks with protein and fat at each meal
🩺 Water intake 2-3+L/ day to thirst
🩺 Check and replace micronutrients esp. iron, zinc, vitamin D and magnesium
🩺 Continue Iodine supplementation of 150mcg/day
🩺 Have family prepare meals, or stock freezer or buy postpartum meals

Stay tuned for Part Two…

28/12/2022

Breastfeeding Medicine Myths and Realities:

Ni**le/ Breast Thrush

Ni**le/ breast thrush is a fungal infection with candida yeasts causing ni**le and or breast pain. It is a common diagnosis or pain and a common misdiagnosis of pain, especially if recurrent or chronic.

❌ Myth 1: It causes sharp/ stabbing/ burning pain and this is diagnostic.

✅ Nerves to the ni**le and breast interpret all tissue damage the same way. Any cause of tissue damage in this area e.g. trauma, cracks, mastitis etc can present this way.

❌ Myth 2: Diagnosis requires swabbing/ culture.

✅ Candida is rarely isolated on culture. Some believe this means it doesn’t exist. Breastmilk is a unique bodily fluid that is alive and active and thus can kill pathogens prior to specimens reaching the lab
✅ Ni**le / breast thrush is a clinical diagnosis

❌ Myth 3: Chronic ni**le/ breast pain must be thrush and it can’t hurt to treat anyway.

✅ Clinical breastfeeding problems are commonly misdiagnosed as thrush, especially if recurrent or chronic
✅ The most common underlying cause in this case is problems with fit and hold and chronic trauma
✅ Treatment comes with risks including delay in appropriate diagnosis, prolonged pain and breastfeeding cessation, side effects of medication, a need to treat a breastfeeding infant in conjunction and the potential for worsen underlying issues if not thrush

Best care is with a breastfeeding informed professional (educated GP, IBCLC or a Breastfeeding Medicine Specialist).

09/12/2022

Holiday Hours 🧑‍🎄

I will be on leave from 19th December 2022 to January 15th 2023.

I will be back for consulting from Monday January 16th onwards, with normal full time hours.

Just a little forward notice for Mamas and Bubs!

08/11/2022

6-7 year olds… wake. 😂

Some perspective in case you need it today ❤️
Thank you LMJ Infant Feeding Support

08/11/2022

Joy.
(Essential Tools for New Parents)

Antidote.
Surrender.
Fearful Abyss.
Muddled and Mixed.
Fleeting and Small.
Loud and Proud.
Retrospective.
Painful.
Exhilarating.

Joy is Medicine in our lives from our birth to our death. It is no less potent in the postpartum and in depths of rolling days and routine, in lightness and in our dark moments with our new selves and our new babies.

Postpartum requires us to move with the flow but thriving requires us to lean into the joy.

It is there and it may look different. How grateful we are for things we took for granted. How much joy there is be a potent observer of discovery.

Joy is the antidote. Joy requires surrender. Joy can feel foreign and scary. Joy can be mixed with other emotions. Joy can be simple. Joy can be big.

Radical acceptance of state. Threads of joy throughout.

When moving through periods of transition, awash without compass, when your mental health feels wobbly or you don’t understand the reflection, move towards the joy. It is a refuge and a respite, of quiet and private solitude.

(Essential Tools for New Parents)

07/11/2022

Dads and Non-Birthing Parents have Perinatal Mental Health needs and issues too.

Very real and difficult challenges include:

Family structure change, upheaval, change in relationship with their partner, what being a good Dad or parent means, juggling work requirements, feeling financial responsibility, dealing with societal expectations.

Lack of understanding of need and DESIRE to be an active and involved parent that is not respected and accommodated by their employer or workforce, to be flexible in their work and home duties, to be a primary stay at home carer.

To struggle in understanding and supporting a partner in crisis with a new baby and no clue what to do or where to go, to have to pretend like everything is ‘normal’ at work.

To have to manage extended family and their desires and complex needs and to protect and cocoon their partner and new baby.

I see you and the work you do. Your perinatal mental health is important too. If you are struggling, you are not alone and many Dads and Non-Birthing Parents feel the same way. Please take care of yourself and your needs and reach out if you need care and assistance. This is not weakness and you are worth it.

01/11/2022

First Blog Post Ever! Evidence Based Ankyloglossia (Tongue Ties) - Part 1

Understanding what a tongue tie is and when it might affect Breastfeeding: What is normal tongue anatomy and diagnosis of functional restriction.

12/10/2022

Mental Health Week 2022. Why darkness is a pivotal part of your story and why this is an evolutionary biological imperative.