Birth Savvy Bub Savvy

11/11/2025

🌍 𝗡𝗲𝘄 𝗪𝗛𝗢 𝗚𝘂𝗶𝗱𝗲𝗹𝗶𝗻𝗲𝘀 𝗼𝗻 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗻𝗴 𝗣𝗼𝘀𝘁𝗽𝗮𝗿𝘁𝘂𝗺 𝗛𝗮𝗲𝗺𝗼𝗿𝗿𝗵𝗮𝗴𝗲 (𝗣𝗣𝗛)

The World Health Organisation has released its 𝟮𝟬𝟮𝟱 𝗖𝗼𝗻𝘀𝗼𝗹𝗶𝗱𝗮𝘁𝗲𝗱 𝗚𝘂𝗶𝗱𝗲𝗹𝗶𝗻𝗲𝘀 𝗳𝗼𝗿 𝘁𝗵𝗲 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗼𝗻, 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀 𝗮𝗻𝗱 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗼𝗳 𝗣𝗼𝘀𝘁𝗽𝗮𝗿𝘁𝘂𝗺 𝗛𝗮𝗲𝗺𝗼𝗿𝗿𝗵𝗮𝗴𝗲, and there’s one section that really caught my attention in the 𝘐𝘯𝘵𝘳𝘢𝘱𝘢𝘳𝘵𝘶𝘮 𝘪𝘯𝘵𝘦𝘳𝘷𝘦𝘯𝘵𝘪𝘰𝘯𝘴 𝘵𝘰 𝘱𝘳𝘦𝘷𝘦𝘯𝘵 𝘱𝘰𝘴𝘵𝘱𝘢𝘳𝘵𝘶𝘮 𝘩𝘢𝘦𝘮𝘰𝘳𝘳𝘩𝘢𝘨𝘦 section.

It says:

“Effective management of labour ensures timely interventions, 𝗮𝘃𝗼𝗶𝗱𝘀 𝗶𝗻𝗱𝘂𝗰𝘁𝗶𝗼𝗻 𝗼𝗿 𝗮𝘂𝗴𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻 𝗼𝗳 𝗹𝗮𝗯𝗼𝘂𝗿 𝗼𝗿 𝗲𝗽𝗶𝘀𝗶𝗼𝘁𝗼𝗺𝘆 𝘄𝗵𝗲𝗿𝗲 𝗻𝗼𝘁 𝗰𝗹𝗶𝗻𝗶𝗰𝗮𝗹𝗹𝘆 𝗶𝗻𝗱𝗶𝗰𝗮𝘁𝗲𝗱, and generally fosters a supportive environment for quality intrapartum care.”

OBs and hospital policies are often quick to promote active management of the third stage of labour to prevent PPH, but how often do they ensure that 𝗶𝗻𝗱𝘂𝗰𝘁𝗶𝗼𝗻, 𝗮𝘂𝗴𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻, 𝗮𝗻𝗱 𝗲𝗽𝗶𝘀𝗶𝗼𝘁𝗼𝗺𝘆 are avoided unless truly necessary to prevent PPH?

I want to really highlight the recommendation on episiotomies.

The guidelines also make this clear:

𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻 𝟲:
“Routine or liberal use of episiotomy is 𝗻𝗼𝘁 𝗿𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗲𝗱 for women undergoing spontaneous vaginal birth.”

The WHO Guideline Development Group went even further, acknowledging both “𝘵𝘩𝘦 𝘭𝘢𝘤𝘬 𝘰𝘧 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦 𝘰𝘯 𝘵𝘩𝘦 𝘦𝘧𝘧𝘦𝘤𝘵𝘪𝘷𝘦𝘯𝘦𝘴𝘴 𝘰𝘧 𝘦𝘱𝘪𝘴𝘪𝘰𝘵𝘰𝘮𝘺 𝘪𝘯 𝘨𝘦𝘯𝘦𝘳𝘢𝘭” and that “𝘵𝘩𝘦𝘳𝘦 𝘪𝘴 𝘯𝘰 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦 𝘤𝘰𝘳𝘳𝘰𝘣𝘰𝘳𝘢𝘵𝘪𝘯𝘨 𝘵𝘩𝘦 𝘯𝘦𝘦𝘥 𝘧𝘰𝘳 𝘢𝘯𝘺 𝘦𝘱𝘪𝘴𝘪𝘰𝘵𝘰𝘮𝘺 𝘪𝘯 𝘳𝘰𝘶𝘵𝘪𝘯𝘦 𝘤𝘢𝘳𝘦.”

While I’m sure no maternity care provider would admit to a policy of “routine” episiotomies, some are certainly liberal with them.
In 2023 in Australia, 𝟮𝟮% 𝗼𝗳 𝗳𝗶𝗿𝘀𝘁-𝘁𝗶𝗺𝗲 𝗺𝗼𝘁𝗵𝗲𝗿𝘀 having a 𝘯𝘰𝘯-𝘪𝘯𝘴𝘵𝘳𝘶𝘮𝘦𝘯𝘵𝘢𝘭 𝘷𝘢𝘨𝘪𝘯𝘢𝘭 𝘣𝘪𝘳𝘵𝘩 received an episiotomy.
(Source: Australian Institute of Health and Welfare, National Core Maternity Indicators 2025)

So if there’s 𝗻𝗼 𝗲𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝗼𝗳 𝗯𝗲𝗻𝗲𝗳𝗶𝘁, and global guidance actively discourages it, why is it still happening so often?

Interestingly, while the WHO 2025 guidelines reaffirm that routine or liberal episiotomy is not recommended, they did continue to support the practice of “hands-on” perineal guarding to help reduce perineal trauma, even though the evidence for its effectiveness is uncertain.

The GDG noted that:

“Although the evidence on the effect of a hands-on approach (guarding) on reducing perineal tears is uncertain, it is unlikely to cause harm, requires minimal resources, may reduce traumatic injury, and is already embedded in clinical practice. In the absence of evidence of harm, the existing recommendation on this technique should be maintained.”

In other words, even with limited evidence, this technique is seen as acceptable because it might help and probably doesn’t harm. (𝘐 𝘥𝘰 𝘸𝘰𝘯𝘥𝘦𝘳 𝘪𝘧 𝘣𝘪𝘳𝘵𝘩𝘪𝘯𝘨 𝘸𝘰𝘮𝘦𝘯 𝘳𝘦𝘢𝘥𝘪𝘯𝘨 𝘵𝘩𝘦 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦 𝘸𝘰𝘶𝘭𝘥 𝘬𝘦𝘦𝘱 𝘵𝘩𝘦 𝘩𝘢𝘯𝘥𝘴-𝘰𝘯 𝘢𝘱𝘱𝘳𝘰𝘢𝘤𝘩 𝘪𝘯 𝘵𝘩𝘦 𝘨𝘶𝘪𝘥𝘦𝘭𝘪𝘯𝘦𝘴 🤔).

Episiotomy, on the other hand, is a 𝘀𝘂𝗿𝗴𝗶𝗰𝗮𝗹 𝗶𝗻𝗰𝗶𝘀𝗶𝗼𝗻 with potential for harm (including increasing PPH risk), so the decision to discourage its routine and liberal use shows that the WHO GDG considered the balance of benefit and risk and found that routine and liberal episiotomy does more harm than good.

If we’re genuinely committed to preventing postpartum haemorrhage, we need to look beyond active management of the third stage.

We need to make sure the 𝗳𝗶𝗿𝘀𝘁 𝗮𝗻𝗱 𝘀𝗲𝗰𝗼𝗻𝗱 𝘀𝘁𝗮𝗴𝗲𝘀 𝗼𝗳 𝗹𝗮𝗯𝗼𝘂𝗿 𝗮𝗿𝗲 𝗻𝗼𝘁 𝗼𝘃𝗲𝗿-𝗺𝗮𝗻𝗮𝗴𝗲𝗱, avoiding unnecessary inductions, augmentations, and yes, episiotomies.

🤱 𝗪𝗵𝗮𝘁’𝘀 𝗠𝗶𝘀𝘀𝗶𝗻𝗴

One thing that disappoints me about the new WHO 2025 PPH Guidelines is the complete absence of any mention of the role of 𝘀𝗸𝗶𝗻-𝘁𝗼-𝘀𝗸𝗶𝗻 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 in supporting a physiological third stage and reducing PPH risk.

A 2023 scoping review by Ruiz et al. (𝘔𝘢𝘵𝘦𝘳𝘯𝘢𝘭 𝘢𝘯𝘥 𝘊𝘩𝘪𝘭𝘥 𝘏𝘦𝘢𝘭𝘵𝘩 𝘑𝘰𝘶𝘳𝘯𝘢𝘭, 27:582–596) highlighted the 𝗽𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝘃𝗲 𝗿𝗼𝗹𝗲 𝗼𝗳 𝗲𝗮𝗿𝗹𝘆 𝘀𝗸𝗶𝗻-𝘁𝗼-𝘀𝗸𝗶𝗻 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 𝗱𝘂𝗿𝗶𝗻𝗴 𝘁𝗵𝗲 𝘁𝗵𝗶𝗿𝗱 𝘀𝘁𝗮𝗴𝗲 𝗼𝗳 𝗹𝗮𝗯𝗼𝘂𝗿 through oxytocin release, uterine contraction, and stabilisation of maternal physiology. The authors concluded that this simple, low-cost practice may help prevent excessive blood loss after birth.

It is surprising that, while the WHO 2025 PPH guideline is so thorough in pharmacological and procedural interventions, it overlooks this evidence, even though 𝘀𝗸𝗶𝗻-𝘁𝗼-𝘀𝗸𝗶𝗻 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 𝗶𝘀 𝗱𝗲𝘀𝗰𝗿𝗶𝗯𝗲𝗱 𝗯𝘆 𝗪𝗛𝗢 𝗶𝘁𝘀𝗲𝗹𝗳 𝗮𝘀 “𝘀𝗶𝗺𝗽𝗹𝗲, 𝗯𝘂𝘁 𝗹𝗶𝗳𝗲𝘀𝗮𝘃𝗶𝗻𝗴” in its 2022 𝘙𝘦𝘤𝘰𝘮𝘮𝘦𝘯𝘥𝘢𝘵𝘪𝘰𝘯𝘴 𝘰𝘯 𝘔𝘢𝘵𝘦𝘳𝘯𝘢𝘭 𝘢𝘯𝘥 𝘕𝘦𝘸𝘣𝘰𝘳𝘯 𝘊𝘢𝘳𝘦 𝘧𝘰𝘳 𝘢 𝘗𝘰𝘴𝘪𝘵𝘪𝘷𝘦 𝘗𝘰𝘴𝘵𝘯𝘢𝘵𝘢𝘭 𝘌𝘹𝘱𝘦𝘳𝘪𝘦𝘯𝘤𝘦, where 𝗶𝗺𝗺𝗲𝗱𝗶𝗮𝘁𝗲 𝗮𝗻𝗱 𝘂𝗻𝗶𝗻𝘁𝗲𝗿𝗿𝘂𝗽𝘁𝗲𝗱 𝘀𝗸𝗶𝗻-𝘁𝗼-𝘀𝗸𝗶𝗻 is promoted as standard care for all mothers and babies.

Because the best way to protect women from complications after birth is to 𝗽𝗿𝗼𝘁𝗲𝗰𝘁 𝗽𝗵𝘆𝘀𝗶𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗯𝗶𝗿𝘁𝗵 𝗶𝘁𝘀𝗲𝗹𝗳 and then keep promoting physiology after birth.

These consolidated guidelines focus on the care of women during pregnancy, childbirth and the immediate postpartum period in any health care setting.

10/11/2025

✨ New research alert ✨
A new paper currently in press with the American Journal of Obstetrics & Gynecology (Edwards et al., 2025) explores how body mass index (BMI) influences labour progression,and the findings are important.

💡 Conclusion:
“Higher body mass index was associated with slower labor progress and longer labor duration in patients ultimately undergoing vaginal delivery. This difference was driven by longer times spent in latent labor, with no significant differences observed in active labor. Results suggest a potential need for the use of labor curves more specifically tailored to body mass index when assessing for progress in labor, in order to avoid performance of unnecessary cesarean deliveries.”

In plain terms: some bodies simply labour differently. Longer doesn’t mean abnormal, unsafe, or failing to progress. When we use a one-size-fits-all “textbook” timeline, we risk unnecessary interventions and lose sight of physiological variation.

🤍 What matters most:
• Individualised care, not clock-watching.
• Recognising that labour diversity = body diversity.
• Updating guidelines and labour charts to reflect this.

📚 For parents navigating pregnancy with a higher BMI, Dr Sara Wickham’s book "Plus Size Pregnancy" is an excellent resource for understanding your options and navigating hospital policies around BMI. sarawickham.com

https://www.sarawickham.com/plus-size-pregnancy/

06/11/2025

Who Decides About Fetal Monitoring in Labour?

I have just read the new RANZCOG Intrapartum Fetal Surveillance Guideline (2025). I can’t wait to hear what Dr Kirstin Small Birth Small Talk makes of them, but for me, two things really stand out:

1. The lack of evidence that continuous CTG improves outcomes when compared with intermittent monitoring.
2. The clear message that monitoring during labour should be guided by informed consent (but is this just lip service?).

Let’s talk about that first one.

The guideline cites plenty of studies showing associations between certain conditions and risk factors, but it doesn’t provide clear evidence that CTG use actually reduces those risks or improves outcomes.

There seems to be a real conflict between what the evidence shows and what the recommendations actually say.

The clinical algorithm says that if a risk factor is present, use continuous CTG.

But the answer to Clinical Question 5 —

“Which method of intrapartum fetal surveillance should be recommended in the presence of, or with emergence of, fetal and/or maternal risk factors during labour?” clearly states that there is little or no difference in outcomes between intermittent auscultation and continuous CTG, except that continuous CTG increases caesarean section rates.

And the answer to Clinical Question 6, "Accuracy of CTG in the diagnosis of fetal compromise", was "No single feature of a CTG performs well in predicting fetal compromise, with a large number of false positive results.

So if CTG doesn’t reliably predict fetal compromise and increases the likelihood of surgical birth without improving outcomes…
why does the algorithm still default to continuous CTG every time a risk factor appears?

That's because these are consensus-based recommendations, and consensus often reflects the biases and priorities of those making the recommendations.

As part of their consensus-based Evidence-to-Decision making framework, RANZCOG used the domain of Acceptability to help shape recommendations.

But it’s important to note,this isn’t about whether women find CTG acceptable. It’s about clinician acceptability.

For example, the guideline states:

“Continuous CTG is the standard care for intrapartum monitoring of women with high-risk births. This recommendation is consistent across the guidelines from all major Obstetric and Midwifery colleges and in state/district health board policies, thus it is expected the CTG use in labours for women with risk factors will be acceptable to clinicians.”

It really makes me wonder, what if you gave a group of consumers (the women and families who actually experience birth) the same evidence? What would their consensus-based recommendations look like?
Would they also say, “Let’s hook everyone up to a machine that limits movement and increases intervention rates, even though it hasn’t been shown to improve safety”?
Or would they say, “Let’s keep women free to move, rest, and follow their instincts, while checking in regularly and respectfully”?

I do like that the guidelines highlight that clinicians have a responsibility to explain the advantages and disadvantages of different types of fetal monitoring so that women can make an informed decision and give valid consent.

However, the clinical algorithm doesn’t include any pathway for women who decline continuous monitoring.
It only gives instructions for what to do if a risk factor is identified, assuming CTG will follow.

Yes, the document does say that:

“Women’s decisions regarding fetal surveillance should not affect the level of general care and support provided in labour.”

That’s an important statement.
But the algorithm itself doesn’t reflect that principle. There’s no branch that says, “If the woman declines CTG, continue with intermittent auscultation and supportive care.”

Instead, there’s an overarching assumption that women will consent, that “informed consent” means eventual agreement.
But true consent includes the right to say no, and to have that decision respected without consequences, guilt, or withdrawal of support.

One of the "Guiding Principles of Care" listed in the guideline includes the provision of woman-centred care.
But reading through the recommendations, it’s hard not to feel that RANZCOG still doesn’t really understand what that means.

True woman-centred care starts from the woman’s experience, her values, her body, her safety, her choices and builds care around her, not just clinician comfort
These guidelines still built around risk, surveillance, and control.

31/10/2025

Have you been told that induction lowers your risk of a caesarean?
You might want to read this before deciding 👇

sarawickham.com’s blog breaks down what the research actually shows.

In short: for most women, induction increases the likelihood of an unplanned caesarean. It’s not a “risk-free shortcut” to a smoother birth, and context really matters.

Before saying yes to an induction, it’s worth asking:
Why is induction being recommended for me personally?
What are the real risks of waiting for labour to start on its own?
How might induction affect my chances of a vaginal birth?

https://www.sarawickham.com/research-updates/induction-increases-caesarean/

Make sure your decisions are based on real evidence, not one flawed study.

I highly recommend Dr Sara Wickham’s books “In Your Own Time” and “Inducing Labour”. They are both brilliant reads to help you make truly informed choices.

Real-world research shows that induction increases caesarean, no matter what certain obstetric trials might have found...

24/10/2025

💗 Skin-to-skin was never a fad.

With the release of the new Cochrane Review on Immediate or early skin‐to‐skin contact for mothers and their healthy newborn infants, a couple of days ago, I just felt the need to revisit a blog I wrote back in 2016.

Back then, I was responding to a news article in which a very prominent obstetrician at the time called skin-to-skin contact a “fad”, even suggesting it was to blame for newborn deaths. I was stunned then, and I still am now, that wanting to hold your baby could ever be seen as something trendy or risky.

That blog did "go viral", probably because I had the OB's name in the title. 😬.

Nine years on, the evidence couldn’t be clearer.
The 2025 Cochrane Review confirms what midwives, parents, and researchers have known all along:

🤱 Babies held skin-to-skin breastfeed more successfully
💓 They stay warmer and more stable, even after a caesarean
💗 And both mother and baby benefit hormonally, emotionally, and physiologically

One of the biggest things that still gets in the way? Staff-focused rather than mother- and baby-focused hospital policies and prodecures! And for caesarean babies, I think it is the myth of the “cold baby” but this is debunked in the Cochrane Review.
The research shows it’s the separation, not the skin-to-skin, that makes babies cold.

The authors of the Cochrane review go so far as to say it may no longer be ethical to randomise babies to separation, because we already know that skin-to-skin is best practice.

And now that we’ve confirmed the importance of immediate contact, it’s time to look beyond the golden hour.

Research from Kerstin Uvnäs Moberg and Nils Bergman shows the benefits continue for hours, days, and weeks.

👉 Read the updated blog: https://birthsavvy.com.au/skin-to-skin-not-a-fad/

Skin-to-skin is not a fad. It’s essential. The 2025 Cochrane Review proves it supports breastfeeding, bonding, and baby stability.

21/10/2025

🌿 Thinking About Cutting Dairy While Breastfeeding? Here’s Why You Might Not Need To.

It’s so common to hear “try cutting dairy” when your baby seems fussy, “windy”, or unsettled. 🥛🧀
But before you start eliminating foods, it’s worth knowing what the latest research actually says.

🌸 The research says exposure, not elimination, builds tolerance

🔬Immunology research (Verhasselt 2024) shows that breast milk doesn’t just nourish, it actively educates the infant’s immune system, helping them learn tolerance to foods.

🌏The World Allergy Organization’s DRACMA guidelines (2023) make it clear that breastfeeding should continue wherever possible. Maternal elimination should only be considered when there’s a strong clinical reason and always reintroduced to confirm diagnosis.

💛 Perth-led research from The Kids Research Institute Australia found babies who had exclusive colostrum in the first 72 hours were about five times less likely to develop peanut allergy later in life and eleven times less likely to develop multiple food allergies (like egg or cow’s milk). Plus NO peanut allergies in any of the babies who had at least 9 feeds of colostrum per 24 hours in the first 72 hours

🥜 The upcoming “Nuts for Babies” trial is even testing whether mums eating more nuts during breastfeeding can reduce infant nut allergy, showing that exposure, not elimination, helps babies build tolerance.

🤱We also know that cutting foods unnecessarily can lead to nutritional deficiencies, reduced milk supply, and added stress around eating (Gelsomino et al., 2024; Munblit et al., 2020).

🤔If science is studying how more exposure might prevent allergy, we should be cautious about cutting foods without a proven need.

In short: your milk doesn’t just feed your baby, it teaches their immune system what’s safe. 🌿

💗 What to do instead

Most unsettled baby behaviours are not caused by food allergy. True cow’s-milk protein allergy (CMPA) is real — but rare — and usually mild and short-lived.

💫 The dialled-up baby explained

What’s much more common are behaviours linked to an immature nervous system, what we call a “dialled-up baby” in the Neuroprotective Developmental Care (NDC) approach.

Babies are born with a nervous system that’s still very much under construction Their nerve pathways are only beginning to develop the protective myelin coating that helps signals travel efficiently between the body and brain. Until this process matures, those messages can get a little “noisy”, especially from the gut, so normal sensations might be interpreted by the baby’s brain as uncomfortable or even painful.

On top of this, a baby’s gut is highly responsive to their sympathetic nervous system, the part responsible for “fight, flight, or fuss.” When babies become upset or overstimulated, this system switches on and can make their gut more active. That extra activity can heighten sensations and add to their distress.

It’s really a perfect storm of immature wiring and heightened sensitivity, a developing nervous system asking for connection and co-regulation, not dietary restriction.

Often, what appears to be “allergy” or “intolerance” is simply the result of this developing nervous system, sometimes combined with underlying breastfeeding issues such as suboptimal fit and hold, positional stability, or milk transfer.

That’s why working with a holistic IBCLC or GP, especially one trained in NDC, can be so valuable. They can help calm the dialled-up baby’s system through feeding support, responsive care, and helping parents understand what’s normal for their baby’s stage of development.

🌼 Getting the Right Support

Before you start restricting your diet, reach out for support from a holistic IBCLC or GP trained in Neuroprotective Developmental Care (NDC).

An NDC health practitioner will help you look beneath the surface of your baby’s behaviour, understanding the biology of their developing brain, gut, and nervous system, and exploring how feeding, sleep, and sensory regulation all interconnect.

This approach focuses on supporting your baby’s regulation, not pathologising normal developmental behaviours, so you can feel confident your baby is thriving without unnecessary elimination diets or stress around feeding.

https://ndcinstitute.au/find-an-ndc-practitioner

✨ Save this post, or send it to a friend who’s thinking about cutting foods while breastfeeding. Let’s keep mums nourished and babies protected. 💕

📚 References

Bhasin M, Cooper M, Macchiaverni P, Joys R S, O’Sullivan T A, Keelan J A, Venter C, Palmer D J, Lowe A J, Prescott S L, Silva D, Verhasselt V. (2025). Colostrum as a protective factor against peanut allergy: Evidence from a birth cohort. Allergy, Epub ahead of print. PMID: 40968490.

Gelsomino M, Liotti L, Barni S. (2024). Elimination diets in lactating mothers of infants with food allergy. Nutrients, 16(14):2317. https://doi.org/10.3390/nu16142317

McWilliam V, Netting M J, Volders E, et al. (2023). World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines update – X – Breastfeeding a baby with cow’s milk allergy. World Allergy Organization Journal, 16:100830.

Munblit D, Perkin M R, Palmer D, Allen K, Boyle R J. (2020). Assessment of evidence about common infant symptoms and cow’s milk allergy. JAMA Pediatrics, 174, 599-608.

Verhasselt V. (2024). A newborn’s perspective on immune responses to food. Immunological Reviews, 326, 117-129.

Additional context:

The Nuts for Babies randomised controlled trial is being conducted by The Kids Research Institute Australia and the Murdoch Children’s Research Institute (MCRI) (Principal Investigator A/Prof Debra Palmer).

16/10/2025

The Perth Pregnancy, Birth & Postpartum Expo is back on Sunday, 9th November 2025 at the Rendezvous Hotel, Scarborough, and the best part? It’s completely FREE!
From pelvic health, natural pain relief and breastfeeding, to sleep, postpartum wellbeing, acupuncture, Chinese medicine, and birth mapping - our speakers have it all covered!
Come and learn from some of Perth’s most knowledgeable experts, gain real, evidence-based insights, and leave feeling supported and inspired.
Don’t miss your chance to hear these amazing talks - then visit our speakers at their stands before or after to ask questions, connect, and find the right support for your journey.
Reserve your FREE tickets today!
Make sure you scan your tickets at the door to go into the draw for some amazing door prizes.

The Perth Pregnancy, Birth & Postpartum Expo is back on Sunday, 9th November 2025 at the Rendezvous Hotel, Scarborough, and the best part? It’s completely FREE!

From pelvic health, natural pain relief and breastfeeding, to sleep, postpartum wellbeing, acupuncture, Chinese medicine, and birth mapping - our speakers have it all covered!

Come and learn from some of Perth’s most knowledgeable experts, gain real, evidence-based insights, and leave feeling supported and inspired.

Don’t miss your chance to hear these amazing talks - then visit our speakers at their stands before or after to ask questions, connect, and find the right support for your journey.

Reserve your FREE tickets today!

Make sure you scan your tickets at the door to go into the draw for some amazing door prizes.
https://www.eventbrite.com.au/e/perth-pregnancy-birth-postpartum-expo-2025-tickets-1637169832039

27/09/2025

💻 New Blog Post 💻

After I shared the new WA research on colostrum and food allergies, my friend and colleague Vicki Hobbs - Back to Basics Birthing asked me to expand on it in a blog. And I couldn’t say no, because this study is a world-first and the implications are huge.

We’ve always known colostrum is liquid gold 💛, packed with living cells, lactoferrin, secretory IgA, and over 200 human milk oligosaccharides that train a baby’s immune system.

But this research found that:
👉 Babies exclusively fed colostrum in their first 72 hours were 5x less likely to develop a peanut allergy.
👉 They were 11x less likely to develop multiple food allergies.
👉 Not a single baby who had 9+ feeds/24hrs of colostrum in those first days developed peanut allergy.

❌ And yet it also found that, right now in WA, 1 in 2 newborns are still given formula top-ups in their first 72 hours and therefore missing out on the full protective effects of colostrum.

In the blog, I dive into:
• Why colostrum is about immunity, not calories
• What the Academy of Breastfeeding Medicine (ABM) protocols say about jaundice and hypoglycaemia
• Why “fresh is best” when it comes to colostrum, and my thoughts on antenatal expressing
• How evidence-based prenatal breastfeeding education can help parents feel confident to say no to unnecessary formula in those critical first hours

👉 You can read the full blog here: https://birthsavvy.com.au/colostrum-protects-against-food-allergies/

A big thank you to Vicki for encouraging me to write this piece.I hope it helps parents and professionals alike see why those first colostrum feeds matter so much.

Babies deserve colostrum. 💛

New WA research shows colostrum protects against food allergies. Learn why formula top-ups in the first 72 hours can undermine this vital protection.

26/09/2025

🌏 World-first research from WA has revealed something shocking.

We’ve always known colostrum is liquid gold 💛 — packed with human growth factors that line and protect a newborn’s gut.

In those first days, a baby’s gut lining is thin and leaky — designed this way so it can absorb colostrum’s protective compounds. Growth factors in colostrum help the epithelial layer of the gut to mature, tighten up, and form a strong protective barrier. This not only supports digestion but also educates the immune system, teaching it to recognise what’s safe and what’s harmful. Formula simply cannot do this.

Now, WA research has shown just how critical those first feeds of colostrum really are:
👉 Babies exclusively fed colostrum in their first 72 hours were 5x less likely to develop peanut allergy.
👉 They were 11x less likely to develop multiple food allergies such as egg or cow’s milk.
👉 And not a single baby who had 9+ colostrum feeds per day in the first 72 hours developed peanut allergy.

⚠️ To be clear: the answer here is not antenatal expressing. The research didn’t specify antenatal vs postnatal, and fresh is best when it comes to colostrum. What this evidence highlights is the importance of ensuring babies receive as much of their mother’s colostrum as possible after birth — and not defaulting to formula unless there is a genuine medical reason.

❌ What really shocked me? Right now in WA, 1 in 2 newborns are given formula top-ups in their first 72 hours — before colostrum has had the chance to finish its vital job of sealing and protecting the gut and shaping the immune system.

This is despite the research and best practice guidelines like the Baby Friendly Hospital Initiative (BFHI) being crystal clear:
👉 Formula should only be given if there are clear medical reasons.

Colostrum isn’t just “first milk.” It’s a powerful biological tool — uniquely designed to protect babies in those critical early days.

✨ That’s why evidence-based prenatal breastfeeding education matters so much. Parents who understand the role of colostrum are confident to say no to unnecessary formula in those critical first hours — and know how to make sure their baby gets only colostrum unless a true medical need arises.

This is exactly why I cover breastfeeding and those first 72 hours in my classes and consultations—so parents walk into birth ready to protect those feeds and give their baby the best start.
I also have an online course because this is so important!

https://birthsavvy.com.au/breastfeeding-course/

Parents deserve better support.
Babies deserve colostrum 💛

📖 Reference:
Bhasin M, Cooper M, Macchiaverni P, Joys RS, O'Sullivan TA, Keelan JA, Venter C, Palmer DJ, Lowe AJ, Prescott SL, Silva D, Verhasselt V. Colostrum as a Protective Factor Against Peanut Allergy: Evidence From a Birth Cohort. Allergy. 2025 Sep 18. doi: 10.1111/all.70043. Epub ahead of print.
*EDIT Free Access here: https://doi.org/10.1111/all.70043

17/09/2025

✨ Silver Ni**le Cups – What the Research Really Says ✨

Silver ni**le cups (like Silverette®) are everywhere right now. They’re promoted as the “must-have” for sore or damaged ni**les, with claims that they:
• Protect from friction
• Use silver’s antimicrobial properties
• Create a “moist healing environment”

Sounds impressive, right? But here’s what the research actually says.

📚 The evidence is limited.
Small studies and surveys exist, but there’s no strong proof that silver cups heal ni**les any better than other products. By contrast, reviews consistently report that the most effective way to prevent and heal ni**le pain is correct fit and hold (latch and positioning).

💦 The “moist healing” debate:
In wound care (like surgical wounds or ulcers), moist healing can promote faster recovery. That idea has been borrowed for ni**les.
But ni**le skin is different and it’s already exposed to saliva and milk many times a day. Dr Pam Douglas and others warn that over-hydration of ni**le skin can cause moisture-associated skin damage (MASD), actually slowing healing rather than speeding it up. This is why many creams, gels, and cups that keep ni**les constantly damp don’t live up to the promise.

🔬 How silver heals — and why ni**le cups are different:
In hospitals, silver is used in creams and special wound dressings that release silver ions (Ag⁺). These ions kill bacteria and reduce inflammation, which can help burns and surgical wounds heal.
But most ni**le cups are made from sterling silver (92.5% silver + copper), which is not the same as the ionic or nanoparticle silver used in treating wounds. Sterling silver only releases tiny amounts of ions when wet, and copper can tarnish or irritate sensitive skin. Cheaper knock-offs may even be just silver-plated over unsafe base metals like nickel or lead. 🚩

So while silver can heal in certain medical forms, there’s no strong evidence that the kind used in ni**le cups makes a meaningful difference.

⚠️ Other risks include:
•If cups press tightly, they can compress ducts and contribute to mastitis (definitely be on the lookout for red rings on your breast).
•Trapping milk can cause over-hydration, delaying healing

💡 Here’s the bottom line:
Silver cups may feel soothing for some, but they don’t fix the cause of ni**le pain. The real solution is understanding how to position your baby deeply at the breast so there’s no ni**le or breast tissue drag.

That’s exactly what I teach in my Online Breastfeeding Course — evidence-based, up-to-date with the latest biomechanics research, and designed to help eliminate breast tissue drag (something even many professionals don’t fully understand).

👉 If you’re experiencing ni**le pain, or better still, you want to learn how to prevent it before your baby arrives, this is the best investment you can make for a more comfortable breastfeeding journey. And it's cheaper than silver ni**le cups. 😊

📲 Find out more here: https://birthsavvy.com.au/breastfeeding-course/

🎁 And here’s a thought: instead of buying silver ni**le cups as a baby shower gift, why not give something that truly helps? My Online Breastfeeding Course makes a far more valuable present. Contact me to organise a gift voucher for the expectant parent in your life.

💬 Have you tried silver ni**le cups? Did they help you — or not so much?

15/09/2025

✨ Rethinking Transition ✨

Most of us have been taught to fear transition. Antenatal classes and TV portray it as the dramatic breaking point, with women shaking, crying, and yelling, “I can’t do this anymore.”

But new research into undisturbed physiological birth shows another side:

🌿Women described instinctive knowing. Their bodies and babies working together.
🌿They spoke of deep safety. Sometimes with trusted support, sometimes in solitude.
🌿Many entered an “other world”. Altered states of consciousness, oneness, even bliss and euphoria.
(Young et al. 2025)

👉This matters because if you understand the hormones of birth (oxytocin and endorphins), then transition should feel amazing!

⚡️And yes, adrenaline plays a role too.
✅ In the right balance, it provides the final surge of energy to birth the baby.
❌ But in the wrong environment — bright lights, unfamiliar faces, constant surveillance — adrenaline flips women into fight-or-flight. Transition then looks and feels like fear and pain, instead of power and transformation.

As reminds us: to birth physiologically, women need to feel private, safe, and unobserved.

Sadly, this research will probably get dismissed as the media, obstetricians and maternity services zero in on the fact that this study involved women who freebirthed. But in doing so, they will miss the point entirely.

👉The lesson isn’t about freebirth. It’s about what happens when birth is undisturbed. It's about what transition can feel like—and what birth was probably always meant to feel like.

As Dr Michel Odent said, “One cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily.”

💭 Imagine if every woman were given the chance to feel transition, not as a breaking point, but as labour's most powerful peak.

Reference: Young, E., Clarke, K-A., Reed, R. and Hastie, C., 2025. Women’s experiences of the transition phase of physiological labour during freebirth: A qualitative study. Sexual & Reproductive Healthcare, 45, p.101115. https://doi.org/10.1016/j.srhc.2025.101115