Andrea Mara encountered a difficulty breastfeeding her third child, but medics diagnosed a quick and easy solution.
When my youngest child was born five years ago, I found breastfeeding very painful and difficult. If he’d been my first child, I would have assumed that the pain was standard. But he was my third, and I knew there was something wrong.
When he was a week old, after much pain and many tears, I discovered he had tongue tie, a condition whereby the piece of tissue (frenulum) under a baby’s tongue is too tight.
A baby with tongue tie is often less able to stretch the tongue in order to efficiently breastfeed, which can leave the baby frustrated, and the mother in pain (and I can wholeheartedly attest to the pain).
When I returned to my maternity hospital desperate for advice, I was told to change feeding position — it didn’t work, and I cried some more.
Then in hushed tones, I was told there was a doctor in Tipperary who might be able to help.
I sought the advice of private lactation consultant Nicola O’Byrne, who referred me to Dr Justin Roche in Clonmel General hospital, and when my baby was five weeks old, on a rainy, cold January morning, we drove down from Dublin to have the tongue tie divided.
Feeding improved within hours and, for us, the problem was solved.
Five years later, parents no longer have to travel to Tipperary — tongue tie divisions are now available in a number of hospitals and clinics around the country. But has the situation changed much in terms of awareness and attitudes? I checked back with Nicola O’Byrne to find out.
“I think there’s definitely more awareness of tongue tie now than there was five years ago,” she says. “In a way, there’s nearly too much awareness among parents — because if anyone is having a problem with breastfeeding, and posts about it in an online forum or in a Facebook group, tongue tie is often suggested very quickly. But it shouldn’t be the first thing that people jump to, because it’s not that prevalent — it affects four to ten per cent of babies. So every breastfed baby who’s having a problem doesn’t have tongue tie.
“Every baby really needs an assessment and some will absolutely need the division straight away whereas others will breastfeed well without it. And of course it’s up to the parents too.”
The positive side of this increased awareness among parents is that they’re less likely to take no for an answer when they look for help.
“You still hear the odd story of parents being told by doctors that there’s no problem — but much less so. Parents are more informed than before, and are less likely to take someone’s word for it.”
Plus there’s now concrete information available for anyone who needs it — two national policies on tongue tie have been published.
“There’s one that was written by paediatricians on HSE.ie, and a second on breastfeeding.ie which is the official HSE website for breastfeeding,” says Nicola. “The latter was written by lactation consultants, and absolutely everything you need to know is there — if anyone is looking for information on tongue tie, the policy on breastfeeding.ie is excellent.
“From a midwifery and lactation consultant point of view in the hospitals, I am seeing that they’re more aware, and they’re more and more likely to say to parents, ‘This may be tongue tie, and there isn’t a fast frenotomy service here in the hospital but here are your options’.”
Frenotomy is the procedure carried out to divide tongue tie — it’s usually done with laser or scissors, and is very quick. My son had his snipped with scissors — he cried for a couple of seconds, then latched on for a feed, and it never bothered him again.
For older babies and children, a general anaesthetic is required, but not for newborns.
So if the maternity hospital spots a tongue tie, what are the next steps?
Nicola explains: “The maternity hospitals have a referral pathway to paediatric hospitals. But unfortunately it can take weeks and weeks before the baby gets seen and that’s too long for breastfeeding.”
Another option is to go privately. “Yes, the baby can be seen by a GP or lactation consultant, who will refer them to a private practitioner who carries out the procedure. If you can pay to go privately, it doesn’t take as long.” But this isn’t affordable for everyone — going privately can cost from €180 to €350.
While it’s encouraging to hear that more medical professionals are offering frenotomies, there is a risk that the pendulum will swing too far.
“There are some practitioners who don’t need a referral, but it means some tongue ties are being divided without the latch having been assessed,” says Nicola. “The question is if some of these are unnecessary.” I asked Nicola what she’d do if she had a magic wand — what further changes would she make?
“I’d like to see tongue tie division carried out in the maternity hospitals. If it’s a bad case, it could be done there and then, and if it’s not as bad, the parents could come back after a week or two. In the UK, it’s done by midwives! So yes, in a perfect world, it would be dealt with in the hospitals.”
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