Valerie Gommon Midwife’s Blog

Archive for the ‘Association of Breastfeeding Mothers’ Category

I have recently had a client whose baby had ankyloglossia and needed a tongue-tie division (or frenulotomy), the baby was having some difficulty with breastfeeding, and the mother was experiencing nipple soreness despite good positioning.

Tongue-tie may be hereditary and is a condition where there is a short or tight membrane underneath the tongue; it can be hard to diagnose and is easily missed. The skin “tie” can be attached at the tongue tip or further back and as a result the tongue-tip can appear heart-shaped; the tongue movements to lift, move from side to side and protrusion can be restricted and this may affect the way the baby feeds.  A recent study found that of babies having feeding difficulties up to 10% had a tongue-tie.

What should you look for?

You may experience pain on breastfeeding your baby, your nipples may become damaged and you may develop mastitis or find it difficult to establish an adequate milk supply (although all these symptoms can relate to positioning issues too).

The baby may have difficulty feeding and may need to feed frequently and for prolonged periods of time to be satisfied. There may also be weight problems, noisy feeding, dribbling and increased windy behaviour (although again your baby could have these symptoms without tongue tie).

Some babies can feed perfectly well despite having a tongue-tie and adjustments to positioning and attachment may be all that is needed if there are problems with feeding.  It is definitely advisable to seek specialist breastfeeding support such as La Leche League, National Childbirth Trust, Association for Breastfeeding Mothers or Lactation Consultants GB and if the problem continues despite this support then tongue-tie division or frenulotomy is an option. You may be able to get an NHS referral from your local breastfeeding clinic or GP; hospitals providing this treatment are listed on the Baby Friendly website, however there are also private practitioners who will perform this for you and some of them are listed at the end of this article.

Should it be decided that a frenulotomy is necessary, the procedure is very simple and takes a few seconds.  Your baby is swaddled and held gently to keep the head still. The tongue-tie is snipped using sterile, sharp, round ended scissors without the need for an anaesthetic; your baby may feel a small amount of pain but will usually settle quickly and will be able to feed, indeed some babies actually sleep through the procedure!  There is usually very little bleeding and any oozing is controlled by applying pressure to the area with sterile gauze and encouraging feeding as soon as possible.

Good information on tongue tie can be found here on the Lactation Consultants GB website.

www.chilternbreastfeeding.co.uk/tongue_tie_division.html

www.ann-dobson.co.uk

www.mosshealthskills.co.uk/denise-pemberton.htm

www.hampshirehomebirths.co.uk

 

Q.A client of mine has developed a fever due to clogged milk glands (she gave birth 2 weeks ago). She is finding breast-feeding very painful and is concerned about infections.

A.Is it breast that is sore, not nipple area?  If it is the breast, perhaps a red, hot area it sounds like the beginning of mastitis.  It is very important that the woman ensure that her breast is not restricted by clothing or a tight bra, or by squashing her breast as she feeds.

The most important thing is to KEEP feeding.  If necessary perhaps start a couple of feeds on that breast to try to drain the excess milk (but be mindful that the other breast doesn’t become blocked too).  She may develop a fever and flu like symptoms – this can all be managed by just resting and breastfeeding (if caught early).  I suggest she take to bed, be naked with her baby and just rest and feed.  Paracetamol can be taken, as can homeopathy (refer to homoeopath).

Other suggestions are to go into the bath, placing hot flannels on the sore area and to gently massage the breast towards the nipple area to encourage the milk to flow out.  When out of the bath cold compresses can help to relieve the pain.  Some women use quark or cream cheese in a muslin on their breasts.  Also try not to touch the breast (apart from if expressing/feeding) as this encourages the breasts to make more milk.

If the infection really takes hold I suggest she consult a homoeopath/doctor and antibiotics are usually prescribed (if this happens she can still breastfeed).  I had this myself, got the flu symptoms, but managed to stave off full blown mastitis – so it can be done.

If it is the nipple area it is probably more about the position of the baby – she will need to look at this again, or get help – getting the baby to have a big wide open mouth prior to attaching.  For further information I suggest you look at www.breastfeeding.nhs.uk www.nct.org.uk www.laleche.org.uk or www.abm.me.uk

I’ve been thinking for a while that I should write about breastfeeding … I’m sure you are very familiar with the benefits of breastfeeding:

Benefits for the baby
Reduced risk of gastro-enteritis, diarrhoea, urinary tract, chest and ear infections, obesity and diabetes.  Latest evidence suggests reduced risk of Sudden Infant Death Syndrome and childhood leukaemia

Benefits for the mother
Reduced risk of breast cancer, ovarian cancer and osteoporosis (www.babyfriendly.org.uk)

This is apart from the benefits of the convenience of breastfeeding: having an ever-ready continuous supply of breastmilk, no need for sterilization, warming up of milk etc

However despite all the positive work and advances in making breastfeeding more acceptable and normative:

– in November 2004 an Act of the Scottish Parliament made it an offence to prevent or stop a person breastfeeding in a public place www.opsi.gov.uk/legislation/scotland/acts2005/asp_20050001_en_1).

– throughout the UK it is government policy to increase the number of babies who are breastfed (the Government is fully committed to the promotion of breastfeeding, which is accepted as the best form of nutrition for infants to ensure a good start in life. Breastmilk provides all the nutrients a baby needs. Exclusive breastfeeding is recommended for the first six months of an infant’s life www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/index.htm).

– this is also supported by the World Health Organisation who state Breastfeeding is the ideal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family and the health care system. should be  Exclusive breastfeeding is recommended up to 6 months of age and supplemented breastfeeding up until the age of two or beyond www.who.int/nutrition/topics/exclusive_breastfeeding/en/.

it is therefore disappointing to note that the social networking website Facebook has been removing breastfeeding photographs and and banning users on the grounds that they’d uploaded “obscene content” to their profiles.  In response an on-line protest group “Hey Facebook, breastfeeding is not obscene! Official petition to Facebook” has been launched at www.facebook.com/group.php?gid=2517126532 and a virtual “nurse-in” event was held on 27th December 2008 at www.facebook.com/event.php?eid=39521488436.

Lots of good free information and support about breastfeeding is available:

“From Bump to Breastfeeding” is a great new FREE DVD available to all pregnant women at www.orderline.dh.gov.uk or call 0300 123 1002.

www.breastfeeding.nhs.uk

National Breastfeeding Helpline
Operated by the Association of Breastfeeding Mothers and The Breastfeeding Network
Tel. 0844 20 909 20

La Leche League
Tel. 0845 120 2918

National Childbirth Trust
Tel. 0870 444 8708

The Breastfeeding Network – breastfeeding support in Bengali and Sylhetti
Tel. 07944 879 759



Twitter