Valerie Gommon Midwife’s Blog

Archive for the ‘www.nct-org.uk’ 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

 

The National Institute for Health and Clinical Excellence (NICE) are suggesting that midwives carbon-monoxide test women to check whether they are smoking – http://bit.ly/bTmg83.  Is this helpful or “policing”?

NICE suggest that every expectant mother should be tested during her pregnancy to enable smokers to receive advice on quitting.  Whilst this might be a positive intervention there is also concern that some women may not engage with midwives if they are seen to be “policing” and judgemental.  It is certainly something that will need careful consideration and sensitive handling as many hard-to-reach clients are also smokers and it would be easy to alienate these women further.

The NHS has made huge attempts to help women stop smoking http://smokefree.nhs.uk/smoking-and-pregnancy/

A baby born to a smoker is:

  • Twice as likely to be born prematurely
  • More likely to suffer from placenta problems around the time of birth
  • Three times more likely to be underweight at birth (even if born on time)
  • More likely to be a victim of cot death.

Whatever stage of pregnancy it is never too late to give up – you and your baby will benefit immediately.  You can call the NHS Pregnancy Smoking helpline 12pm to 9pm, 7 days a week 0800 169 9 169


STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS

Royal College of Midwives (RCM), National Childbirth Trust (NCT) Independent Midwives UK (IM UK) Association of Radical Midwives (ARM) Association for Improvements in Maternity Services (AIMS) and the Albany Mums Support Group present:

THE ‘RECLAIMING BIRTH’ RALLY SUNDAY, MARCH 7th 2010

Please consider joining us for this important Rally to support mothers and babies.  “Mothers and babies are the foundations of our society, what is more important than getting the foundations right?”

This is a once in a lifetime opportunity – with an election coming up – to send a very loud message, there is a real sense of all the different stakeholders being united in one voice and it could, with hindsight be seen as the turning point for the midwifery profession.

We demand that all women should have a midwife they can get to know, be able to access home birth, a local birth centre, and that there should be independent midwifery available as an option for women to choose.

Meet at 1.00PM in Geraldine Mary Harmsworth Park, Lambeth Road, SE14EQ

We will march to Whitehall to hand in a petition to the Health Minister and letters to the Prime Minister

Master of Ceremonies: Peter Duncan.  Speakers include: Professor Wendy Savage, AIMS Chair Beverley Beech, Albany Midwife Becky Reed, IM UK Board Member Annie Francis, NCT CEO Belinda Phipps, Albany Mums Support Group campaigner Emma Neamish and Duncan Fisher OBE

PLEASE TELL EVERYONE ABOUT THIS IMPORTANT RALLY.

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

Following my recent posting when I mentioned that some women choose unassisted birth as a result of previous trauma, I have recently read that  American actor and talk-show host Rikki Lake has revealed that she was sexually abused as a young child.

Ricki Lake bravely discusses her past in her new book “Your Best Birth”.  Lake discusses her past battles with her weight and body image but goes on to describe the healing that she has experienced through her own birthing experiences, and I have to say that this concurs with my experiences as a midwife – I absolutely believe that a positive birth experience can be healing and empowering for women whether their past trauma was sexual abuse or a traumatic birth experience and am very happy to speak to women about this subject www.3shiresmidwife.co.uk.   It is well recognised by midwives that pregnancy and birth are significant times for women who have experienced sexual abuse – memories may well come to the fore, or a woman may remember events that she had previously buried and forgotten.

The documentary “The Business of Being Born”, www.thebusinessofbeingborn.com, which Lake made with filmmaker Abby Epstein, has touched many people and was championed by both the Independent Midwives Association (IMA) www.independentmidwives.org and the National Childbirth Trust (NCT) www.nct-org.uk and has been shown to packed audiences around this country and abroad.

Help is available for survivors of child sexual abuse from a number of sources including:

www.thesurvivorstrust.org

www.childline.org.uk

www.sheilakitzinger.com


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