Field Trip to the Fitzwilliam Tongue-Tie Clinic
One of the things that I assess for at a Home Visit is tongue-tie. This involves listening carefully to the mother’s description of her experience of breastfeeding and any problems she has had with feeding. I also look at the baby feeding at the breast, their position and attachment and how they are transferring milk.
I then physically check the baby's suck by putting on gloves so I can put my finger in the baby's mouth. I want to feel how the baby moves their tongue and its range of motion. If there is restriction and I think this may be contributing to a mothers breastfeeding difficulties I offer to make a referral to a tongue-tie clinic for diagnosis and the option of revision.
In supporting parents to decide if this is something they want to proceed with, we talk about how tongue-tie can affect breastfeeding and what to expect at an appointment in a tongue-tie clinic. As this is very often the baby’s first procedure, I understand that the prospect can be daunting.
With that in mind I was delighted to be invited to spend a morning at the Fitzwilliam Clinic in Bray where Dr. Gillian Smith and Fiona Rea IBCLC run a weekly tongue-tie clinic. If you are referred by your GP, PHN or IBCLC you will get a call from Rachel the clinic’s administrator to make a booking.
I spoke to Rachel over the phone myself and she was really helpful giving me all the information I needed to plan the visit. She supplied the Eircode, directions and details on the ample parking right outside. I know from my own experience travelling with young babies that an uncomplicated drive and easy parking make any trip less stressful. Rachel will answer any questions parents have and endeavour to schedule an appointment at a time that works best. That first conversation with Rachel set the tone of the Clinic, warm and friendly.
On arrival Fiona took me around the building showing me where parents sign in and the waiting area. We then went to the clinic room which is set up like any dental surgery with the addition of a baby changing table. The morning I was there six babies were seen and ranged from brand new to four months of age. Each mother was accompanied by her husband, partner, mother or mother-in-law. It was lovely to see both the practical and emotional support.
At each baby's appointment the parents came into the room and both Fiona and Gillian were welcoming and friendly giving them a chance to sit down and settle themselves. Gillian talked to each mother about what had led them to booking in. Reasons included the baby not latching, persistent plugged ducts, sore nipples, poor weight gain and a baby who couldn’t manage to feed with a bottle. It was a great opportunity for mom’s to talk through their breastfeeding or bottle feeding challenges. Gillian listened very attentively to each mother noting the symptoms that may indicate a tongue restriction is a contributing factor to their feeding challenges. At each of the appointments there was no rush and parents were given plenty of time to ask any questions they had. I noticed how Fiona and Gillian are not only excellent clinical practitioners but wonderful communicators.
If a mother got upset talking about her breastfeeding experience Fiona and Gillian listened and compassionately acknowledged how hard breastfeeding can be. Gillian then went on to explain how she does the physical exam to diagnose tongue-tie and how she does a frenectomy. She also explained that once she has done the assessment she can proceed or let the parents take some time to decide, it’s no problem to come back another day after thinking things through.
Gillian went through the consent form before the physical exam as it meant if parents did decide to proceed that the baby was distressed for the shortest period of time. Gillian was very clear in explaining what happens with a frenectomy and as with any surgical procedure the risks involved while at the same time providing reassurance of how things have gone to date with the hundreds of babies she has seen.
When it was time for the exam Fiona swaddled each baby up like a little burrito and the mothers set themselves up to either feed the baby directly at the breast or give a bottle. Gillian explained that the best way to stop any bleeding is to apply pressure and with a baby’s mouth this is easily done by feeding. The examination involved Fiona holding the baby in place while Gillian did the physical exam. She explained what she was observing to each of the parents and was very quickly able to make her diagnosis and gave her recommendation for revision or not.
If parents opted to go ahead with the procedure it was done with blunt disposable scissors and each time completed in seconds with the baby quickly back in their mothers arms feeding. Fiona was on hand to support the mothers to breastfeed their babies with gentle guidance on positioning and attachment. While there were some tears from both the babies and some moms everything settled down each time. Gillian and Fiona checked the babies and once any bleeding had stopped the families were free to go. What I really liked is that there is a private room that each family could go to after the procedure, to take a breath, continue to feed their baby in and have a cup of tea or a coffee.
The after care included Gillian contacting each of the mothers that evening and then by text with some short questions a day after, a week after and a month after. This is very reassuring and also is gathering data on the outcomes for the babies at this clinic.
It was a wonderful opportunity to spend the morning at the Tongue-Tie Clinic both to see it in action and improve my assessment skills. Lactation education is an ever changing field and it's really important to keep up to date with the best evidence based practice. I'd like to thank Rachel, Fiona and Gillian for having me, and especially to the families who were there that morning. It was a fantastic experience made all the sweeter with a hot cup of tea and a slice of Gillian’s delicious birthday cake.
